Valuing Health-Related Quality of Life in Diabetes

Coffey, J. Todd; Brändle, Michael; Zhou, Honghong; Marriott, Deanna J.; Burke, Ray; Tabaei, Bahman P.; Engelgau, Michael M.; Kaplan, Robert M.; Herman, William H.

doi:10.2337/diacare.25.12.2238

Cited by 325 publications

(297 citation statements)

References 27 publications

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“…Our results are consistent with other studies that have demonstrated lower health-utility scores in women with diabetes [6,[31][32][33] and worse QoL in the presence of complications [6,20,33,34]. However, even with inclusion of gender and diabetic complications in the model, frequency of hyperglycemic symptoms was associated with lower health-utility scores.…”

Section: Discussionsupporting

confidence: 92%

“…Previously, we have shown that major diabetes complications are associated with lower healthutility scores [6]. Our current study involved four questions: first, which symptoms in the QWB-SA are most strongly associated with measures of glycemia (self-reported frequencies of symptomatic hyperglycemia and hypoglycemia, and HbA1c) in patients with diabetes?…”

Section: Introductionmentioning

confidence: 95%

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Glycemia and the Quality of Well-Being in Patients with Diabetes

et al. 2004

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Objectives: To investigate the cross-sectional relationships among self-reported frequencies of symptomatic hyperglycemia and hypoglycemia, HbA1c, and symptoms in the Quality of Well-Being Self-Administered (QWB-SA), and to examine the associations among these measures of glycemia and health-utility scores. Methods: The study group included 1522 patients with diabetes who attended University of Michigan Health System clinics. Published studies were reviewed to identify symptoms in the QWB-SA that might be associated with measures of glycemia. Linear-regression analyses were performed to evaluate the strength of the associations among the frequency of self-reported measures of glycemia, QWB-SA symptoms, and QWB-SA-derived health-utility scores. Results: Frequency of hyperglycemic symptoms was associated with 3% of the variance in the QWB-SA-derived health-utility score in type-1 diabetes and with 5% of the variance in type-2 diabetes. Frequency of hypoglycemic symptoms was not associated with the QWB-SAderived health-utility score in type-1 diabetes but was associated with 1% of the variance in type-2 diabetes. HbA1c levels were not significantly associated with QWB-SA-derived health-utility scores. After controlling for age, gender, and complications, frequency of hyperglycemic symptoms was significantly associated with QWB-SA-derived health-utility scores in type-1 and type-2 diabetes. Conclusions: Reported frequency of hyperglycemic symptoms is associated with symptoms included in the QWB-SA and with QWB-SAderived health-utility scores. The QWB-SA may be an appropriate measure to assess the health burden of hyperglycemia.

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Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 95%

Glycemia and the Quality of Well-Being in Patients with Diabetes

et al. 2004

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“…The absolute decrement for amputation was converted into utility decrement factors that could be multiplied by the individual's current EQ-5D to estimate the relative effect of the complication. Utility decrements for renal failure and foot ulcers were not available from the UKPDS study described above, so were obtained from a different study 303 of 2048 subjects with type 1 diabetes mellitus and T2DM. Utility decrements for the variety of cardiovascular events were taken from a HTA assessing statins to reflect the utility decrements in the general population.…”

Section: Utility Decrementsmentioning

confidence: 99%

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Dunkley

Tyrer

Spong

et al. 2017

Programme Grants Appl Res

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BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) and of cardiovascular disease (CVD) is believed to be higher among people with intellectual disability (ID) than in the general population. However, research on prevalence and prevention in this population is limited.ObjectivesThe objectives of this programme of work were to establish a programme of research that would significantly enhance the knowledge and understanding of impaired glucose regulation (IGR) and T2DM in people with ID; to test strategies for the early identification of IGR and T2DM in people with ID; and to develop a lifestyle education programme and educator training protocol to promote behaviour change in a population with ID and IGR (or at a high risk of T2DM/CVD).SettingLeicestershire, UK.ParticipantsAdults with ID were recruited from community settings, including residential homes and family homes. Adults with mild to moderate ID who had an elevated body mass index (BMI) of ≥ 25 kg/m2and/or IGR were invited to take part in the education programme.Main outcome measuresThe primary outcome of the screening programme was the prevalence of screen-detected T2DM and IGR. The uptake, feasibility and acceptability of the intervention were assessed.Data sourcesParticipants were recruited from general practices, specialist ID services and clinics, and through direct contact.ResultsA total of 930 people with ID were recruited to the screening programme: 58% were male, 80% were white and 68% were overweight or obese. The mean age of participants was 43.3 years (standard deviation 14.2 years). Bloods were obtained for 675 participants (73%). The prevalence of previously undiagnosed T2DM was 1.3% [95% confidence interval (CI) 0.5% to 2%] and of IGR was 5% (95% CI 4% to 7%). Abnormal IGR was more common in those of non-white ethnicity; those with a first-degree family history of diabetes; those with increasing weight, waist circumference, BMI, diastolic blood pressure or triglycerides; and those with lower high-density lipoprotein cholesterol. We developed a lifestyle educational programme for people with ID, informed by findings from qualitative stakeholder interviews (health-care professionals,n = 14; people with ID,n = 7) and evidence reviews. Subsequently, 11 people with ID (and carers) participated in pilot education sessions (two groups) and five people attended education for the feasibility stage (one group). We found that it was feasible to collect primary outcome measures on physical activity and sedentary behaviour using wrist-worn accelerometers. We found that the programme was relatively costly, meaning that large changes in activity or diet (or a reduction in programme costs) would be necessary for the programme to be cost-effective. We also developed a quality development process for assessing intervention fidelity.LimitationsWe were able to screen only around 30% of the population and involved only a small number in the piloting and feasibility work.ConclusionsThe results from this programme of work have significantly enhanced the existing knowledge and understanding of T2DM and IGR in people with ID. We have developed a lifestyle education programme and educator training protocol to promote behaviour change in this population.Future workFurther work is needed to evaluate the STOP Diabetes intervention to identify cost-effective strategies for its implementation.Trial registrationClinicalTrials.gov NCT02513277.FundingThe National Institute for Health Research Programme Grants for Applied Research programme and will be published in full inHealth Research Programme Grants for Applied Research; Vol. 5, No. 11. See the NIHR Journals Library website for further project information.

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“…Seventh, we removed the costs for administrative charges from the base case and reduced the lost productivity hours associated with an OGTT to 2 h. Finally, we decreased the rate of progression of diabetes from 8 to 2% in order to reflect the lower rates of progression reported in predominantly white populations (6). We extrapolated the base case results to a cohort of 1,000 women and calculated incremental cost per case for annual, biannual, and every 3-year OGTT screening (23).…”

Section: Sensitivity Analysesmentioning

confidence: 99%

Efficacy and Cost of Postpartum Screening Strategies for Diabetes Among Women With Histories of Gestational Diabetes Mellitus

2007

Self Cite

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OBJECTIVE -To compare the cost and time to diagnosis associated with several screening strategies for diabetes in women with histories of gestational diabetes mellitus (GDM).RESEARCH DESIGN AND METHODS -We simulated screening for diabetes with fasting plasma glucose (FPG), a 2-h oral glucose tolerance test (OGTT), and A1C annually, every 2 years, and every 3 years over a period of 12 years. We assumed that women had negative screening tests 6 weeks after delivery, progressed to diabetes at 8% per year, and that each positive FPG and A1C was followed by a confirmatory FPG. For each strategy, we calculated the cost per case detected, cost per woman screened, the percent of cases detected, and the time elapsed with undiagnosed diabetes. In sensitivity analyses, we considered the inclusion of indirect costs, the impact of imperfect adherence to screening strategies, exclusion of confirmatory tests, and lower rates of progression to diabetes.RESULTS -When annual, biannual, or every 3-year screening strategies were utilized, OGTTs resulted in lower costs per case detected than FPG or A1C. Testing every 3 years resulted in lower costs per case detected compared with more frequent testing. These patterns persisted in sensitivity analyses, except that FPG resulted in lower cost per case detected than OGTT, assuming annual screening and inclusion of indirect costs or assuming annual screening without a confirmatory FPG.CONCLUSIONS -Screening every 3 years with OGTTs results in the lowest cost per case of detected diabetes. Diabetes Care 30:1102-1106, 2007G estational diabetes mellitus (GDM), or glucose intolerance first recognized during pregnancy, affects 4 -12% of pregnancies in the U.S. (1). The incidence of GDM is increasing, fueled by maternal obesity and advancing maternal age (2-4). Whereas most women with GDM return to normal glucose tolerance after delivery, as many as 10 -50% of women with GDM are diagnosed with diabetes within 5 years (5,6). Therefore, the Fourth International WorkshopConference for Gestational Diabetes recommended that an oral glucose tolerance test (OGTT) be used to screen for diabetes at least 6 weeks after delivery. If glucose levels are normal, glycemia should be reassessed at a minimum of 3-year intervals with a screening test appropriate for the prevalence of diabetes in the population (1). A 2003 survey of American College of Obstetricians and Gynecologists fellows indicated that about three-quarters reported performing postpartum screening for diabetes in their patients with histories of GDM (7).There are no long-term studies that compare the benefits of different screening strategies (8). Comparison of screening strategies for diabetes among women with histories of GDM is challenging for several reasons. First, a single screening strategy may not be appropriate across populations, as the performance and cost of screening strategies will vary with incidence of diabetes. A systematic review by Kim et al. (6) found that the 8% per year conversion rate to diabetes did not apply to non-Hi...

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Valuing Health-Related Quality of Life in Diabetes

Cited by 325 publications

References 27 publications

Glycemia and the Quality of Well-Being in Patients with Diabetes

Glycemia and the Quality of Well-Being in Patients with Diabetes

Screening for glucose intolerance and development of a lifestyle education programme for prevention of type 2 diabetes in a population with intellectual disabilities: the STOP Diabetes research project

Efficacy and Cost of Postpartum Screening Strategies for Diabetes Among Women With Histories of Gestational Diabetes Mellitus

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