Patient perceptions of quality of life with diabetes-related complications and treatments

Abstract

Objective: Understanding how individuals weigh the quality of life associated with complications and treatments is important to assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients' utilities (a measure of preference) for the full array of diabetes-related complications and treatments.

Research Design and Methods: We conducted interviews with a multi-ethnic sample of 701 adult patients living with diabetes, attending Chicago area clinics. We elicited utilities (ratings on a 0-1 scale (0-death; 1-perfect health) for hypothetical health states by using time tradeoff questions. We evaluated 9 complication states (e.g., Diabetic Retinopathy and Blindness) and 10 treatment states (e.g., Intensive (IGC) vs. Conventional Glucose Control (CGC), and Comprehensive Diabetes Care (i.e., intensive control of multiple risk factors)).

Results: End-stage complications had lower means utilities than intermediate complications (e.g., Blindness 0.38 (Standard Deviation, SD, 0.35) vs. Retinopathy 0.53 (SD 0.36), p<0.01) and end-stage complications had the lowest ratings among all health states. Intensive treatments had lower mean utilities than conventional treatments (e.g. IGC 0.67 (SD 0.34) vs. CGC 0.76 (SD 0.31), p<0.01) and the lowest rated treatment state was Comprehensive Diabetes Care (mean 0.64 (SD 0.34)). Patients rated comprehensive treatment states similarly to intermediate complication states.

Conclusions: End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality of life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery.