Does glucose tolerance affect quality of life in an elderly population?

Comparison of health-related quality of Life (HRQOL) among patients with pre-diabetes, diabetes and normal glucose tolerance, using the 15D-HRQOL questionnaire in Greece: the DEPLAN study

BACKGROUND

Diabetes mellitus is usually preceded by a pre-diabetic stage before the clinical presentation of the disease, the influence of which on persons' quality of life is not adequately elucidated. The purpose of this study was to compare the Health-Related Quality of Life (HRQOL) of persons with pre-diabetes with that of diabetes or normal glucose tolerance (NGT), using the validated HRQOL-15D questionnaire.

METHODS

The HRQOL-15D scores of 172 people with pre-diabetes (108 with Impaired Fasting Glucose [IFG], 64 with Impaired Glucose Tolerance [IGT], aged 58.3 ± 10.3 years) and 198 with NGT (aged 54.4 ± 10.1 years) from the Greek part of the DEPLAN study (Diabetes in Europe - Prevention using Lifestyle, Physical Activity and Nutritional Intervention), were compared to 100 diabetes patients' scores (aged 60.9 ± 12.5 years, diabetes duration 17.0 ± 10.0 years, HbA1c 7.2 ± 1.2%), derived from the outpatient Diabetes Clinic of a University Hospital.

RESULTS

The diabetes patients' HRQOL-15D score (0.8605) was significantly lower than the pre-diabetes' (0.9008) and the controls' (0.9092) (p < 0.001). There were no differences in the total score between the controls and the group with pre-diabetes. However, examination of individual parameters of the score showed that people with IGT had lower scores compared to the control group, as related to the parameters of "mobility" and "psychological distress". No differences were found in any component of the HRQOL-15D score between the control group and the IFG group, nor between the two groups with pre-diabetes (IFG vs. IGT).

CONCLUSIONS

Persons with pre-diabetes had a similar HRQOL score with healthy individuals, and a higher score than persons with diabetes. Specific components of the score, however, were lower in the IGT group compared to the controls. These findings help clarify the issue of HRQOL of persons with pre-diabetes and its possible impact on prevention.

Association between health-related quality of life and impaired glucose metabolism in Iran: the Qazvin Metabolic Diseases Study

AIM

To evaluate the association between health-related quality of life and glucose metabolism status in a study population in Qazvin, Iran.

METHODS

This cross-sectional study was conducted in 1044 people (aged 20-78 years old) between September 2010 and April 2011 in Qazvin, Iran. An oral glucose tolerance test was performed for each participant who had never been diagnosed with diabetes. Participants were characterized as having normal glucose metabolism, pre-diabetes or diabetes according to American Diabetes Association criteria. The short-form 36 questionnaire was used to measure quality of life. Data were analysed using a chi-squared test, anova and ancova.

RESULTS

A total of 530 (51.7%) of the participants were women, and 24.1 and 11.6% of the participants were categorized as having prediabetes and diabetes mellitus, respectively. Except for the role emotional domain, there was a gradual decrease in the mean scores of every domain of the short-form 36 scale across the three study groups. The mean scores in the physical domains were significantly different among the participants with normal glucose metabolism and those with diabetes. After adding age as covariate, there were no significant differences between the categories in any of the domains.

CONCLUSION

There is no association between quality of life domains and glucose metabolism status in Iranian subjects. More longitudinal studies are necessary to investigate the natural history of pre-diabetes, diabetes and quality of life.

Impaired glucose metabolism and health related quality of life

AIMS

We aimed at investigating whether different categories of glucose tolerance have any effect on a person's HRQoL.

METHODS

Population-based cross-sectional study conducted as a community sample of apparently healthy middle-aged individuals living in Western Finland. The subjects of the study, 1383 individuals, aged 45-70 years, had at least one cardiovascular risk factor but no previous diagnoses of either diabetes or cardiovascular disease. They completed health related quality of life (HRQoL) questionnaire before the oral glucose tolerance test (OGTT) was performed to diagnose the gategories of glucose tolerance.

RESULTS

Persons with newly diagnosed type 2 diabetes (NDM) had lower scores for physical functioning, general health and emotional role than subjects with normal glucose tolerance.

CONCLUSION

The results of the HRQoL questionnaire demonstrated that NDM is negatively associated with HRQoL, but prediabetes - IFG or IGT - does not.

Quality of life in type 2 diabetes mellitus after a very low calorie diet and exercise

OBJECTIVE

To evaluate whether the addition of exercise to a very low calorie diet (VLCD) has beneficial short- and long-term effects on health-related quality of life (QoL) in obese patients with type 2 diabetes mellitus (T2DM).

METHODS

We included 27 obese, insulin-dependent T2DM patients in a 16-week VLCD study, of whom 13 participated simultaneously in an exercise program (VLCD+E). Before, immediately after and 18 months after the intervention anthropometric measurements, glucoregulation and QoL (SF-36, HADS, NHP and MFI-20) were assessed. Patients were compared to healthy lean and obese (matched for body mass index) controls matched for gender and age.

RESULTS

At baseline, T2DM patients had significantly worse QoL scores in 18 and 14 of the 22 subscales of the QoL questionnaires, compared to lean and obese controls, resp. The 16-week VLCD (n=27) decreased bodyweight (-25.4±1.3 kg, p<0.0001, p=0.179 between groups), and improved glucoregulation (HbA1c -1.3±0.3%, p<0.0001, p=0.488 between groups) and 9 (VLCD-only) and 11 (VLCD+E) of the 22 subscales of QoL. After 18 months, in the VLCD+E group the QoL subscales did not differ from those in obese controls and only 4 of the 22 subscales were significantly worse compared to lean controls. However, in the VLCD-only group 17 and 13 of the 22 QoL subscales were significantly worse compared to the lean and obese controls, resp.

CONCLUSION

A 16-week VLCD induces considerable weight loss, metabolic amelioration, and major improvements in QoL in obese T2DM patients. The addition of exercise is of paramount importance for the maintenance of better QoL.

Is there a link between components of health-related functioning and incident impaired glucose metabolism and type 2 diabetes? The Australian Diabetes Obesity and Lifestyle (AusDiab) study

OBJECTIVE

To determine the longitudinal association of components of health-related functioning (HRF) with incident impaired glucose metabolism and type 2 diabetes.

RESEARCH DESIGN AND METHODS

The Australian Diabetes Obesity and Lifestyle (AusDiab) study is a national, longitudinal study of adults aged > or =25 years from 42 randomly selected areas of Australia. Diabetes status was defined using the World Health Organization criteria, and HRF was assessed using the SF-36 questionnaire in 1999-2000 and 2004-2005.

RESULTS

Incident impaired fasting glucose (IFG), impaired glucose tolerance (IGT), and newly diagnosed type 2 diabetes were associated with increased bodily pain at baseline compared with those with normal glucose tolerance (NGT) (IFG P = 0.005, IGT P < 0.004, and newly diagnosed type 2 diabetes P = 0.005), after adjustment. In addition, those with incident IGT and newly diagnosed type 2 diabetes had significantly reduced physical functioning, general health, mental health, and vitality at baseline compared with those with NGT. After we controlled for factors associated with incident diabetes, those in the lowest quartile of the physical component summary scale at baseline had at least a 50% higher risk of progression to impaired glucose metabolism and diabetes 5 years later.

CONCLUSIONS

These findings show that incident IFG, IGT, and newly diagnosed type 2 diabetes are associated with reduced HRF independent of cardiovascular disease and that this is evident before the onset of these conditions. If future health promotion campaigns are to effectively target those at high risk of developing diabetes, an understanding of the process of declining health before onset of the disease is essential.

Quality of life and insulin resistance in patients with coronary heart disease

BACKGROUND AND OBJECTIVE

Diabetes mellitus and impaired glucose tolerance have not only been associated with increased morbidity and mortality, but also with poor quality of life. The purpose of this study was to determine whether there is a relationship between poor quality of life and insulin resistance in patients with myocardial infarction without known diabetes mellitus.

METHODS AND RESULTS

One hundred and nineteen patients, men and women aged between 31 and 80 years with a hospital-diagnosed myocardial infarction occurring 3 months before inclusion, were studied. Minor symptoms evaluation profile was used to estimate the quality of life at entry. Low quality of life (contentment and vitality) was significantly negatively (P<0.05) associated with insulin resistance.

CONCLUSION

In patients with coronary heart disease and without known diabetes mellitus an estimated measure of quality of life was significantly and independently associated with poor insulin resistance.

Association between impaired glucose metabolism and quality of life: results from the Australian diabetes obesity and lifestyle study

AIMS

We examined the association of quality of life with glucose tolerance status in an Australian population to determine the stage in the development of diabetes that quality of life is impaired.

METHODS

The Australian Diabetes, Obesity and Lifestyle study (AusDiab) was a population-based study of 11,247 people from randomly selected areas of Australia. As part of the study, participants underwent an oral glucose tolerance test and completed the SF-36 quality of life questionnaire.

RESULTS

Previously diagnosed diabetes was associated with a significantly greater risk of being in the lowest quartile of each dimension of the SF-36 scale (except for mental health) and this association was only partially attenuated by adjustment for age, sex, body mass index (BMI), physical activity and treatment for hypertension and lipid abnormalities (adjusted odds ratios [95% CI]: bodily pain, 1.51 [1.18-1.94]; general health, 2.20 [1.64-2.95]; physical functioning, 1.50 [1.10-2.05]; role limitation (emotional), 1.43 [1.07-1.91]; role limitation (physical), 1.57 [1.13-2.18]; social functioning, 1.93 [1.46-2.54] and vitality, 2.24 [1.56-3.22]. Among those with newly diagnosed diabetes (NDM) and impaired glucose tolerance (IGT), there was also evidence of reduced quality of life on some dimensions of the SF-36 scale (NDM, general health, physical functioning and role limitation (physical); IGT, physical functioning and social functioning) after adjustment for confounders.

CONCLUSION

These findings show that diabetes is associated with a reduced quality of life and that this is evident in the early stage of the disease, particularly in relation to the ability to perform physical activities.

Quality of life of patients with diabetes mellitus. An overview of research in primary health care in the Nordic countries

OBJECTIVE

A review of articles on health-related quality of life (HRQoL) among diabetes patients in primary health care in the Nordic countries.

DESIGN

Search in PubMed and related sources. Used MeSH terms were: "Diabetes Mellitus", "Quality of Life", "Primary Health Care", and "Scandinavia" or "Denmark", "Finland", "Iceland", "Norway", or "Sweden".

RESULTS

In total, 19 relevant articles were found, 9 from Finland and 10 from Sweden. HRQoL questionnaires used were from the Medical Outcomes Study, i.e. the SWED-QUAL in seven, SF-20 in four and SF-36 in one, NHP in two, GQL in two, GHQ in one, and own questionnaires in two. HRQoL was moderately affected in diabetic patients, with macrovascular diseases, especially coronary heart disease, and non-vascular diseases as the most consistently found and strongest predictors. Weaker predictors were microvascular complications, age, sex, metabolic level, and education. Other groups at higher risk of worse HRQoL were diabetes patients with psychiatric disorders, especially depression, and foreign-born patients. Good continuity of care was associated with better HRQoL.

CONCLUSION

Diabetes affects the HRQoL through macrovascular complications and associated non-vascular comorbidity, and also by adding to the total burden of disease. Future research areas include transcultural and ethnic aspects, and effects of lifestyle interventions.

Diabetes mellitus and health-related quality of life among older adults. Findings from the behavioral risk factor surveillance system (BRFSS)

The aim of the present study was to examine associations between the presence of diabetes mellitus and health-related quality of life (HRQOL) among older adults. Using data from 37,054 adults aged 50 years or older who participated in the 2001 BRFSS, we examined the independent association between diabetes and four measures of HRQOL developed by the U.S. Centers for Disease Control and Prevention. Multivariate logistic regression was used to obtain adjusted odds ratios (ORs) and 95% confidence intervals (CIs). On average, older adults with diabetes reported nearly twice as many unhealthy days (physical or mental) as those without the condition (mean: 10.1 [S.E.: 0.32] versus 5.7 [0.43]) after age adjustment. The proportion of older adults reporting 14 or more unhealthy days (physical or mental) was significantly higher among those with diabetes (n = 4032; 11%) compared to those without the condition (OR: 1.64; 95% CI: 1.20, 2.23) after multivariate adjustment. Among older diabetic adults, the adjusted relative odds of having 14 or more unhealthy days (physical or mental) was 1.71 (95% CI: 1.31, 2.22) times greater for those treated with insulin compared to those not treated with insulin. Diabetes is independently associated with lower levels of HRQOL among older adults. These results reinforce the importance of preventing diabetes and its complications through health education messages stressing a balanced diet and increased physical activity.