Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D

Abstract

Background: Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15-34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence.

Methods: Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1.

Results: Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5Dindex for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL.

Conclusions: Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.

Figure 1

Mean EQ-5D_index in individuals with diabetes compared to control individuals by disease duration. Comparison (ANOVA) of the cohorts for the different years of disease duration found significant differences between the different cohorts of women with diabetes (p = 0.022), of female control individuals (p = 0.011), of men with diabetes (p = 0.002) and of male control individuals (p = 0.001), respectively. Post hoc tests could not detect between which cohorts the significance for women with diabetes lay. The test, however, showed significant differences men with diabetes between the 1983 cohort and all other cohorts (1992, p = 0.002; 1999, p = 0.007; 2008, p = 0.027), for female control individuals between the 2008 and 1983 cohorts (p = 0.025), and for male control individuals between the 1983 cohort compared with the 2008 (p = 0.002) and 1999 (p = 0.009) cohorts.

Figure 2

Mean EQ VAS scores in individuals with diabetes compared to control individuals by disease duration. ANOVA and post hoc tests showed significant differences between the cohorts of men with diabetes (p = 0.004) which were found between the 1983 cohort and the 2008 (p = 0.020) and 1999 (p = 0.028) cohorts. Between the cohorts of male control individuals significant differences were found (p < 0.001) between the 1983 cohort and all other cohorts (1992, p = 0.045; 1999, p = 0.040; 2008, p < 0.001). The post hoc tests could not detect any significant differences between the cohorts for women, neither for women with diabetes nor for the control individuals.