Abstract
Objective
To assess health-related quality of life (HRQL) among adults with type 2 diabetes
using the Short Form (SF)-36 and to obtain pooled estimates of HRQL for subpopulations
defined by demographic characteristics, diabetes-related complications, and comorbidities.
Study Design and Methods
We conducted computerized searches of multiple electronic bibliographic databases,
and studies in any language were selected in which HRQL was reported among adults
with type 2 diabetes using the SF-36. Estimates were combined using a random-effects
model.
Results
One hundred eighteen studies fulfilled the inclusion criteria. HRQL was lower in persons
with type 2 diabetes, as measured by all the eight component scores of the SF-36 when
compared with the existing U.S. population norms and with previously published type
2 diabetes norms. SF-36 component and summary scores were extremely heterogeneous,
and subpopulation data were sparse; this precluded obtaining meaningful pooled scores
for most populations of interest and made comparisons among subpopulations difficult.
Conclusion
Our data suggest that previously published norms may underestimate the effect of diabetes
on HRQL, and diabetes populations are extremely heterogeneous, making broad population
“norms” for HRQL in type 2 diabetes of limited use. Additional research with important
subpopulations and individual-level data are needed to further explore the effect
of diabetes on HRQL.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical EpidemiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Quality of life and diabetes.Diab Metab Res Rev. 1999; 15: 205-218
- Distinguishing between quality of life and health status in quality of life research: a meta-analysis.Qual Life Res. 1999; 8: 447-459
- Measuring health-related quality of life.Ann Intern Med. 1993; 118: 622-629
- Glossary: health outcomes methodology.Med Care. 2000; 38: II-7-II-13
- Generic and disease-specific measures in assessing health status and quality of life.Med Care. 1989; 27: S217-S232
- Measurement of health outcomes in treatment effectiveness evaluations: conceptual and methodological challenges.Med Care. 2000; 38: II14-II25
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- The Sickness Impact Profile: development and final revision of a health status measure.Med Care. 1981; 19: 787-805
- Measuring health status: a new tool for clinicians and epidemiologists.J R Coll Gen Pract. 1985; 35: 185-188
- Diabetes Control and Complications Trial (DCCT) Research Group. Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial.Diabetes Care. 1996; 19: 195-203
- The development of an instrument for assessing the quality of life of people with diabetes. Diabetes-39.Med Care. 1997; 35: 440-453
- Cochrane reviews handbook (updated October 2001.Update Software, Oxford, UK2001
- Measures of general health status.in: Andresen E.M. Assessing the health status of older adults. Springer Publishing Co, New York1997: 41-91
- SF-36 Health Survey manual and interpretation guide.The Health Institute, New England Medical Center, Boston, MA1993
- SF-36 physical and mental health summary scales: a user's manual.The Health Institute, New England Medical Center, Boston, MA1994
- McDowell I. Newell C. General health status and quality of life. In: Measuring health: a guide to rating scales and questionnaires. Oxford University Press, Oxford, UK1996: 380-492
- User's manual for the Medical Outcomes Study (MOS) core measures of health-related quality of life.RAND, Santa Monica, CA2005
- Quantifying heterogeneity in a meta-analysis.Stat Med. 2002; 21: 1539-1558
- The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus.Med Care. 1994; 32: 1173-1181
- The uses of outcomes research for medical effectiveness, quality of care, and reimbursement in type II diabetes.Diabetes Care. 1994; 17: 32-39
- Quality of life over time in a cohort of patients with type I diabetes mellitus measured with the EUROQOL and the SF-36.EQ-5D. 2003; : 249-255
- Development and application of a model to estimate the impact of type 1 diabetes on health-related quality of life.Diabetes Care. 1998; 21: 725-731
- The impact of incontinence on health-related quality of life in a South Australian population sample.Aust NZ J Public Health. 2004; 28: 173-179
- Diabetes, depression, and quality of life: a population study.Diabetes Care. 2004; 27: 1066-1070
- Psychometric and clinical validity of the SF-36 general health survery in the Whitehall II study.Br J Health Psychol. 1997; 2: 285-300
- Grandparenthood status and health outcomes in midlife African American women with type 2 diabetes.Ethn Dis. 2008; 18: 141-146
- North West Adelaide Health Study T. Health status assessed by the SF-36 along the diabetes continuum in an Australian population.Qual Life Res. 2006; 15: 687-694
- The health-related utility and health-related quality of life of hospital-treated subjects with type 1 or type 2 diabetes with particular reference to differing severity of peripheral neuropathy.Diabetologia. 2006; 49: 2272-2280
- The financial costs of healthcare treatment for people with type 1 or type 2 diabetes in the UK with particular reference to differing severity of peripheral neuropathy.Diabet Med. 2007; 24: 187-194
- Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study.Health Qual Life Outcomes. 2007; 5: 39
- Anales del Sistema Sanitario de Navarra. 2007; 30: 45-52
- Effect of blood pressure and diabetes mellitus on cognitive and physical functions in older adults: a longitudinal analysis of the advanced cognitive training for independent and vital elderly cohort.J Am Geriatr Soc. 2005; 53: 1154-1161
- Individuals' perception of oral health and its impact on the health-related quality of life.J Oral Rehabil. 2007; 34: 79-87
- The relationship between visual acuity and functioning and well-being among diabetics.Qual Life Res. 1995; 4: 319-323
- Anales de Medicina Interna. 2006; 23: 357-360
- Gesundheitswesen. 2008; 70: 250-255
- Clinical determinants of long-term quality of life after stroke.Age Ageing. 2007; 36: 316-322
- Psychological morbidity and problems of daily living in people with visual loss and diabetes: do they differ from people without diabetes?.Diabet Med. 2006; 23: 1110-1116
- Assessment of quality of life and relevant factors in elderly diabetic patients in the Shanghai community.Pharmacoepidemiol Drug Saf. 2006; 15: 123-130
- The impact of diabetes mellitus and other chronic medical conditions on health-related quality of life: is the whole greater than the sum of its parts?.Health Qual Life Outcomes. 2005; 3: 2
- The influence of ethnicity on health-related quality of life in diabetes mellitus: a population-based, multiethnic study.J Diabetes Complications. 2006; 20: 170-178
- Self-rated health and diabetes of long duration. The Wisconsin Epidemiologic Study of Diabetic Retinopathy.Diabetes Care. 1998; 21: 236-240
- Insulin improves well-being for selected elderly type 2 diabetic subjects.Diabetes Res Clin Pract. 2002; 55: 201-207
- A comparison of health-related quality of life of elderly and younger insulin-treated adults with diabetes.Age Ageing. 2003; 32: 613-618
- Longitudinal study on glycaemic control and quality of life in patients with type 2 diabetes mellitus referred for intensified control.Diabet Med. 1999; 16: 23-30
- A randomised trial of insulin on well-being and carer strain in elderly type 2 diabetic subjects.J Diabetes Complications. 2004; 18: 148-154
- PDA-assisted low glycemic index dietary intervention for type II diabetes: a pilot study.Eur J Clin Nutr. 2006; 60: 1235-1243
- Assessment of group versus individual diabetes education: a randomized study.Diabetes Care. 2002; 25: 269-274
- Effectiveness of lifestyle counseling by certified expert nurse of Japan for non-insulin-treated diabetic outpatients: a 1-year randomized controlled trial.Diabetes Res Clin Pract. 2007; 76: 265-268
- Adding insulin glargine versus rosiglitazone: health-related quality-of-life impact in type 2 diabetes.Diabetes Care. 2007; 30 ([erratum appears in Diabetes Care 2007;30:1684]): 795-800
- Health-related quality of life in a randomised placebo-controlled trial of sibutramine in obese patients with type II diabetes.Int J Obes. 2004; 28: 600-605
- Quality of life in CAPD, transplant, and chronic renal failure patients with diabetes.Renal Fail. 2007; 29: 189-197
- Health related quality of life among Egyptian patients on hemodialysis.J Med Sci. 2006; 6: 314-320
- Health-related quality of life of hemodialysis patients in Taiwan: a multicenter study.Blood Purif. 2004; 22: 490-498
- Perceived health-related quality of life and comorbidity in diabetic patients starting dialysis (CALVIDIA Study).J Nephrol. 2004; 17: 544-551
- Proteinuria is a determinant of quality of life in diabetic nephropathy: modeling lagged effects with path analysis.Am J Nephrol. 2007; 27: 488-494
- Long-term follow-up of 78 simultaneous pancreas-kidney transplants at a single-center institution in Europe.Transplantation. 2004; 78: 1802-1808
- Qualidade de vida de pacientes com insuficiencia renal cronica em hemodialise avaliada atraves do instrumento generico SF-36.Revista Da Associacao Medica Brasileira. 2003; 49: 245-249
- Diabetic patients treated with dialysis: complications and quality of life.Diabetologia. 2007; 50: 2254-2262
- Perceived mental health at the start of dialysis as a predictor of morbidity and mortality in patients with end-stage renal disease (CALVIDIA Study).Nephrol Dial Transpl. 2004; 19: 2347-2353
- The Diabetic Foot Ulcer Scale (DFS): a quality of life instrument for use in clinical trials.Pract Diabetes Int. 2002; 19: 167-175
- Duloxetine for the management of diabetic peripheral neuropathic pain: evaluation of functional outcomes.Pain Med. 2007; 8: 410-418
- Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial.Pain. 2004; 110: 628-638
- Development of a health-related quality of life measure for peripheral neuropathy.Neurorehabil Neural Repair. 2000; 14: 93-104
- Health-related quality of life in patients with Charcot foot.Am J Orthop. 2003; 32: 492-496
- Quality of life in patients with diabetic foot ulcers.Disabil Rehabil. 2001; 23: 336-340
- Foot infections in diabetic patients. Decision and cost-effectiveness analyses.JAMA. 1995; 273: 712-720
- Health-related quality of life among patients with diabetes and foot ulcers: association with demographic and clinical characteristics.J Diabetes Complications. 2007; 21: 227-236
- A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population.Qual Life Res. 2007; 16: 179-189
- The prevalence and occurrence of diabetic foot ulcer pain and its impact on health-related quality of life.J Pain. 2006; 7: 290-299
- Health-related quality of life of diabetic foot ulcer patients and their caregivers.Diabetologia. 2005; 48: 1906-1910
- Impact of achilles tendon lengthening on functional limitations and perceived disability in people with a neuropathic plantar ulcer.Diabetes Care. 2004; 27: 1559-1564
- Quality of life improvement and long-term effects of peripheral blood mononuclear cell transplantation for severe arteriosclerosis obliterans in diabetic patients on dialysis.Circ J. 2007; 71: 1193-1198
- Health-related quality of life of patients with diabetes and foot ulcers.Foot Ankle Int. 2005; 26: 32-37
- Reliability of AOFAS diabetic foot questionnaire in Charcot arthropathy: stability, internal consistency, and measurable difference.Foot Ankle Int. 2005; 26: 717-731
- Impact of diabetes screening on quality of life.Diabetes Care. 2002; 25: 1022-1026
- Intensive telephone follow-up to a hospital-based disease management model for patients with diabetes mellitus.Dis Manage. 2005; 8: 15-25
- Effect of multifactorial intervention on quality of life and cost-effectiveness in newly diagnosed type 2 diabetic patients.Chin J Evid Based Med. 2005; 5: 386-390
- World Economic Outlook Database: WEO groups and aggregates information.([updated April 2009]. Available at) (Accessed November 19, 2009)
- Quality of life in patients with diabetes mellitus.Semin Clin Neuropsychiatry. 1997; 2: 82-93
- Quality of life and associated characteristics in a large national sample of adults with diabetes.Diabetes Care. 1997; 20: 562-567
- Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study.JAMA. 1989; 262 ([erratum appears in JAMA 1989;262:2542]): 907-913
- Meta-analysis of the literature or of individual patient data: is there a difference?.Lancet. 1993; 341: 418-422
- To IPD or not to IPD? Advantages and disadvantages of systematic reviews using individual patient data.Eval Health Prof. 2002; 25: 76-97
- Angiotensin-converting enzyme inhibition in Progressive Renal Disease Study G. Constructing a database of individual clinical trials for longitudinal analysis.Control Clin Trials. 2003; 24: 324-340
- Definitions of quality of life: a taxonomy.J Adv Nurs. 1995; 22: 502-508
- Importance of differentiating health status from quality of life.Lancet. 2001; 357: 7-8
- Health-related quality-of-life assessments in diverse population groups in the United States.Med Care. 2000; 38: II102-II124
- SF-36 summary scores: are physical and mental health truly distinct?.Med Care. 1998; 36: 567-572
Article info
Publication history
Published online: August 30, 2010
Accepted:
April 24,
2010
Footnotes
With regard to the contributions of Xuanping Zhang, PhD; Farrah M. Chowdhury, MBBS, MPH; and Ping Zhang, PhD, the findings and conclusions in this article are those of the authors and do not necessarily represent the official positions of the Centers for Disease Control and Prevention.
Identification
Copyright
Published by Elsevier Inc.
