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Association Between Glycated Hemoglobin and Health Utility for Type 1 Diabetes

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Abstract

Objectives

Cost-effectiveness models for diabetes link glycated hemoglobin (HbA1c) to diabetes-related complications. Independent of diabetes-related complications, there is little known on the association between HbA1c and health utility scores. This link can alter the cost effectiveness of interventions designed to improve HbA1c. The cross-sectional relationship between HbA1c and health utility scores in adult type 1 diabetes patients was estimated after adjusting for diabetes-related complications.

Methods

The EuroQoL-5 dimension (EQ-5D) questionnaire and an ad hoc survey requesting demographic information and adherence to glucose monitoring therapies was administered to adult type 1 diabetes patients during a clinic visit and combined with clinical medical record data. Health utility scores were derived using the US time-tradeoff valuation of the EQ-5D. Linear regression was used to estimate the relationship between HbA1c and utility, adjusting for treatments, demographics, and diabetes-related complications.

Results

Among 176 patients, mean (standard deviation [SD]) age was 38 (12.2) years, duration of disease was 22 (12.1) years, and number of chronic conditions other than type 1 diabetes was 2.7 (2.0). Unadjusted mean (SD) utility was 0.94 (0.09) for those with HbA1c levels <7 % (n = 54), 0.89 (0.15) for those with HbA1c ≥ 7 % (n = 122), and 0.91 (0.14) for all patients. After adjustment, a 1 % absolute increase in HbA1c was associated with a disutility of −0.03 (95 % confidence interval [CI] −0.049, −0.006).

Conclusions

Findings suggest that, after adjusting for diabetes-related complications, higher HbA1c levels are associated with a significant health disutility. Pending additional data from longitudinal studies, these findings could be used in cost-effectiveness evaluations of type 1 diabetes interventions that impact HbA1c.

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Acknowledgments

The authors would like to thank Dr. Satish K. Garg, the Barbara Davis Center staff, and the study subjects for their participation. This research was funded in part by the PhRMA Foundation as part of a post-doctoral fellowship grant for RBM. RBM, SLE, DMM, HDA, KVN, AML, and JDC have declared no financial conflicts of interest directly related to this research.

Author contributions

This study was a part of RBM’s dissertation and he is the overall guarantor of the work. RBM designed the study, managed survey administration and data collection, conducted the statistical analysis, and wrote/revised the manuscript; SLE was a member of RBM’s dissertation committee and contributed to the design of the study, assisted in survey administration and data collection, and edited/revised all sections of the manuscript; DMM, HDA, and AML were members of RBM’s dissertation committee and contributed to the design of the study and edited/revised all sections of the manuscript; KVN was the process chair of RBM’s dissertation committee and contributed to the design of the study, and edited/revised all sections of the manuscript; JDC was RBM’s thesis advisor and contributed to the design of the study, participated in data management and statistical analysis, and edited/revised all sections of the manuscript.

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Authors and Affiliations

  1. Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado Anschutz Medical Campus, Mail Stop C238, 12850 E. Montview Blvd., Aurora, CO, 80045, USA

    R. Brett McQueen, Samuel L. Ellis, Heather D. Anderson, Kavita V. Nair, Anne M. Libby & Jonathan D. Campbell

  2. Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Samuel L. Ellis & David M. Maahs

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  1. R. Brett McQueen
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  2. Samuel L. Ellis
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Correspondence to R. Brett McQueen.

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McQueen, R.B., Ellis, S.L., Maahs, D.M. et al. Association Between Glycated Hemoglobin and Health Utility for Type 1 Diabetes. Patient 7, 197–205 (2014). https://doi.org/10.1007/s40271-014-0045-4

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