Health related quality of life and healthcare utilization among adults with diabetes and kidney and eye complications in the United States

Abstract

Background: One-third of adults with diabetes in the United States have chronic kidney disease (CKD), and 19% of them have eye complications (ECs). However, little is known about the Health-related Quality of Life (HRQoL) of adults with both of these diabetes-related complications. Therefore, the purpose of this study is to examine differences in the HRQoL, mental health, and healthcare utilization of adults with diabetes who have CKD, ECs, both or neither. Methods: A cross-sectional study design was implemented using data from multiple panels (2009-2015) of the Medical Expenditure Panel Survey. HRQoL was measured using the SF-12 Physical and Mental Component Summary (PCS & MCS) scores. The HRQoL, mental health, and healthcare utilization of four mutually exclusive groups: 1) diabetes with both CKD and ECs; 2) diabetes with CKD only; 3) diabetes with ECs only, and 4) diabetes with neither CKD nor ECs were compared. In all analyses, adults with neither CKD nor ECs were the reference group. Results: There were 8415 adults with diabetes who met the inclusion criteria. Approximately, 75% of the study sample had neither CKD nor ECs, 13.3% had ECs only, 5.7% had CKD only, and 5.5% had both CKD and ECs. In the adjusted analyses, adults with both CKD and/or ECs complications exhibited significantly lower HRQoL compared to those with neither CKD nor ECs. Mental illness and psychological distress were higher among adults with both CKD and ECs compared to those with neither CKD nor ECs. Furthermore, adults with CKD and/or ECs had higher polypharmacy, inpatient and emergency services use compared to those with neither CKD nor ECs. Conclusions: The results indicate that the presence of both CKD and/or ECs was negatively associated with poor HRQoL, poor mental health, higher psychological distress and healthcare utilization in adults with diabetes. The findings emphasize the need for routine assessment and treatment for diabetes-related CKD and/or ECs complications to improve the quality of care for individuals with diabetes.

Is it time to consider depression as a major complication of type 2 diabetes? Evidence from a large population-based cohort study

“…Diabetes cardiovascular complications are considered major complications, that not only negatively affect the global health, but also the quality of life of people with diabetes [39], increasing the burden of Fig. 3 Ten-year all-cause mortality: cumulative hazard function from unadjusted and adjusted Cox regression models according to the presence of depression the disease in terms of health care utilization [40], economic expenditure [41], and mortality.…”

“…Evidence from the literature suggests people with type 2 diabetes have a twofold higher risk than the general population of fatal and non-fatal coronary heart disease, hemorrhagic or ischemic stroke [ 38 ]. Diabetes cardiovascular complications are considered major complications, that not only negatively affect the global health, but also the quality of life of people with diabetes [ 39 ], increasing the burden of the disease in terms of health care utilization [ 40 ], economic expenditure [ 41 ], and mortality.…”

Noninfectious Intermediate, Posterior, or Panuveitis: Results from the Retrospective, Observational, International EyeCOPE Study

“…Patients receiving treatment for chronic health conditions may report a lower quality of life, which can be exacerbated by comorbid conditions. A cross-sectional study of patients aged ≥ 21 years with diabetes showed that those with diabetes-related eye conditions reported a lower quality of life in the physical health domain than those with diabetes but no eye conditions (physical component summary: 37.6 vs. 42.4, respectively) [ 38 ]. In addition, after controlling for a large number of variables, patients with diabetes-related comorbid eye conditions were significantly more likely to require polypharmacy (defined as ≥ 6 medication classes; odds ratio = 1.27; p = 0.006) than those with diabetes but no eye conditions [ 38 ].…”

“…A cross-sectional study of patients aged ≥ 21 years with diabetes showed that those with diabetes-related eye conditions reported a lower quality of life in the physical health domain than those with diabetes but no eye conditions (physical component summary: 37.6 vs. 42.4, respectively) [ 38 ]. In addition, after controlling for a large number of variables, patients with diabetes-related comorbid eye conditions were significantly more likely to require polypharmacy (defined as ≥ 6 medication classes; odds ratio = 1.27; p = 0.006) than those with diabetes but no eye conditions [ 38 ]. According to the WPAI, more than half of patients (54.5%) enrolled in EyeCOPE were in paid employment; however, a discrepancy in the number of employed patients was observed between the answers provided in the employment section of the eDRF compared with the WPAI.…”

Prevalence and global trends of polypharmacy in patients with chronic kidney disease: A systematic review and meta-analysis

“…Table 1 summarizes the characteristics of the included studies. The reviewed studies were distributed across four continents with three studies conducted in the USA (Bowling et al, 2014;Sutaria et al, 2016;Hawley et al, 2019), two in Germany (König et al, 2017;Schmidt et al, 2019), and one each in Canada (Battistella et al, 2018), Saudi Arabia (Meraya and Alwhaibi, 2020), Lebanon (Chahine, 2020), Italy (Cojutti et al, 2016), India (Subeesh et al, 2020), Korea (Min et al, 2021), Japan (Kimura et al, 2021), and Ethiopia (Garedow et al, 2019). The last study took place across multiple European countries (Hayward et al, 2020).…”