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The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus

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Singapore Med J 2014; 55(4): 209-216; http://dx.doi.org/10.11622/smedj.2014054
The association of cardiovascular disease with impaired health-related quality of life among patients with type 2 diabetes mellitus

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Tan MC, Ng OC, Wong TW, Hejar AR, Anthony J, Sintonen H
Correspondence: Ms Mun Chieng Tan, mun_chieng_tan@yahoo.com

ABSTRACT
INTRODUCTION The aim of this study was to evaluate the health-related quality of life (HRQoL) of Malaysian patients with type 2 diabetes mellitus (T2DM) who have cardiovascular disease (CVD), as well as identify the determinants of HRQoL among this cohort of patients.
METHODS This study was an analytical cross-sectional study involving 313 patients aged 30–78 years (150 men, 163 women; mean age 55.7 ± 9.2 years) who were diagnosed with T2DM (mean duration of T2DM 10.1 ± 8.1 years) at two tertiary Malaysian government hospitals. The patients’ sociodemographic, lifestyle, clinical and laboratory data were collected prospectively from medical records and via face-to-face interviews. HRQoL was assessed using the 15D instrument – a generic, 15-dimensional and standardised measure of HRQoL that can be used as both a profile and a single index score measure. 
RESULTS T2DM patients with CVD were found to have significantly lower 15D HRQoL scores than their nonCVD counterparts (p < 0.001). The HRQoL of T2DM patients with CVD was significantly lower than those without CVD (p < 0.05) in all of the 15 dimensions of the 15D instrument. Multinomial logistic regression analysis using backward stepwise method revealed a significant association between CVD and impaired HRQoL (odds ratio [OR] 11.746, 95% confidence interval [CI] 4.898–28.167). Age (OR 1.095, 95% CI 1.054–1.137), duration of T2DM (OR 1.085, 95% CI 1.032–1.140), ethnicity (OR 0.411, 95% CI 0.187–0.903), body mass index (OR 1.074, 95% CI 1.006–1.148), and physical activity level (OR 3.506, 95% CI 1.415–8.689) were also significant predictors of HRQoL.
CONCLUSION In T2DM patients, the presence of CVD was significantly associated with a lower HRQoL. Therefore, the importance of tertiary prevention to minimise the potential deterioration of the HRQoL of T2DM patients with CVD should be highly emphasised.

Keywords: 15D instrument, cardiovascular disease, health-related quality of life, type 2 diabetes mellitus
Singapore Med J 2014; 55(4): 209-216; http://dx.doi.org/10.11622/smedj.2014054

http://smj.org.sg/sites/default/files/5504/5504a4.pdf

REFERENCES

1. International Diabetes Federation. IDF Diabetes Atlas. 5th ed. Brussels, Belgium: IDF, 2011.
 
2. Hahl J, Hämäläinen H, Sintonen H, et al. Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Qual Life Res 2002; 11:427-36.
http://dx.doi.org/10.1023/A:1015684100227
 
3. Haffner SM, Letho S, Rönnemaa T, Pyörälä K, Laakso M. Mortality from coronary heart disease in subject with type 2 diabetes and in non diabetic subjects with and without prior myocardial infarction. N Engl J Med 1998; 339:229-34.
http://dx.doi.org/10.1056/NEJM199807233390404
 
4. Diabetes Drafting Group. Prevalence of small vessel and large vessel disease in diabetic patients from 14 centres: The World Health Organization Multinational Study of Vascular Disease in Diabetics. Diabetologia 1985; 28:615- 40.
http://dx.doi.org/10.1007/BF00290267
 
5. Assmann G, Schulte H. The Prospective Cardiovascular Münster (PROCAM) study: Prevalence of hyperlipidemia in persons with hypertension and/or diabetes mellitus and the relationship to coronary heart disease. Am Heart J 1988; 116:1713-24.
http://dx.doi.org/10.1016/0002-8703(88)90220-7
 
6. Stamler J, Vaccaro O, Neaton JD, Wentworth D. Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial. Diabetes Care 1993;16:434-44.
http://dx.doi.org/10.2337/diacare.16.2.434
 
7. Gu K, Cowie CC, Harris MI. Diabetes and decline in heart disease mortality in US adults. JAMA 1999; 281:1291-7.
http://dx.doi.org/10.1001/jama.281.14.1291
 
8. Fox CS. Cardiovascular disease risk factors, type 2 diabetes mellitus, and the Framingham Heart Study. Trends Cardiovas Med 2010; 20:90-5.
http://dx.doi.org/10.1016/j.tcm.2010.08.001
 
9. Fisher M, McMurray JJ. Diabetic cardiology. London: John Wiley & Sons, 20 07.
 
10. American Heart Association. Heart Disease and Stroke Statistics: 2009 Update. Dallas: American Heart Association, 2009.
 
11. Stern MP. Glycemia and cardiovascular risk. Diabetes Care 1997; 20:1501-2.
 
12. Laakso M. Hyperglycemia and cardiovascular disease in type 2 diabetes. Diabetes 1999; 48:937-42.
http://dx.doi.org/10.2337/diabetes.48.5.937
 
13. Morrish NJ, Wang SL, Stevens LK, Fuller JH, Keen K. Mortality and causes of death in the WHO multinational study of vascular disease in diabetes. Diabetologia 2001; 44 Suppl 2:S14-21.
http://dx.doi.org/10.1007/PL00002934
 
14. Lloyd A, Sawyer W, Hopkinson P. Impact of long-term complications on quality of life in patients with type 2 diabetes not using insulin. Value Health 2001; 4:392-400.
http://dx.doi.org/10.1046/j.1524-4733.2001.45029.x
 
15. The Criteria Committee of the New York Heart Association. Nomenclature and criteria of diseases of the heart and blood vessels. Boston: Little, Brown and company, 1973.
 
16. Kaplan RM. Health-related quality of life in cardiovascular disease.J Consult Clin Psychol 1988; 56:382-92.
http://dx.doi.org/10.1037/0022-006X.56.3.382
 
17. Sintonen H. The 15D instrument of health-related quality of life: Properties and applications. Ann Med 2001; 33:328-36.
http://dx.doi.org/10.3109/07853890109002086
 
18. Lee RD, Nieman DC. Nutritional Assessment. 5th ed. New York: McGrawHill Higher Education, 2010.
 
19. International Physical Activity Questionnaire Research Committee. Guidelines for Data Processing and Analysis of the International Physical Activity Questionnaire (IPAQ). November 2005. Available at: www.ipaq.ki.se. Accessed August 1, 2011.
 
20. World Health Organization. Health topics. Reproductive health. Available at: www.who.int/topics/reproductive_health/en. Accessed September 1, 2011.
 
21. Sintonen H. Outcome measurements in acid-related diseases. Pharmacoeconomics 1994; 5:17-26.
http://dx.doi.org/10.2165/00019053-199400053-00005
 
22. Sintonen H. The 15D-measure of health-related quality of life. I. Reliability, validity and sensitivity of its health state descriptive system. Working Paper 41. Melbourne: National Centre for Health Program Evaluation, 1994.
 
23. Sintonen H. The 15D-measure of health-related quality of life. II. Feasibility, reliability and validity of its valuation system. Working Paper 42. Melbourne: National Centre for Health Program Evaluation, 1995.
 
24. Testa MA, Simonson DC. Assessment of quality-of-life outcomes. N Engl J Med 1996; 334:835-40.
http://dx.doi.org/10.1056/NEJM199603283341306
 
25. Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev 1999; 15:205-18.
http://dx.doi.org/10.1002/(SICI)1520-7560(199905/06)15:3<205::AID-DMRR29>3.0.CO;2-O
 
26. Wändell PE, Brorsson B, Åberg H. Functioning and well-being of patients with type 2 diabetes or angina pectoris, compared with the general population. Diabetes Metab 2000; 26:465-71.
 
27. Unsar S, Sut N, Durna Z. Health-related quality of life in patients with coronary artery disease. J Cardiovasc Nurs 2007; 22:501-7.
http://dx.doi.org/10.1097/01.JCN.0000297382.91131.8d
 
28. Stafford M, Soljak M, Pledge V, Mindell J. Socio-economic differences in the health-related quality of life impact of cardiovascular conditions. Eur J Public Health 2012; 22:301-5.
http://dx.doi.org/10.1093/eurpub/ckr007
 
29. Li C, Ford ES, Mokdad AH, et al. Clustering of cardiovascular disease risk factors and health-related quality of life among US adults. Value Health 2008; 11:689-99.
http://dx.doi.org/10.1111/j.1524-4733.2007.00307.x
 
30. Ahola AJ, Saraheimo M, Forsblom C, et al. Health-related quality of life in patients with type 1 diabetes-association with diabetic complications (The FinDiane Study). Nephrol Dial Transplant 2010; 25:1903-8.
http://dx.doi.org/10.1093/ndt/gfp709
 
31. Akinci F1, Yildirim A, Gözü H, et al. Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey. Diabetes Res Clin Pract 2008; 79:117-23.
http://dx.doi.org/10.1016/j.diabres.2007.07.003
 
32. Hänninen J, Takala J, Keinänen-Kiukaanniemi S. Quality of life in NIDDM patients assessed with the SF-20 questionnaire. Diabetes Res Clin Pract 1998; 42:17-27.
http://dx.doi.org/10.1016/S0168-8227(98)00085-0
 
33. Papadopoulos AA, Kontodimopoulos N, Frydas A, Ikonomakis E, Niakas D. Predictors of health-related quality of life in type II diabetic patients in Greece. BMC Public Health 2007; 7:186.
http://dx.doi.org/10.1186/1471-2458-7-186
 
34. Järvinena O, Saarinen T, Julkunen J, Huhtala H, Tarkka MR. Changes in health-related quality of life and functional capacity following coronary artery bypass graft surgery. Eur J Cardiothorac Surg 2003; 24:750-6.
http://dx.doi.org/10.1016/S1010-7940(03)00413-5
 
35. Fischbacher CM, Hunt S, Alexander L. How physically active are South Asians in the United Kingdom? A literature review. J Public Health (Oxf) 2004; 26:250-8.
http://dx.doi.org/10.1093/pubmed/fdh158
 
36. Miettola J, Niskanen LK, Viinamaki H, Sintonen H, Kumpusalo E. Metabolic syndrome is associated with impaired health-related quality of life: Lapinlahti 2005 study. Qual Life Res 2008; 17:1055-62.
http://dx.doi.org/10.1007/s11136-008-9386-6
 
37. Hlatky MA, Chung S-C, Escobedo J, et al. The effect of obesity on quality of life in patients with diabetes and coronary artery disease. Am Heart J 2010; 159:292-300.
http://dx.doi.org/10.1016/j.ahj.2009.11.004
 
38. Dennett SL, Boye KS, Yurgin NR. The impact of body weight on patient utilities with or without type 2 diabetes: A review of the medical literature. Value Health 2008; 11:478-86.
http://dx.doi.org/10.1111/j.1524-4733.2007.00260.x
 
39. Azman AB, Sararaks S, Rugayah B, et al. Quality of life of the Malaysian General Population: Results from a postal survey using the SF-36. Med J Malaysia 2003; 58:694-711.
 
40. Johnstone MT, Kinzfogl GP. Contemporary Cardiology: Diabetes and Cardiovascular Disease. 2nd ed. New Jersy: Humana Press Inc, 2005.
 
41. Shaw JE, Punjabi NM, Wilding JP, Alber ti KG, Zimmet PZ. Sleep- disordered breathing and type 2 diabetes: A report from the International Diabetes Federation Taskforce on Epidemiology and Prevention. Diabetes Res Clin Pract 2008; 81:2-12.
http://dx.doi.org/10.1016/j.diabres.2008.04.025
 
42. Durmaz T, Özdemir Ö, Özdemir BA, et al. Factors affecting quality of life in patients with coronary heart disease. Turk J Med Sci 2009; 39:343-51.
 
43. Liles DR, Kallen MA, Petersen LA, Bush RL. Quality of life and peripheral arterial disease. J Surg Res 2006; 136:294-301.
http://dx.doi.org/10.1016/j.jss.2006.06.008
 
44. Anderson RM, Fitzgerald JT, Wisdom K, Davis WK, Hiss RG. A comparison of global versus disease- specific quality-of-life measures in patients with NIDDM. Diabetes Care 1997; 20:299-305.
http://dx.doi.org/10.2337/diacare.20.3.299
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