Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study

Abstract

Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death. RESEARCH DESIGN AND METHODSWe followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities. RESULTSWhile predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort). CONCLUSIONSLow HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.

Validity and reliability of the Greek version of the Diabetic Foot Ulcer Scale - Short Form (DFS-SF)

“…42 However, it is usually the combined effect of macrovascular and microvascular complications, comorbid conditions, and background demographic, clinical and treatment satisfaction variables which degrade HRQoL and not diabetes per se. 43 The results of the known-groups comparisons performed here conform to the literature 1,[12][13][14][15]17,[27][28][38][39][40][41] in terms of the score differences and the direction of these differences.…”

“…The overall results for the psychometric properties [38][39][40][41] but in the end their absence can be taken as evidence that the instrument is sensitive at its lower end. All SF-36 mean scale scores (not shown) were lower than the respective general population scores reported in the instrument validation study.…”

Translation and validation of the Korean version of the Diabetic Foot Ulcer Scale‐Short Form

“…The interdisciplinary treatment plan should consider not only clinical factors but also patients' experiences and perceptions . Furthermore, when medical professionals take a patient‐oriented approach, assessing patients' experiences and understanding and how they have been treated for diabetes and its complications, they could give prescriptions and education tailored to individual patients, which would greatly help patients manage their diabetic feet preventatively …”

Social deprivation modifies the association between incident foot ulceration and mortality in type 1 and type 2 diabetes: a longitudinal study of a primary-care cohort

“…Conversely, one Scottish study considered healthcare accessibility as well as socioeconomic disadvantage in the population and demonstrated evidence of increased foot ulceration in the more disadvantaged areas within Scotland [21]. The Eurodiale study has reported that low health-related quality of life is predictive of major amputation and mortality [22].…”