Jacobson A M, de Groot M, Samson J A
Mental Health Unit, Joslin Diabetes Center, Boston, MA 02215.
Diabetes Care. 1994 Apr;17(4):267-74. doi: 10.2337/diacare.17.4.267.
To examine the effects of type I and type II diabetes on patient perceptions of their quality of life and compare the psychometric properties of a generic versus a diabetes-specific quality of life measure.
Consecutive outpatients (n = 240) from a large multispecialty diabetes clinic were studied on a single occasion using two measures of quality of life--Diabetes Quality of Life Measure (DQOL) and the Medical Outcome Study Health Survey 36-Item Short Form (SF-36). No interventions were performed. This study examines three issues: 1) the reliability (internal consistency) of the two measures; 2) the relationship between the DQOL and SF-36 scales; and 3) the influence of clinical patient characteristics, such as number and severity of diabetes complications, on quality of life. Examination of this issue provides information about the construct validity of the two quality of life measures.
The estimates of internal consistency (Cronbach's alpha) for the DQOL and SF-36 subscales ranged from 0.47 to 0.97. These values were very similar to the published findings from previous studies. The subscales of the two measures were variably correlated with one another (range of correlations: -0.003 to 0.60), indicating that the areas of functioning addressed by the DQOL and SF-36 overlapped only to a modest degree. Examination of the relationship of demographic factors to the DQOL measures suggests that they are not generally confounded by factors such as education, sex, or duration of diabetes. Health-related quality of life is affected by the marital status of both type I and type II diabetic patients, with separated and divorced individuals generally experiencing lower levels of quality of life. The quality of life measures were sensitive to clinical characteristics, such as frequency and severity of complications. Even after factors such as marital status and, among type II diabetic patients, type of treatment, patients' severity of diabetes complications was a significant predictor of both the diabetes-related and the more broad-based measure of quality of life. For type II diabetic patients, insulin treatment was associated with lower levels of satisfaction with diabetes and greater impact of diabetes on quality of life.
This study provides evidence for the reliability and validity of two measures of quality of life. The two measures examine quality of life from different but complimentary perspectives. The DQOL seems more sensitive to lifestyle issues and contains special questions and worry scales oriented toward younger patients, whereas the SF-36 provides more information about functional health status. Thus, the measures may be used usefully in combination in studies of both type I and type II diabetic patients.
研究I型和II型糖尿病对患者生活质量认知的影响，并比较通用型与糖尿病特异性生活质量测量工具的心理测量特性。
对一家大型多专科糖尿病诊所的连续门诊患者（n = 240）进行一次性研究，使用两种生活质量测量工具——糖尿病生活质量测量量表（DQOL）和医学结局研究简明健康调查问卷36项简表（SF - 36）。未进行干预。本研究探讨三个问题：1）两种测量工具的信度（内部一致性）；2）DQOL与SF - 36量表之间的关系；3）临床患者特征，如糖尿病并发症的数量和严重程度，对生活质量的影响。对这一问题的研究提供了有关两种生活质量测量工具结构效度的信息。
DQOL和SF - 36分量表的内部一致性估计值（Cronbach's α）范围为0.47至0.97。这些值与先前研究发表的结果非常相似。两种测量工具的分量表彼此之间的相关性各不相同（相关范围：-0.003至0.60），表明DQOL和SF - 36所涉及的功能领域仅部分重叠。对人口统计学因素与DQOL测量结果之间关系的研究表明，它们一般不受教育程度、性别或糖尿病病程等因素的混淆。健康相关生活质量受到I型和II型糖尿病患者婚姻状况的影响，分居和离异个体的生活质量水平通常较低。生活质量测量工具对临床特征敏感，如并发症的频率和严重程度。即使在考虑婚姻状况以及II型糖尿病患者的治疗类型等因素后，糖尿病并发症的严重程度仍是糖尿病相关生活质量和更广泛生活质量测量的重要预测因素。对于II型糖尿病患者，胰岛素治疗与对糖尿病较低的满意度以及糖尿病对生活质量的更大影响相关。
本研究为两种生活质量测量工具的信度和效度提供了证据。这两种测量工具从不同但互补的角度考察生活质量。DQOL似乎对生活方式问题更敏感，包含针对年轻患者的特殊问题和担忧量表，而SF - 36提供了更多关于功能健康状况的信息。因此，在I型和II型糖尿病患者的研究中，这两种测量工具可联合有效使用。
