Value in Health

Volume 19, Issue 1, January 2016, Pages 36–41

Patient-Reported Outcomes

Changes in Quality of Life Associated with Complications of Diabetes: Results from the ADVANCE Study

• Alison Hayes, PhD^{1, ,} ,
• Hisatomi Arima, PhD^{2, 3},
• Mark Woodward, PhD^{2, 4},
• John Chalmers, MD²,
• Neil Poulter, FMedSci⁵,
• Pavel Hamet, MD⁶,
• Philip Clarke, PhD⁷

 Show more

Choose an option to locate/access this article:

Check if you have access through your login credentials or your institution

Check access

Purchase $31.50

• 

doi:10.1016/j.jval.2015.10.010

Get rights and content

---

Abstract

Objective

To measure the impact of complications on summary measures of health-related quality of life among people with type 2 diabetes.

Methods

Patients participating in the Action in Diabetes and Vascular Disease:Preterax and Diamicron MR Controlled Evaluation (ADVANCE) trial were administered a health-related quality-of-life questionnaire, the three-level EuroQol five-dimensional questionnaire (EQ-5D-3L), on four occasions over a 5-year period. We used two-way fixed-effects longitudinal regression models to investigate the impact of incident diabetes complications (stroke, heart failure, myocardial infarction, ischemic heart disease, renal failure, blindness, and amputation) on EQ-5D-3L utility score (where 1 = perfect health), while controlling for characteristics of individuals that do not vary over time.

Results

The effect of having any one of the seven complications was to reduce the EQ-5D-3L utility score by 0.054 (95% confidence interval 0.044–0.064), and this was not significantly affected by baseline age, sex, economic region, or the value set used to derive utilities. The complication with the largest disutility was amputation (0.122), followed by stroke (0.099), blindness (0.083), renal failure (0.049), heart failure (0.045), and myocardial infarction (0.026). Ischemic heart disease did not significantly reduce the utility score. Quality of life also declined with elapsed time—by an average of 0.006 per year, in addition to the effect of complications.

Conclusions

Common complications significantly reduce health-related quality of life. Utility scores derived from the EQ-5D-3L provide a potential measure that can be used to summarize patient-reported outcomes and inform health economic models. Prevention of complications is critical to reduce the progressive burden of declining quality of life for people with diabetes.

Keywords

• complications;
• longitudinal analysis;
• quality of life;
• type 2 diabetes

Address correspondence to: Alison Hayes, Sydney School of Public Health, Edward Ford Building (A27), University of Sydney, Sydney, NSW 2006, Australia.

Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.