Decrements in health-related quality of life associated with adverse events in people with diabetes

Abstract

Aim: To estimate the decrements in health-related quality of life (QoL) associated with a range of adverse events to inform assessments of the effects of diabetes treatments on QoL in contemporary clinical practice.

Methods: Participants' QoL utility measures were derived from the five-level EuroQoL five-dimensional (EQ-5D-5L) questionnaires completed by 11 683 ASCEND participants (76% of 15 480 recruited). EQ-5D utility decrements associated with cardiovascular (myocardial infarction, coronary revascularization, transient ischaemic attack [TIA], ischaemic stroke, heart failure), bleeding (gastrointestinal [GI] bleed, intracranial haemorrhage, other major bleed), cancer (GI tract cancer, non-GI tract cancer), and microvascular events (end-stage renal disease [ESRD], amputation) were estimated using a linear regression model following adjustment for participants' sociodemographic and clinical risk factors.

Results: Amputation was associated with the largest EQ-5D utility decrement (-0.206), followed by heart failure (-0.185), intracranial haemorrhage (-0.164), GI bleed (-0.091), other major bleed (-0.096), ischaemic stroke (-0.061), TIA (-0.057), and non-GI tract cancer (-0.026). We were unable to detect decrements in EQ-5D utility associated with myocardial infarction, coronary revascularization, GI tract cancer, or ESRD. EQ-5D utility was lower at older age, independent of other factors.

Conclusion: These estimated decrements in QoL associated with cardiovascular, bleeding, cancer, and other adverse events can inform assessments of the overall value of treatments in patients with diabetes.

Keywords: cardiovascular disease; diabetes complications; health economics.

FIGURE 1

EuroQoL five‐dimensional (EQ‐5D) utility by adverse event and time since event occurrence. *For intracranial haemorrhage, there were too few participants who experienced an event within 1 year prior to EQ‐5D response, so the EQ‐5D utility was presented for participants who had experienced an event irrespective of time of event. ≤1 y, an event occurred within 1 year prior to EQ‐5D questionnaire response; >1 y, an event occurred more than 1 year prior to EQ‐5D questionnaire response; GI, gastrointestinal. Other major bleed refers to bleeding events that are neither intracranial haemorrhage nor GI bleed. The number in brackets is the number of participants who had experienced a particular adverse event by the time of the EQ‐5D questionnaire

FIGURE 2

EuroQoL five‐dimensional (EQ‐5D) utility in people with diabetes associated with patient characteristics, clinical factors, and adverse events. The EQ‐5D utility for the reference individual (male, not current smoker, living in least deprived region, aged 70, BMI < 25 kg/m², diabetes duration < 10 years, eGFR ≥ 90 mL/min/1.73m², no albuminuria, with no disease history) is 0.906 (0.891, 0.920). ≤1 y, an event occurred within 1 year prior to EQ‐5D questionnaire response; >1 y, an event occurred more than 1 year prior to EQ‐5D questionnaire response; BMI, body mass index; eGFR, estimated glomerular filtration rate; GI, gastrointestinal. Other major bleed refers to bleeding events that are neither intracranial haemorrhage nor GI bleed. We were unable to detect decrements in EQ‐5D utility associated with myocardial infarction, coronary revascularizations, GI tract cancer, and end‐stage renal disease, so these events were not included in the model