Decreased health-related quality of life in patients with diabetic foot problems

Abstract

Purpose: The aim of this study was to investigate health-related quality of life (HRQoL) in patients with diabetic foot problems and compare the HRQoL between diabetic patients with: 1) diabetic foot problems (DF), including diabetic foot ulcer (DFU) or amputation (AMPU); 2) other diabetic complications (COM), such as diabetic retinopathy (DR), end-stage renal disease (ESRD), or coronary artery disease (CAD); and 3) no diabetic complication (CON).

Patients and methods: A total of 254 diabetic patients were studied in a cross-sectional setting. HRQoL was evaluated using Thai version of the Euro Quality of Life Questionnaire (EuroQoL), with five dimensions and five-level scale (EQ-5D-5L). Utility scores were calculated using time trade-off methods.

Results: A total of 141 patients in the DF group (98 DFU and 43 AMPU groups), 82 in the COM group (27 DR, 28 ESRD, and 27 CAD groups), and 31 in the CON group were interviewed. The mean age was 63.2±12.1 years, body mass index was 24.9±4.7 kg/m², mean hemoglobin A1c was 7.7±2.1%, duration of diabetes was 13.1±9.9 years, and the mean utility scores were 0.799±0.25. After having DF, 21% of patients had lost their jobs. The COM group had lower utility scores than the CON group. Among the diabetic complications, the DF group had the lowest mean utility scores as compared to the COM and CON groups (0.703±0.28 in the DF group, 0.903±0.15 in the COM group, and 0.961±0.06 in the CON group, P<0.01). There was no difference in the mean utility scores between DFU and AMPU groups. Patients in the DF group reported moderate-to-severe problem in all dimensions more than the other groups.

Conclusion: DF have the greatest negative impact on HRQoL. Therefore, diabetic foot care should be emphasized in clinical practice to prevent foot complications.

Keywords: diabetic complications; diabetic foot problems; health-related quality of life.

Figure 1

The time-trade-off model calculates the utility score. Notes: If respondents were living with the health state, each one of them has t years to live. To live in full health, they need to give up some life years to live for a shorter period. X is the number of years of life expected to be lived in full health.

Figure 2

The number of patients in each group. Abbreviations: CAD, coronary artery disease; DR, diabetic retinopathy; ESRD, end-stage renal disease.

Figure 3

The utility value in the DF, COM, and CON groups. Notes: The DF group had the least mean utility score, followed by COM and CON groups. *Statistically significant. Abbreviations: COM, other diabetic complications; CON, control; DF, diabetic foot.

Figure 4

The utility value in DF, DR, ESRD, CAD, and CON groups. Notes: Patients with diabetic foot problem had the least mean utility score as compared to other complications. The mean utility score among patients with DR, ESRD, CAD, and CON groups were not statistically different. *Statistically significant. Abbreviations: CAD, coronary artery disease; CON, control; DF, diabetic foot; DR, diabetic retinopathy; ESRD, end-stage renal disease.

Figure 5

Percentage of patients in DF, DR, ESRD, CAD, and CON groups with moderate-to-extreme problem in each dimension. Note: Patients with diabetic foot problems reported moderate-to-extreme problem in each dimension more than patients with other complications and those without complication. Abbreviations: DF, diabetic foot; DR, diabetic retinopathy; ESRD, end-stage renal disease; CAD, coronary artery disease; CON, control.

Figure 6

Comparison of the mean utility values among patients with diabetic foot problems. Notes: (A) Between post amputation and diabetic foot ulcer; (B) between below and above knee amputation, and (C) between those diabetic foot ulcers. There was no difference in the utility score between diabetic foot ulcer and post amputation. Quality of life was not significantly different in patients who had amputation, either below or above knee. Among patients with diabetic foot ulcer, those with ischemic ulcer, either infected or non-infected, had the lowest utility value as compared to those without ischemic ulcer. *Statistically significant. Abbreviations: AMPU, amputation; DFU, diabetic foot ulcer.

Figure 7

Comparison of the mean utility values among patients with diabetic foot problems with different weight-bearing statuses. Notes: Patients with non-weight bearing had the worst quality of life than other groups. *Statistically significant. Abbreviation: DFU, diabetic foot ulcer.

Figure 8

Comparison of the mean utility values among patients with acute major amputation, acute ulcer, and chronic ulcer. Note: There was no difference in the utility value between acute major amputation, acute ulcer, and chronic ulcer.