Objective: To measure subjective health-related quality of life (HRQoL) of patients with type 1 diabetes and describe the influence of symptoms of diabetes-related long-term complications on HRQoL. Methods: The 15-D health-related quality of life measure (15D) was used to measure HRQoL of a representative sample of Finnish insulin-treated patients expected to have type 1 diabetes. Background data were gathered with a separate questionnaire. A tobit (censored regression) model was constructed to estimate the effects of symptoms of complications on HRQoL and to separate these effects from those of other health problems and aging. Results: The 15D scores declined markedly with increasing age, and the prevalence of symptoms of long-term complications increased. The tobit regression model showed that these symptoms have a significant negative influence on HRQoL. The model explained over 50% of the variation in the 15D scores. Conclusions: High prevalence of symptoms of long-term complications combined with their significant negative influence on HRQoL causes substantial losses in terms of quality of life and utility from both individual and societal perspectives. Thus, the importance of secondary prevention, i.e., prevention of complications by better metabolic control, and also the so-far theoretic possibility to prevent type 1 diabetes itself is emphasized.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
Brazier J, Deverill M, Green C, et al. A review of the use of health status measures in economic evaluation. Health Technol Assess 1999; 3.
Karvonen M, Pitkäniemi J, Tuomilehto J, and The Finnish Childhood Diabetes Registry Group. The onset age oftype 1 diabetes in Finnish children has become younger. Diabet Care 1999; 22: 1066-1070.
Onkamo P, Väänänen S, Karvonen M, Tuomilehto J. Worldwide increase in incidence ofType I diabetes-the analysis of the data on published incidence trends. Diabetologia 1999; 42: 1395-1403.
Simell TT, Sintonen H, Hahl J, Simell OG. Costs ofinsulindependent diabetes mellitus. Pharmaco Economics 1996; 9: 24-38.
Lounamaa R. Mortality in Finnish Patients with Insulin-Dependent Diabetes Mellitus: A Follow-up Study of Patients Diagnosed when under Twenty Years of Age. ML: 126.Helsinki: Social Insurance Institution, Finland, 1993.
Borch-Johnsen K, Kreiner S, Deckert T. Mortality oftype 1 (insulin-dependent) diabetes mellitus in Denmark: A study ofrelative mortality in 2930 Danish type 1 diabetic patients diagnosed from 1933 to 1972. Diabetologia 1986; 29: 767-772.
Dorman JS, LaPorte RE, Kuller LH, et al. The Pittsburgh insulin-dependent diabetes mellitus (IDDM) morbidity and mortality study. Diabetes 1984; 33: 271-276.
Green A, Borch-Johnsen K, Andersen KP, Hougaard P, Keiding N, Deckert T. Relative mortality oftype 1 (insulindependent) diabetes in Denmark: 1933-1981. Diabetologia 1985; 28: 339-342.
Fryback DG, Lawrence WF, Martin PA, Klein R, Klein BE. Predicting Quality ofWell-being scores from the SF-36: Results from the Beaver Dam Health Outcomes Study. Med Decis Making 1997; 17: 1-9.
Hermann BP, Vickrey B, Hays J, et al. A comparison of health-related quality of life in patients with epilepsy, diabetes and multiple sclerosis. Epilepsy Res 1996; 25: 113-118.
Keinänen-Kiukaanniemi S, Ohinmaa A, Pajunpää P, Koivukangas P. Health related quality of life in diabetic patients measured by the Nottingham Health Profile. Diabet Med 1995; 13: 382-388.
Klein BEK, Klein R, Moss SE. Self-rated health and diabetes oflong duration. Diabet Care 1998; 21: 236-240.
The Diabetes Control and Complications Trial Research Group. Influence ofintensive diabetes treatment on qualityof-life outcomes in the diabetes control and complications trial. Diabet Care 1996; 19: 195-203.
Vickrey BG, Hays RD, Rausch R, et al. Quality of life of epilepsy patients as compared with outpatients with hy-pertension, diabetes, heart disease, and/or depressive symptoms. Epilepsia 1994; 35: 597-607.
Wändell PE, Brorsson B, Åberg H. Quality of life in diabetic patients registered with primary health care services in Sweden. Scand J Prim Health Care 1997; 15: 97-102.
Wikblad K, Leksell J, Wibell L. Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus. Qual Life Res 1996; 5: 123-130.
Wu S-Y, Sainfort F, Tomar RH et al. Development and application ofa model to estimate the impact oftype 1 diabetes on health-related quality of life. Diabet Care 1998; 21: 725-731.
Aalto A-M, Uutela A, Aro AR. Health related quality of life among insulin-dependent diabetics: disease-related and psychosocial correlates. Patient Educ Couns 1997; 30: 215-225.
Backonja M, Beydoun A, Edwards KR, et al. Gababentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998; 280: 1831-1836.
Gross CR, Zehrer CL. Health-related quality of life outcomes ofpancrea s transplant recipients. Clin Trasplant 1992; 6: 165-171.
Jacobson AM, de Groot M, Samson JA. The effects of psychiatric disorders and symptoms on quality of life in patients with type I and type II diabetes mellitus. Qual Life Res 1997; 6: 11-20.
Kiebert GM, van Oosterhout EC, van Bronswijk H, Lemkes HH, Gooszen HG. Quality of life after combined kidneypancreas or kidney transplantation in diabetic patients with end-stage renal disease. Clin Trasplant 1994; 8: 239-245.
Kohen D, Burgess AP, Catalan J, Lant A. The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus. Qual Life Res 1998; 7: 197-204.
Lloyd CE, Orchard TJ. Physical and psychosocial wellbeing in adults with Type 1 diabetes. Diabetes Res Clin Pract 1999; 44: 9-19.
Piehlmeier W, Bullinger M, Nusser J, et al. Quality of life in Type 1 (insulin-dependent) diabetic patients prior to and after pancreas and kidney transplantation in relation to organ function. Diabetologia 1991; 34: S150-S157.
Piehlmeier W, Bullinger M, Kirchberger I, Land W, Landgraf R. Evaluation of the quality of life of patients with insulin-dependent diabetes mellitus before and after organ transplantation with the SF 36 health survey. Eur J Surg 1996; 162: 933-940.
Bott U, Mühlhauser I, Overmann H, Berger M. Validation of a diabetes-specific quality-of-life scale for patients with type 1 diabetes. Diabet Care 1998; 21: 757-769.
Boyer JG, Earp JA. The development ofan instrument for assessing the quality of life ofpeople with diabetes. Med Care 1997; 35: 440-453.
Bradley C, Todd C, Gorton T, et al. The development ofan individualized questionnaire measure ofperceived inpact of diabetes on quality of life: the ADDQoL. Qual Life Res 1999; 8: 79-91.
Hammond GS, Aoki TT. Measurement of health status in diabetic patients. Diabetes impact measurement scales. Diabet Care 1992; 15: 469-477.
Jacobson AM, de Groot M, Samson JA. The evaluation of two measures of quality of life in patients with Type I and Type II diabetes. Diabet Care 1994; 17: 267-274.
Kotsanos JG, Vignati L, Huster W et al. Health-related quality-of-life results from multinational clinical trials of insulin lispro. Assessing benefits ofa new diabetes therapy. Diabet Care 1997; 20: 948-958.
Meadows K, Steen N, McColl E, et al. The Diabetes Health Profile (DHP): A new instrument for assessing the psychosocial profile ofinsulin requiring patients-development and psychometric evaluation. Qual Life Res 1996; 5: 242-254.
Arinen S, Häkkinen U, Klaukka T, Klavus J, Lehtonen R, Aro S. Health and the use of health Services in Finland. Official Statistics ofFinland. Health Care 1998: 5 Jyväskylä: Statistics Finland, 1998.
Sintonen H. The 15D instrument of health-relate d quality of life: properties and applications. Ann Med 2001; 33: 328-336. <http://www.annmed.org/annmed/articles/2001_33_5_328-36._pdf>.
Sintonen H. The 15-D measure of health-relate d quality of life: Reliability, validity and sensitivity of its health state descriptive system. Working Paper 41. Melbourne: National Centre for Health Program Evaluation, 1994. <http://chpe.buseco.monash.edu.au/pubs/wp41._pdf>.
Sintonen H. The 15-D measure of health-relate d quality of life: Feasibility, reliability and validity of its valuation system. Working Paper 42. Melbourne: National Centre for Health Program Evaluation, 1994. <http://chpe.buseco.-monash.edu.au/pubs/wp42._pdf>.
Nord E. Health status index models for use in resource allocation decisions: A critical review in the light ofobserved preferences for social choice. Int J Technol Assess Health Care 1996; 12: 31-44.
Stavem K. Reliability, validity and responsiveness oftwo multiattribute utility measures in patients with chronic obstructive pulmonary disease. Qual Life Res 1999; 8: 45-54.
Kannisto M, Sintonen H. Later health-related quality of life in adults who have sustained spinal cord injury in childhood. Spinal Cord 1997; 35: 747-751.
Kannisto M, Merikanto J, Alaranta H, Hokkanen H, Sintonen H. Comparison of health-relate d quality of life in three subgroups ofspinal cord injury patients. Spinal Cord 1998; 36: 193-199.
Kauppinen R, Sintonen H, Tukiainen H. One-year economic evaluation ofintensive vs conventional patient education and supervision for self-management of new asthmatic patients. Respir Med 1998; 92: 300-307.
Lönnqvist J, Sintonen H, Syvälahti E, et al. Antidepressant efficacy and quality of life in depression: A double-blind study with moclobemide and fluoxetine. Acta Psychiatr Scand 1994; 89: 363-369.
Lönnqvist J, Sihvo S, Syvälahti E, et al. Moclobemide and fluoxetine in the prevention ofrelapses following acute treatment ofdepressio n. Acta Psychiatr Scand 1995; 91: 189-194.
Rissanen P, Aro S, Slätis P, Sintonen H, Paavolainen P. Health and quality of life before and after hip or knee arthroplasty. J Arthroplasty 1995; 10: 169-175.
Rissanen P, Aro S, Sintonen H, Slätis P, Paavolainen P. Quality of life and functional ability in hip and knee replacements: a prospective study. Qual Life Res 1996; 5: 56-64.
Rissanen P, Aro S, Sintonen H, et al. Costs and cost-effectiveness in hip and knee replacements. A prospective study. Int J Technol Assess Health Care 1997; 13: 575-588.
Boyle MH, Torrance GW. Developing multiattribute health indexes. Med Care 1984; 22: 1045-1057.
Torrance GW, Boyle MH, Horwood SP. Application of multi-attribute utility theory to measure social preferences for health states. Oper Res 1982; 30: 1043-1069.
SPSS Inc. SPSS Base 9._0 Users Guide. Chicago: SPSS Inc., 1999.
Greene WH. Econometric Analysis. Upper Saddle River: Prentice-Hall International, 1993.
Maddala GS. Limited-Dependent and Qualitative Variables in Econometrics. New York: Cambridge University Press, 1997.
Greene WH. LIMDEP version 7._0 User's Manual. Revised edition. Plainview: Econometric Software Inc., 1998.
Sintonen H. Outcome measurement in acid-related diseases. Pharmaco Economics 1994; 5(Suppl. 3): 17-26.
The Diabetes Control and Complications Trial Research Group. The effect ofintensive treatment ofdiabetes on the development and progression oflong-ter m complications in insulin-dependent diabetes mellitus. N Engl J Med 1993; 329: 977-986.
Hahl J, Simell T, Ilonen J, Knip M, Simell O. Costs of predicting IDDM. Diabetologia 1998; 41: 79-85.
Kupila A, Muona P, Simell T, et al. Feasibility ofgenetic and immunological prediction ofType I diabetes in a population-based birth cohort. Diabetologia 2001; 44: 290-297.
Reimers JI, Andersen HU, Pociot F. Nicotinamide and prevention ofinsulin-depende nt diabetes mellitus. Rationale, effects, toxicology and clinical experiences. ENDIT Group. Ugeskr Laeger 1994; 156: 461-465.
The DPT-1 Study Group. The diabetes prevention trial-type 1 diabetes (DPT-1): Progress report. Autoimmunity 1995; 21
About this article
Cite this article
Hahl, J., Hämäläinen, H., Sintonen, H. et al. Health-related quality of life in type 1 diabetes without or with symptoms of long-term complications. Qual Life Res 11, 427–436 (2002). https://doi.org/10.1023/A:1015684100227
- Health-Related Quality of Life
- Symptom impact
- Type 1 diabetes