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Main predictors in health-related quality of life in Chinese patients with type 2 diabetes mellitus

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Abstract

Purpose

This study aimed to identify the predictors of decline in health-related quality of life (HRQOL) in Chinese patients with type 2 diabetes mellitus (T2DM).

Methods

A prospective longitudinal observational study was conducted on 1826 Chinese T2DM patients managed in public primary care setting. HRQOL was measured at baseline, 1 and 2 years by the Short Form-12 Health Survey version 2 (SF-12v2) and Chinese (HK) Short Form-6 Dimensions (SF-6D). Linear mixed effect models with forward stepwise method were performed to select the factors associated with SF-12v2 physical (PCS) and mental component summary (MCS) scores and SF-6D value.

Results

Over a 2-year observation period, the HRQOL (PCS: −0.626; MCS: −1.869; and SF-6D: −0.017 per year) scores decreased significantly with time. Female, unmarried, current smoker, no regular exercise, obesity, comorbid hypertension, chronic kidney disease (CKD) or cardiovascular disease (CVD) and insulin use were predictors of one or more poorer HRQOL scores after 12 or 24 months. Older age had a negative impact on PCS score and SF-6D value, but had a positive impact on MCS score.

Conclusions

The HRQOL of Chinese T2DM patients under primary care declined significantly over time. Obesity, smoking and no regular exercise were found to be modifiable risk factors of the decline in HRQOL in T2DM, which strengthened the importance of these lifestyle changes in diabetes care. More attention should be given to T2DM patients who are female, older, unmarried, or on anti-hypertensive drugs or insulin, or have comorbid hypertension, CKD or CVD in minimizing the negative impact of illness on their life.

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Abbreviations

BMI:

Body mass index

CHD:

Coronary heart diseases

CKD:

Chronic kidney disease

DM:

Diabetes mellitus

HbA1c:

Haemoglobin A1c

HRQOL:

Health-related quality of life

ICPC-2:

International Classification of Primary Care version 2

ICD-9-CM:

International Classification of Diseases, Ninth Edition, Clinical Modification

MCS:

Mental component summary

PCS:

Physical component summary

PEP:

Patient empowerment programme

RAMP-DM:

Multidisciplinary Risk Assessment and Management Program for Patients with Diabetes Mellitus

SF-12v2:

Short Form-12 Health Survey version 2

SF-6D:

Short Form-6 Dimensions

T2DM:

Type 2 diabetes mellitus

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Acknowledgments

We would like to thank the programme team at the Hospital Authority head office including Dr Christina Maw and Ms Ruby Kwok and all representatives and clinical staff who helped with the recruitment in the clinics. Moreover, we would like to thank Dr. S.V. Lo and the staff of the Statistics and Workforce Planning Department in the Hospital Authority Strategy and Planning Division.

Funding

This study has been funded by the Hong Kong Hospital Authority (Ref. No: 8011014157) and Health Services Research Fund, Food and Health Bureau, HKSAR Commissioned Research on Enhanced Primary Care Study (Ref. No EPC-HKU-2). The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

Author information

Authors and Affiliations

  1. Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F., 161 Main Street, Ap Lei Chau Clinic, Ap Lei Chau, Hong Kong

    Eric Y. F. Wan, Colman S. C. Fung, Carlos K. H. Wong, Anca K. C. Chan, Karina H. Y. Chan & Cindy L. K. Lam

  2. School of Nursing, The University of Hong Kong, 4/F William MW Mong Block, 21 Sassoon Road, Pokfulam, Hong Kong

    Edmond P. H. Choi

Authors
  1. Eric Y. F. Wan
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  2. Colman S. C. Fung
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  3. Edmond P. H. Choi
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  4. Carlos K. H. Wong
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  5. Anca K. C. Chan
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  6. Karina H. Y. Chan
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  7. Cindy L. K. Lam
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Corresponding author

Correspondence to Eric Y. F. Wan.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki ethics committee and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Wan, E.Y.F., Fung, C.S.C., Choi, E.P.H. et al. Main predictors in health-related quality of life in Chinese patients with type 2 diabetes mellitus. Qual Life Res 25, 2957–2965 (2016). https://doi.org/10.1007/s11136-016-1324-4

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