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Evaluation of health utility values for diabetic complications, treatment regimens, glycemic control and other subjective symptoms in diabetic patients using the EQ-5D-5L

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Abstract

Aims

This study aimed to reveal health utility values for diabetic complications and treatment regimens with adjustment for glycemic control and other clinical manifestations in a diabetic population.

Methods

The EuroQol 5-Dimension 5-Level (EQ-5D-5L) health utility values for 4963 Japanese diabetic patients were analyzed using a multivariate regression model including major complications and treatment regiments (minimally adjusted model), and that additionally included glycemic control and other subjective symptoms (musculoskeletal, dental, respiratory, gastrointestinal, urinary, and cutaneous symptoms, and hearing impairment) (further adjusted model).

Results

The mean utility value was 0.901 ± 0.137. In the minimally adjusted model, blindness, overt nephropathy, regular dialysis, cardiac symptom, sequelae of stroke, symptomatic peripheral neuropathy, decreased sensation, claudication, foot ulcer/gangrene, major amputation, and complex treatment regimens were significantly associated with lower utility values, whereas proliferative retinopathy without blindness, coronary artery disease without cardiac symptom, sequela-free cerebrovascular disease, asymptomatic peripheral artery disease, and minor amputation were not. Major complications and treatment regimens that showed significant association in the minimally adjusted model still presented significant impact on the utility decrement in the further adjusted model. However, most of their regression coefficients were lower in absolute value compared to those in the minimally adjusted model.

Conclusions

The utility decrement related to each diabetic complication varied with its severity and accompanying symptoms. Complex treatment regimens were independently associated with lower utility values. The utility decrement associated with diabetic complication and complex treatment regimens would be overestimated in the analysis without adjustment for glycemic control or other subjective symptoms.

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References

  1. Narayan KM, Gregg EW, Fagot-Campagna A, Engelgau MM, Vinicor F (2000) Diabetes–a common, growing, serious, costly, and potentially preventable public health problem. Diabetes Res Clin Pract 50(Suppl 2):S77–S84

    Article  PubMed  Google Scholar 

  2. Weinstein MC, Siegel JE, Gold MR, Kamlet MS, Russell LB (1996) Recommendations of the Panel on Cost-effectiveness in Health and Medicine. JAMA 276:1253–1258

    Article  PubMed  CAS  Google Scholar 

  3. Richardson G, Manca A (2004) Calculation of quality adjusted life years in the published literature: a review of methodology and transparency. Health Econ 13:1203–1210

    Article  PubMed  Google Scholar 

  4. Brooks R (1996) EuroQol: the current state of play. Health Policy 37:53–72

    Article  PubMed  CAS  Google Scholar 

  5. Clarke P, Gray A, Holman R (2002) Estimating utility values for health states of type 2 diabetic patients using the EQ-5D (UKPDS 62). Med Decis Making 22:340–349

    Article  PubMed  Google Scholar 

  6. Bagust A, Beale S (2005) Modelling EuroQol health-related utility values for diabetic complications from CODE-2 data. Health Econ 14:217–230

    Article  PubMed  Google Scholar 

  7. Zhang P, Brown MB, Bilik D, Ackermann RT, Li R, Herman WH (2012) Health utility scores for people with type 2 diabetes in U.S. managed care health plans: results from Translating Research Into Action for Diabetes (TRIAD). Diabetes Care 35:2250–2256

    Article  PubMed  PubMed Central  Google Scholar 

  8. Kiadaliri AA, Gerdtham UG, Eliasson B, Gudbjornsdottir S, Svensson AM, Carlsson KS (2014) Health utilities of type 2 diabetes-related complications: a cross-sectional study in Sweden. Int J Environ Res Public Health 11:4939–4952

    Article  PubMed  PubMed Central  Google Scholar 

  9. Peasgood T, Brennan A, Mansell P, Elliott J, Basarir H, Kruger J (2016) The impact of diabetes-related complications on preference-based measures of health-related quality of life in adults with type I diabetes. Med Decis Making 36:1020–1033

    Article  PubMed  PubMed Central  Google Scholar 

  10. Vinik AI, Maser RE, Mitchell BD, Freeman R (2003) Diabetic autonomic neuropathy. Diabetes Care 26:1553–1579

    Article  PubMed  Google Scholar 

  11. Casanova L, Hughes FJ, Preshaw PM (2014) Diabetes and periodontal disease: a two-way relationship. Br Dent J 217:433–437

    Article  PubMed  CAS  Google Scholar 

  12. Petrou S, Hockley C (2005) An investigation into the empirical validity of the EQ-5D and SF-6D based on hypothetical preferences in a general population. Health Econ 14:1169–1189

    Article  PubMed  Google Scholar 

  13. Bharmal M, Thomas J (2006) Comparing the EQ-5D and the SF-6D descriptive systems to assess their ceiling effects in the US general population. Value Health 9:262–271

    Article  PubMed  Google Scholar 

  14. Brazier J, Roberts J, Tsuchiya A, Busschbach J (2004) A comparison of the EQ-5D and SF-6D across seven patient groups. Health Econ 13:873–884

    Article  PubMed  Google Scholar 

  15. Herdman M, Gudex C, Lloyd A et al (2011) Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res 20:1727–1736

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  16. Agborsangaya CB, Lahtinen M, Cooke T, Johnson JA (2014) Comparing the EQ-5D 3L and 5L: measurement properties and association with chronic conditions and multimorbidity in the general population. Health Qual Life Outcomes 12:74

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wang P, Luo N, Tai ES, Thumboo J (2016) The EQ-5D-5L is more discriminative than the EQ-5D-3L in patients with diabetes in Singapore. Value Health Reg Issues 9:57–62

    Article  PubMed  Google Scholar 

  18. Ikeda S, Shiroiwa T, Igarashi A et al (2015) Developing a Japanese version of the EQ-5D-5L value set. J Natl Inst Public Health 64:47–55

    Google Scholar 

  19. Haneda M, Noda M, Origasa H et al (2018) Japanese clinical practice guideline for diabetes 2016. Diabetol Int 9:1–45

    Article  PubMed  PubMed Central  Google Scholar 

  20. Pullenayegum EM, Tarride JE, Xie F, Goeree R, Gerstein HC, O’Reilly D (2010) Analysis of health utility data when some subjects attain the upper bound of 1: are Tobit and CLAD models appropriate? Value Health 13:487–494

    Article  PubMed  Google Scholar 

  21. Laxy M, Wilson ECF, Boothby CE, Griffin SJ (2017) Incremental costs and cost effectiveness of intensive treatment in individuals with type 2 diabetes detected by screening in the ADDITION-UK trial: an update with empirical trial-based cost data. Value Health 20:1288–1298

    Article  PubMed  PubMed Central  Google Scholar 

  22. Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577–1589

    Article  PubMed  CAS  Google Scholar 

  23. Vijan S, Sussman JB, Yudkin JS, Hayward RA (2014) Effect of patients’ risks and preferences on health gains with plasma glucose level lowering in type 2 diabetes mellitus. JAMA Intern Med 174:1227–1234

    Article  PubMed  PubMed Central  Google Scholar 

  24. Stratton IM, Adler AI, Neil HA et al (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 321:405–412

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  25. Ikeda Y, Kubo T, Oda E, Abe M, Tokita S (2018) Incidence rate and patient characteristics of severe hypoglycemia in treated type 2 diabetes mellitus patients in Japan: retrospective diagnosis procedure combination database analysis. J Diabetes Investig 9:925–936

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  26. Shim YT, Lee J, Toh MP, Tang WE, Ko Y (2012) Health-related quality of life and glycaemic control in patients with Type 2 diabetes mellitus in Singapore. Diabet Med 29:e241–e248

    Article  PubMed  CAS  Google Scholar 

  27. Currie CJ, Morgan CL, Poole CD, Sharplin P, Lammert M, McEwan P (2006) Multivariate models of health-related utility and the fear of hypoglycaemia in people with diabetes. Curr Med Res Opin 22:1523–1534

    Article  PubMed  Google Scholar 

  28. Southerland JH, Moss K, Taylor GW et al (2012) Periodontitis and diabetes associations with measures of atherosclerosis and CHD. Atherosclerosis 222:196–201

    Article  PubMed  CAS  Google Scholar 

  29. Bytzer P, Talley NJ, Leemon M, Young LJ, Jones MP, Horowitz M (2001) Prevalence of gastrointestinal symptoms associated with diabetes mellitus: a population-based survey of 15,000 adults. Arch Intern Med 161:1989–1996

    Article  PubMed  CAS  Google Scholar 

  30. Frimodt-Moller C (1980) Diabetic cystopathy: epidemiology and related disorders. Ann Intern Med 92:318–321

    Article  PubMed  CAS  Google Scholar 

  31. Duff M, Demidova O, Blackburn S, Shubrook J (2015) Cutaneous manifestations of diabetes mellitus. Clin Diabetes 33:40–48

    Article  PubMed  PubMed Central  Google Scholar 

  32. Rosenbloom AL, Silverstein JH, Lezotte DC, Richardson K, McCallum M (1981) Limited joint mobility in childhood diabetes mellitus indicates increased risk for microvascular disease. N Engl J Med 305:191–194

    Article  PubMed  CAS  Google Scholar 

  33. Cohen SP, Argoff CE, Carragee EJ (2008) Management of low back pain. BMJ 337:a2718

    Article  PubMed  Google Scholar 

  34. Blagojevic M, Jinks C, Jeffery A, Jordan KP (2010) Risk factors for onset of osteoarthritis of the knee in older adults: a systematic review and meta-analysis. Osteoarthr Cartil 18:24–33

    Article  CAS  Google Scholar 

  35. Bae JP, Lage MJ, Mo D, Nelson DR, Hoogwerf BJ (2016) Obesity and glycemic control in patients with diabetes mellitus: Analysis of physician electronic health records in the US from 2009 to 2011. J Diabetes Complicat 30:212–220

    Article  CAS  Google Scholar 

  36. Cederholm J, Eeg-Olofsson K, Eliasson B, Zethelius B, Nilsson PM, Gudbjornsdottir S (2008) Risk prediction of cardiovascular disease in type 2 diabetes: a risk equation from the Swedish National Diabetes Register. Diabetes Care 31:2038–2043

    Article  PubMed  PubMed Central  Google Scholar 

  37. Goman AM, Lin FR (2016) Prevalence of hearing loss by severity in the United States. Am J Public Health 106:1820–1822

    Article  PubMed  PubMed Central  Google Scholar 

  38. Bainbridge KE, Hoffman HJ, Cowie CC (2008) Diabetes and hearing impairment in the United States: audiometric evidence from the National Health and Nutrition Examination Survey, 1999 to 2004. Ann Intern Med 149:1–10

    Article  PubMed  PubMed Central  Google Scholar 

  39. Bainbridge KE, Hoffman HJ, Cowie CC (2011) Risk factors for hearing impairment among U.S. adults with diabetes: National Health and Nutrition Examination Survey 1999–2004. Diabetes Care 34:1540–1545

    Article  PubMed  PubMed Central  Google Scholar 

  40. Bradshaw PJ, Jamrozik KD, Gilfillan IS, Thompson PL (2006) Asymptomatic long-term survivors of coronary artery bypass surgery enjoy a quality of life equal to the general population. Am Heart J 151:537–544

    Article  PubMed  Google Scholar 

  41. Pickwell K, Siersma V, Kars M et al (2017) Minor amputation does not negatively affect health-related quality of life as compared with conservative treatment in patients with a diabetic foot ulcer: an observational study. Diabetes Metab Res Rev. https://doi.org/10.1002/dmrr.2867

    Article  PubMed  Google Scholar 

  42. Ragnarson Tennvall G, Apelqvist J (2000) Health-related quality of life in patients with diabetes mellitus and foot ulcers. J Diabetes Complicat 14:235–241

    Article  CAS  Google Scholar 

  43. Rutherford RB, Baker JD, Ernst C et al (1997) Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg 26:517–538

    Article  PubMed  CAS  Google Scholar 

  44. Jia H, Lubetkin EI (2005) The impact of obesity on health-related quality-of-life in the general adult US population. J Public Health (Oxf) 27:156–164

    Article  Google Scholar 

  45. Busutil R, Espallardo O, Torres A, Martinez-Galdeano L, Zozaya N, Hidalgo-Vega A (2017) The impact of obesity on health-related quality of life in Spain. Health Qual Life Outcomes 15:197

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Principal investigators at the participating centers were: Hiroki Yokoyama (Jiyugaoka Medical Clinic, Internal Medicine, Hokkaido), Mitsuo Shimizu (Shimizu Medical Clinic, Gunma), Yasuaki Ishimaru (Dr. Yasuyo Ishimaru Memorial Kumagaya Diabetes Clinic, Saitama), Osamu Tomonaga (Diabetes And Lifestyle Center, Tomonaga Clinic, Tokyo), Tetsuyuki Yasuda (Department of Diabetes and Endocrinology, Osaka Police Hospital, Osaka), Yutaka Umayahara (Department of Diabetes and Metabolism, Osaka General Medical Center, Osaka), Hideki Taki and Ken Kato (Department of Diabetes, National Hospital Organization Osaka National Hospital), Mitsuyoshi Takahara (Department of Metabolic Medicine, Osaka University Hospital, Osaka), Toshihiko Shiraiwa (Shiraiwa Medical Clinic, Osaka), Tsunehiko Yamamoto (Department of Diabetes and Endocrinology, Kansai Rosai Hospital, Hyogo), Masahiro Iwamoto (Iwamoto Medical Clinic, Kagawa), Hideo Ayame (Ayame Medical Clinic, Yamaguchi), and Katsushige Abe (Abe Diabetic Clinic, Oita).

Funding

The current study was supported by the grant of the Japan Diabetes Society.

Author information

Authors and Affiliations

  1. Department of Diabetes Care Medicine, Osaka University Graduate School of Medicine, 2-2 Yamada-oka, Suita, Osaka, 565-0871, Japan

    Mitsuyoshi Takahara

  2. Department of Metabolism and Atherosclerosis, Osaka University Graduate School of Medicine, Osaka, Japan

    Naoto Katakami

  3. Shiraiwa Medical Clinic, Osaka, Japan

    Toshihiko Shiraiwa

  4. Abe Diabetic Clinic, Oita, Japan

    Katsushige Abe

  5. Ayame Medical Clinic, Yamaguchi, Japan

    Hideo Ayame

  6. Dr. Yasuyo Ishimaru Memorial Kumagaya Diabetes Clinic, Saitama, Japan

    Yasuaki Ishimaru

  7. Iwamoto Medical Clinic, Kagawa, Japan

    Masahiro Iwamoto

  8. Shimizu Medical Clinic, Gunma, Japan

    Mitsuo Shimizu

  9. Diabetes and Lifestyle Center, Tomonaga Clinic, Tokyo, Japan

    Osamu Tomonaga

  10. Internal Medicine, Jiyugaoka Medical Clinic, Hokkaido, Japan

    Hiroki Yokoyama

  11. Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan

    Taka-aki Matsuoka & Iichiro Shimomura

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  1. Mitsuyoshi Takahara
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Corresponding author

Correspondence to Mitsuyoshi Takahara.

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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 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

According to the Ethical Guidelines for Medical and Health Research Involving Human Subjects in Japan, written informed consent from the participants was substituted for by their oral consent after notification of relevant information on the study and ensured opportunities for refusal, on the ground of the study’s intervention- and invasiveness-free nature.

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Takahara, M., Katakami, N., Shiraiwa, T. et al. Evaluation of health utility values for diabetic complications, treatment regimens, glycemic control and other subjective symptoms in diabetic patients using the EQ-5D-5L. Acta Diabetol 56, 309–319 (2019). https://doi.org/10.1007/s00592-018-1244-6

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  • DOI: https://doi.org/10.1007/s00592-018-1244-6

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