RT Journal Article
SR Electronic
T1 Health-Related Quality of Life Predicts Major Amputation and Death, but Not Healing, in People With Diabetes Presenting With Foot Ulcers: The Eurodiale Study
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP 694
OP 700
DO 10.2337/dc13-1212
VO 37
IS 3
A1 Siersma, Volkert
A1 Thorsen, Hanne
A1 Holstein, Per E.
A1 Kars, Marleen
A1 Apelqvist, Jan
A1 Jude, Edward B.
A1 Piaggesi, Alberto
A1 Bakker, Karel
A1 Edmonds, Michael
A1 Jirkovská, Alexandra
A1 Mauricio, Didac
A1 Ragnarson Tennvall, Gunnel
A1 Reike, Heinrich
A1 Spraul, Maximilian
A1 Uccioli, Luigi
A1 Urbancic, Vilma
A1 van Acker, Kristien
A1 van Baal, Jeff
A1 Schaper, Nicolaas C.
YR 2014
UL http://care.diabetesjournals.org/content/37/3/694.abstract
AB OBJECTIVE Low health-related quality of life (HRQoL) has been consistently reported to be associated with poor prognosis for a variety of health outcomes in various settings. We aimed to evaluate whether HRQoL in patients presenting with new diabetic foot ulcers (DFUs) has prognostic significance for ulcer healing, major amputation, and death.RESEARCH DESIGN AND METHODS We followed 1,088 patients with new DFUs presenting for treatment at one of the 14 centers in 10 European countries participating in the Eurodiale (European Study Group on Diabetes and the Lower Extremity) study, prospectively until healing (76.9%), major amputation (4.6%), or death (6.4%) up to a maximum of 1 year. At baseline, patient and ulcer characteristics were recorded as well as EQ-5D, a standardized instrument consisting of five domains and a visual analog scale for use as a measure of HRQoL. The prognostic influence of the EQ-5D domains was evaluated in multivariable Cox regression analyses on the time-to-event data, adjusting for baseline clinical characteristics of the ulcer and comorbidities.RESULTS While predictive effects of HRQoL, adjusted for possible confounders, were absent for healing, decreased HRQoL, especially in the physical domains, was statistically significant for major amputation (mobility, self-care, usual activities) and death (self-care, usual activities, pain/discomfort).CONCLUSIONS Low HRQoL appears to be predictive for major amputation and death, but high HRQoL does not increase healing. Future studies into the influence of HRQoL on ulcer outcome are important in attempts to decrease treatment failure and mortality.