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Chronic Disease

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Individual characteristics, complications, and treatments influence quality of life among adults with diabetes

The quality of life (QOL) of adults with diabetes is affected by a number of interrelated factors including sex, age, educational levels, duration of the disease, complications, and treatment. Susan L. Norris, M.D., M.P.H., a researcher with the Center for Outcomes and Effectiveness, Agency for Healthcare Research and Quality, recently reviewed studies on how personal characteristics, complications, and treatment regimens affected health-related quality of life (HRQOL) of adults with diabetes.

The studies reviewed indicate that adults with diabetes have lower QOL than people without the disease, but not as low as people with congestive heart failure, coronary artery disease, or depression (although diabetes doubles the risk of depression). On the other hand, people with diabetes who remain free of complications have a HRQOL only slightly lower than people of similar ages in the general population.

Insulin therapy, obesity, and complications of diabetes are associated with lower HRQOL, independent of age and sex. For both type 1 and type 2 diabetes, QOL decreases in relation to an increase in the number of complications. In fact, complications may be the most important disease-specific determinant of QOL. Adults who have diabetes a shorter time have higher QOL than those who live with the disease longer.

People with type 2 diabetes using insulin report lower physical and social functioning than those taking oral medications or using diet only for glycemic control. Conversely, improved glycemic control with oral agents among those with type 2 diabetes may improve QOL.

The relationship between treatment regimens and QOL is less clear in type 1 diabetes. Several studies suggest that HRQOL among people with type 1 diabetes is not negatively affected by intensive insulin regimens, and that the new types of rapid-acting insulin may increase dietary and leisure time flexibility.

Finally, the meaning of QOL changes with age. Younger people with diabetes are more concerned with fitness, sexuality, peer group acceptance, and fertility, while people in middle age are concerned with fulfilling daily tasks and sexual and motor function, and the elderly are concerned with their capacity to live independently.

See "Health-related quality of life among adults with diabetes," by Dr. Norris, in the April 2005 Current Diabetes Reports 5, pp. 124-130, 2005. Reprints (AHRQ Publication No. 06-R003) are available from the AHRQ Publications Clearinghouse.

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