Instrumentos específicos de medida de la calidad de vida relacionada con la salud en la diabetes mellitus tipo 2 disponibles en España

Poorer Quality of Life and Treatment Satisfaction is Associated with Diabetic Retinopathy in Patients with Type 1 Diabetes without Other Advanced Late Complications

Diabetic retinopathy (DR) may potentially cause vision loss and affect the patient’s quality of life (QoL) and treatment satisfaction (TS). Using specific tools, we aimed to assess the impact of DR and clinical factors on the QoL and TS in patients with type 1 diabetes. This was a cross-sectional, two-centre study. A sample of 102 patients with DR and 140 non-DR patients were compared. The Audit of Diabetes-Dependent Quality of Life (ADDQoL-19) and Diabetes Treatment Satisfaction Questionnaire (DTSQ-s) were administered. Data analysis included bivariate and multivariable analysis. Patients with DR showed a poorer perception of present QoL (p = 0.039), work life (p = 0.037), dependence (p = 0.010), and had a lower average weighted impact (AWI) score (p = 0.045). The multivariable analysis showed that DR was associated with a lower present QoL (p = 0.040), work life (p = 0.036) and dependence (p = 0.016). With regards to TS, DR was associated with a higher perceived frequency of hypoglycaemia (p = 0.019). In patients with type 1 diabetes, the presence of DR is associated with a poorer perception of their QoL. With regard to TS, these subjects also show a higher perceived frequency of hypoglycaemia.

Health-related quality of life in diabetes mellitus and its social, demographic and clinical determinants: A nationwide cross-sectional survey

AIMS AND OBJECTIVES

To investigate health-related quality of life in a representative sample of adults with diabetes mellitus in Spain, as well as its clinical and sociodemographic determinants.

BACKGROUND

Diabetes mellitus is a chronic disease causing considerable morbidity and mortality worldwide, resulting in an impaired quality of life in affected people.

DESIGN

A nationwide cross-sectional study, based on an online survey and carried out between February-March 2016, was performed on diabetic subjects recruited through diabetic patients' organisations.

METHODS

A validated Spanish-language version of the self-administered Diabetes Quality of Life questionnaire was used, with 0 being the worst and 100 the best QoL level. Determinant factors of health-related quality of life were assessed with the aid of multivariate analysis to control for confounding factors.

RESULTS

The responses provided by 456 patients (52.4% being women) revealed an overall mean score of 66.4 ± 13.3. Social/vocational worries and diabetes-related worries were the dimensions with the highest (74.3 ± 20.1) and lowest (61.1 ± 20.6) scores, respectively. Younger age, female gender, having no studies and poor glycaemic control were all independent determinants for an impaired overall health-related quality of life, with most of these factors having a higher impact than the dimensions negative impact of therapy on daily life, satisfaction with therapy and diabetes-related worries. Married (or equivalent) subjects had better scores in the diabetes-related worries dimension. The perception of health-related quality of life progressively worsens as glycaemic control deteriorates and with an increased number of disease complications. Most of the associations did not vary significantly with the type of diabetes mellitus.

CONCLUSION

Overall health-related quality of life perception in the Spanish diabetic population is moderate and depends on several sociodemographic factors. Adequate glycaemic control to avoid disease complications improves perception.

RELEVANCE TO CLINICAL PRACTICE

The results can help health professionals to develop strategies to promote diabetic patient self-care, in order to improve the metabolic control of the disease and avoid its complications, as a therapeutic goal towards an improvement in health-related quality of life perception.

Systematic review of the psychometric properties and theoretical grounding of instruments evaluating self-care in people with type 2 diabetes mellitus

AIM

To determine the psychometric properties and theoretical grounding of instruments that evaluate self-care behaviour or barriers in people with type 2 diabetes.

BACKGROUND

There are many instruments designed to evaluate self-care behaviour or barriers in this population, but knowledge about their psychometric validation processes is lacking.

DESIGN

Systematic review.

DATA SOURCES

We conducted a search for psychometric or validation studies published between January 1990-December 2012. We carried out searches in Pubmed, CINAHL, PsycINFO, ProQuolid, BibliPRO and Google SCHOLAR to identify instruments that evaluated self-care behaviours or barriers to diabetes self-care.

REVIEW METHODS

We conducted a systematic review with the following inclusion criteria: Psychometric or clinimetric validation studies that included patients with type 2 diabetes (exclusively or partially) and which analysed self-care behaviour or barriers to self-care and proxies like self-efficacy or empowerment, from a multidimensional approach. Language: Spanish or English. Two authors independently assessed the quality of the studies and extracted data using Terwee's proposed criteria: psychometrics properties, dimensionality, theoretical ground and population used for validation through each included instrument.

RESULTS

Sixteen instruments achieved the inclusion criteria for the review. We detected important methodological flaws in many of the selected instruments. Only the Self-management Profile for Type 2 Diabetes and Problem Areas in Diabetes Scale met half of Terwee's quality criteria.

CONCLUSION

There are no instruments for identifying self-care behaviours or barriers elaborated with a strong validation process. Further research should be carried out to provide patients, clinicians and researchers with valid and reliable instruments that are methodologically solid and theoretically grounded.

Quality of life and satisfaction with treatment in subjects with type 2 diabetes: results in Spain of the PANORAMA study

OBJECTIVES

Few studies are available on quality of life and treatment satisfaction of patients with type 2 diabetes mellitus (T2DM). Both of them were the primary objectives of the PANORAMA (NCT00916513) study. Metabolic control, treatment patterns, and management by healthcare professionals were also evaluated.

MATERIAL AND METHODS

This multicenter, cross-sectional, observational study randomly recruited>40 year-old patients with T2DM from Spanish healthcare centers. HbA1c was measured using the same technique in all patients, who also completed quality of life (EQ-5D and ADDQoL) and treatment satisfaction (DTSQ) questionnaires and the Hypoglycemia Fear Survey (HFS-II).

RESULTS

Fifty-four investigators recruited 751 patients, 60.3% of whom had HbA1c levels <7%. Approximately 25% of patients on monotherapy had HbA1c values ≥ 7%, Patients with longer disease duration and more complex treatments, especially with insulin, showed the poorer control. Despite good overall treatment satisfaction (mean 29.3±6.1, 0 to 36-point scale), patients with a poorer metabolic control, previous hypoglycemia episodes, and more complex therapies had a worse QoL and a greater fear of suffering hypoglycemia.

CONCLUSIONS

Despite advances in metabolic control, there are still areas to improve. Early addition of safe drugs to monotherapy would help achieve control objectives without increasing the risk of hypoglycemia, and delaying the start of insulin therapy. This would also improve QoL and treatment satisfaction.