Is quality of life different between diabetic and non-diabetic people? The importance of cardiovascular risks

BackgroundTo analyse and compare the impact of cardiovascular risk factors and disease on health-related quality of life (HRQoL) in people with and without diabetes living in the community.MethodsWe used data of 1,905 people with diabetes and 19,031 people without diabetes from the last Spanish National Health Survey (years 2011–2012). The HRQoL instrument used was the EuroQol 5D-5L, based on time trade-off scores. Matching methods were used to assess any differences in the HRQoL in people with and without diabetes with the same characteristics (age, gender, education level, and healthy lifestyle), according to cardiovascular risk factors and diseases. Disparities were also analysed for every dimension of HRQoL: mobility, daily activities, personal care, pain/discomfort, and anxiety/depression.ResultsThere were no significant differences in time trade-off scores between people with and without diabetes when cardiovascular risk factors or established cardiovascular disease were not present. However, when cardiovascular risk factors were present, the HRQoL score was significantly lower in people with diabetes than in those without. This difference was indeed greater when cardiovascular diseases were present. More precisely, people with diabetes and any of the cardiovascular risk factors, who have not yet developed any cardiovascular disease, report lower HRQoL, 0.046 TTO score points over 1 (7.93 over 100 in the VAS score) compared to those without diabetes, and 0.14 TTO score points of difference (14.61 over 100 in the VAS score) if cardiovascular diseases were present. In fact, when the three risk factors were present in people with diabetes, HRQoL was significantly lower (0.10 TTO score points over 1 and 10.86 points over 100 in VAS score), obesity being the most influential risk factor.ConclusionsThe presence of established cardiovascular disease and/or cardiovascular risk factors, specially obesity, account for impaired quality of life in people with diabetes.

背景 本研究旨在分析并比较社区居住的糖尿病患者与非糖尿病患者中，心血管危险因素及心血管疾病对健康相关生命质量（health-related quality of life, HRQoL）的影响。
方法 本研究使用西班牙2011-2012年全国健康调查的数据集，纳入1905名糖尿病患者与19031名非糖尿病受试者。本研究采用基于时间权衡（time trade-off, TTO）得分的EuroQol 5D-5L量表评估HRQoL。为控制混杂因素，本研究采用匹配法，在年龄、性别、教育水平及健康生活方式等特征匹配的两组人群中，分析心血管危险因素及疾病相关的HRQoL差异。同时，针对HRQoL的五个维度——移动能力、日常活动、自我照料、疼痛/不适及焦虑/抑郁——分别进行差异分析。
结果 当未合并心血管危险因素或确诊心血管疾病时，糖尿病患者与非糖尿病患者的TTO得分无显著统计学差异。但当存在心血管危险因素时，糖尿病患者的HRQoL得分显著低于非糖尿病患者；若同时合并确诊心血管疾病，则该组间差异进一步增大。具体而言，合并任意心血管危险因素但尚未发生心血管疾病的糖尿病患者，其HRQoL较非糖尿病患者更低：相较于满分1分的TTO得分低0.046分（对应视觉模拟评分（Visual Analogue Scale, VAS）得分7.93/100）；若同时合并确诊心血管疾病，则两组TTO得分差异达0.14分（对应VAS得分14.61/100）。进一步分析显示，当糖尿病患者同时存在三种心血管危险因素时，其HRQoL显著受损（TTO得分较满分1分低0.10分，VAS得分低10.86/100），其中肥胖为影响程度最高的危险因素。
结论 确诊心血管疾病及/或心血管危险因素（尤其是肥胖）是导致糖尿病患者生命质量受损的关键因素。