Evaluating health-related quality of life in type 1 diabetes: a systematic literature review of utilities for adults with type 1 diabetes

Abstract

Background and aimsType 1 diabetes is a chronic condition associated with micro- and macrovascular complications that have a notable impact on health-related quality of life, the magnitude of which can be quantified via the use of utility values. The aim of this review was to conduct a systematic literature review to identify and compare published health state utility values for adults with type 1 diabetes both, with and without diabetes-related complications.MethodsLiterature searches of the PubMed, EMBASE, and Cochrane Library databases were performed to identify English language studies on adults with type 1 diabetes, published from 2000 onward, reporting utility values for patients with or without diabetes-related complications or assessing the impact of changes in HbA1c or body mass index on quality of life. For inclusion, studies were required to report utilities elicited using validated methods.ResultsA total of 20 studies were included in the final review that included utility values elicited using the EuroQuol five dimensions questionnaire (n=9), 15D questionnaire (n=2), Quality of Well-Being scale (n=4), time trade-off (n=3), and standard gamble (n=2) methods. For patients with no complications, reported utility values ranged from 0.90 to 0.98. Complications including stroke (reported disutility range, −0.105 to −0.291), neuropathy (range, −0.055 to −0.358), and blindness (range, −0.132 to −0.208) were associated with the largest decrements in utility values. The magnitude of utility values and utility decrements was influenced by the assessment method used.ConclusionComplications lead to impaired health-related quality of life in patients with type 1 diabetes, the magnitude of which is influenced by the method used to determine utilities. There is currently a lack of utility data for certain complications of type 1 diabetes, meaning that many economic evaluations have relied on a combination of type 1 and type 2 diabetes utilities, despite differences between the conditions and populations, or type 1 diabetes-specific utilities derived from different instruments.

Global Mapping of Interventions to Improve Quality of Life of People with Diabetes in 1990–2018

“…It is a chronic metabolic disorder characterized by elevated blood glucose levels due to the body's impaired insulin secretion and/or insulin resistance [1]. Persistent diabetes devastates vascular and nerve systems, causing many severe life-threatening complications (e.g., cardiovascular diseases, neuropathy, diabetic foot complications, diabetic retinopathies, or renal failure) and increasing the risk of hospitalization and mortality [2][3][4]. This disease has now been among the leading causes of disease burden worldwide [5].…”

“…Therefore, ensuring that people living with diabetes have a good quality of life (QOL) and can function adequately has become the ultimate goal of diabetic care [7]. Research increasingly looks to QOL as a favorable outcome of interventions focused on diabetes [2,6]. QOL is a multidimensional concept that does not have a unified definition [8][9][10][11].…”

“…When two treatments have similar clinical outcomes, measuring QOL can reflect patients' different experiences or perceptions of treatments and symptoms, helping clinicians to identify which intervention's benefits outweigh its drawbacks [12]. In the case of diabetes, evaluating QOL is critically important as its enhancement is associated with good self-care management, including adherence to prescribed medication and suggested lifestyle modifications, which are significant protective factors for diabetes care [2,6,13,14].…”

Health-related quality of life in a group of Egyptian children and adolescents with type 1 diabetes: relationship to microvascular complications

“…Several studies have demonstrated that diabetes has a strong negative impact on HRQOL, relative to the general population (Abuawad 2013;Jain et al 2014;Nielsen et al 2016), especially in the presence of complications (Hirai et al 2013;Smith-Palmer et al 2016). Diabetic neuropathy greatly reduces the quality of life in people with DM through increased disability and assuming more hospitalizations than other diabetic complications (Mahmood et al 2009;Tesfaye and Selvarajah 2012;Abuawad 2013).…”

Bringing Stem Cell‐Based Therapies for Type 1 Diabetes to the Clinic: Early Insights from Bioprocess Economics and Cost‐Effectiveness Analysis

“…It was considered that patients could suffer complications from five main groups: hypoglycemia, cardiovascular, neuropathy, nephropathy, and ophthalmological . Each complication was computed with increased medical costs and a utility decrement per patient of up to −0.29 . Yearly costs and quality‐of‐life scores (i.e., utility weights) associated with each state were computed.…”