Effects of comorbid conditions on health-related quality of life in youth with Type 2 diabetes: the TODAY clinical trial

Abstract

Aim: To explore associations between health-related quality of life (HRQOL) and comorbidities in youth with Type 2 diabetes.

Patients & methods: Of 699 youth in the TODAY study, 685 (98%) had baseline HRQOL data, 649 (93%) at 6 months and 583 (83%) at 24 months. Comorbidities were defined by sustained abnormal values and treatment regimens.

Results: At baseline, 22.2% of participants demonstrated impaired HRQOL. Only depressive symptoms distinguished those with versus without impaired HRQOL and were significantly related to later impaired HRQOL (p < 0.0001). A significant correspondence between impaired HRQOL and number of comorbidities (p = 0.0003) was noted, but was driven by the presence of depressive symptoms.

Conclusion: Results emphasize the need for evaluation of depressive symptoms. Other comorbidities did not have a significant impact on HRQOL in this cohort.

Keywords: health-related quality of life; hyperlipidemia; hypertension; microalbuminuria; pediatric Type 2 diabetes.

Figure 1. Distribution of impaired HRQOL by each comorbidity at baseline

Only the presence of clinically significant depressive symptoms (by self-report) was associated with impaired HRQOL.

Figure 2. Percent impaired HRQOL by presence of clinically depressive symptom summary subscales across visit month

The significant association between presence of clinically depressive symptoms (total score) and impaired HRQOL was repeated for each subscale: (A) Physical Health Summary Score and (B) Psychosocial Health Summary Score: all p < 0.0001. The difference was less pronounced for the Physical Score than the Psychosocial Score (B), likely due in part to some overlap between the PedsQL Psychosocial Score (15 items addressing problems with feelings, getting along with others and school) and the BDI.

Figure 3. Percentage impaired HRQOL by presence of multiple comorbidities at baseline

Participants were categorized as having 0 (56%), one (32%) or two or more (12%) comorbidities. When all five comorbidities were included there was a significant correspondence between impaired HRQOL and number of comorbidities (p = 0.0003). However, when the analysis was repeated with only four comorbidities not including depressive symptoms, there was no relationship between number of comorbidities and impaired HRQOL. Results were the same at 6 and 24 months.