Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes

Abstract

AimsTo examine differences in health-related quality of life (HRQoL) between patients with and without diabetic peripheral neuropathy (DPN), and whether these differences can be explained by functional deficits.MethodsThis was a cross-sectional study of 160 patients with type 2 diabetes mellitus, 80 with DPN and 80 without. Assessments included HRQoL (health utility score derived from EQ-5D-5L), functional status measurements [muscle strength, timed up and go (TUG), five times sit-to-stand (FTSTS), functional reach, body sway velocity] and self-reported balance confidence [Activities-specific Balance Confidence (ABC) scale].ResultsMean utility scores were 0.67 ± 0.14 and 0.77 ± 0.16 in patients with and without DPN, respectively (p < 0.001). Patients with DPN had lower great toe extensor strength (6.4 ± 1.8 vs 7.6 ± 2.8 lbs, p = 0.001), greater body sway velocity (2.40 ± 1.31 vs 1.90 ± 0.52 mm/s, p = 0.002), slower TUG (12.1 ± 4.6 vs 10.1 ± 2.3 s, p < 0.001) and FTSTS (15.8 ± 5.8 vs 13.9 ± 5.4 s, p = 0.03) scores, and lower ABC score (73.4 ± 21.3 vs 82.6 ± 16.9, p = 0.003), compared to those without DPN. On stepwise multiple regression, DPN status, FTSTS, body sway velocity, BMI, diabetes duration, pain, and gender explained 38% of HRQoL variance. Addition of ABC score into the model explained 45% of variance. Results from structural equation modelling showed that DPN had direct effects on HRQoL and indirect effects through FTSTS, body sway velocity, and ABC score, with χ 2 = 8.075 (p = 0.044), root mean square error of approximation = 0.103 (lower bound 0.015, upper bound 0.191), Comparative Fit Index = 0.966, Tucker–Lewis Index = 0.887, and Standardized Root Mean Square Residual = 0.053.ConclusionsPatients with DPN have worse HRQoL compared to patients without DPN, partly mediated by functional status parameters. Effective interventions targeting functional status may be beneficial in improving HRQoL in these patients. Electronic supplementary materialThe online version of this article (10.1007/s00592-017-1077-8) contains supplementary material, which is available to authorized users.

Diagnosing peripheral neuropathy in South‐East Asia: A focus on diabetic neuropathy

“…A recent study compared 8,150 patients with diabetes mellitus who underwent foot screening with 8,150 patients who did not, and showed that the risk of both minor (3.5‐fold) and major (25‐fold) amputation was significantly increased in the latter, emphasizing the importance of screening for DPN 18 . In two separate studies from Singapore, the presence of DPN has been associated with a poorer functional status and health‐related quality of life 19,20 .…”

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Test-Retest Reliability of Vibration Perception Threshold Test in People with Type 2 Diabetes Mellitus

“…This VPT estimate can be considered as an indicator of diabetic neuropathy, which may influence their health-related quality of life, as reported in a study involving patients with and without this illness [24]. Suffering from neuropathy also leads to balance problems and mobility disorders [25,26], and increases the risk of falls [27].…”