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Does ancestry influence health-related quality of life in type 1 diabetes patients? A nationwide study in Brazil

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Abstract

Aims

The aim of the present study was to evaluate the relationship between self-reported color/race and genomic ancestry with HRQoL of patients with type 1 diabetes in a highly admixed population.

Methods

This was a nationwide, cross-sectional study conducted with 1760 patients with type 1 diabetes from 2011 to 2014 at public clinics in all five Brazilian geographical regions. Information on HRQoL was obtained from two self-completed questionnaires: Short Form-6 Dimensions (SF-6D) and EuroQol-5 Dimensions (EQ-5D) with a visual analogue scale (EQ-VAS). Genomic ancestry was assessed using a Multiplex PCR methodology. Utility scores generated from the questionnaires were analyzed with multivariate logistic regression models.

Results

We included 1698 patients. Those patients who self-reported as black had lower EQ-VAS scores compared to the patients who self-reported as white (67.46 ± 18.45; 72.37 ± 16.44, respectively, p = 0.02). In a linear regression model, each 1% increase in African ancestry resulted in a 9.5 point decrease in EQ-VAS score (p < 0.001). In a multivariate logistic regression, after adjusting for demographic, socioeconomic status and diabetes-related variables, African ancestry remained associated with lower EQ-VAS scores.

Conclusion

A higher level of African ancestry implicates on lower quality of life even after adjustments for sociodemographic and diabetes-related data. Gender, physical activity and diabetes-related microvascular complications were strongly associated with low HRQoL in all three questionnaires used. This fact highlights the importance of social aspects when assessing quality of life, as well as the need for regular practice of physical activity and prevention of chronic complications to improve patients’ quality of life.

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Acknowledegments

This work was funded by Fundação de Amparo a Pesquisa do Estado do Rio de Janeiro (FAPERJ) and Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). BrazDiab1SG study group. Executive steering committee: Marilia Brito Gomes (chair), Carlos Antonio Negrato. Principal investigators are indicated by an asterisk. Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Brazil: Marilia Brito Gomes* (mariliabgomes@gmail.com); Roberta Cobas (robertacobas@gmail.com); Lucianne Righeti Monteiro Tannus (luciannetannus@ig.com.br) Federal University Hospital of Rio de Janeiro: Melanie Rodacki* (mrodacki2001@yahoo.com.br); Lenita Zajdenverg (lenitazaj@gmail.com) Joana Rodrigues Dantas (joanardantasp@ig.com.br). Diabetes Unit, University Hospital of São Paulo, São Paulo: Maria Lúcia Cardillo Corrêa-Giannella* (malugia@lim25fm.usp.br); Sharon Nina Admoni (sharonadmoni@ gmail.com); Daniele Pereira dos Santos (dps.daniele@hotmail.com) Bauru’s Diabetics Association, Bauru, São Paulo: Carlos Antonio Negrato* (carlosnegrato@uol.com.br); Maria de Fatima Guedes (tatiguedeses@hotmail.com) Diabetes Unit, Federal University of São Paulo State, São Paulo: Sergio Atala Dib* (sergio.dib@unifesp.br); Celso Ferreira de Camargo Sallum Filho (celsosallum@superig.com.br). Diabetes Unit, University of Campinas, São Paulo: Elisabeth João Pavin* (ejpavin@fcm.unicamp.br); Caroline Takano (caroline.takano@gmail.com) Clinical Hospital of the Federal University of Paraná: Rosângela Roginski Rea* (rosangelarea@uol.com.br); Nicole Balster Romanzini (nikbr@hotmail.com) Clinical Hospital of Porto Alegre, Rio Grande do Sul: Mirela Azevedo* (mirelajobimazevedo@gmail.com); Luis Henrique Canani (luishenriquecanani@gmail.com)Regional Hospital of Taguatinga, Brasília: Hermelinda Cordeiro Pedrosa* (pedrosa.hc@globo.com); Monica Tolentino (monicatolentino@uol.com.br); Cejana Hamu Aguiar. Diabetes and Endocrinology Center of Bahia: Reine Marie Chaves Fonseca* (reinemar@terra.com.br); Ludmila Chaves Fonseca; Raffaele Kasprowicz (raffaellebarros@hotmail.com). Diabetes and Hypertension Center of Ceará: Adriana Costa e Forti* (adrianaforti@uol.com.br); Angela Delmira Nunes Mendes (angeladelmira@terra.com.br). Federal University of Ceará: Renan Montenegro Junior* (renanjr@ufc.br); Virgínia Oliveira Fernandes (virginiafernande@hotmail.com) Federal University Hospital of Pará: João Soares Felício* (felicio.bel@terra.com.br); Flavia Marques Santos (drafms@bol.com.br).

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Authors and Affiliations

  1. Diabetes Unit, Department of Internal Medicine, State University of Rio de Janeiro (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, RJ, CEP 20551-030, Brazil

    Deborah Conte Santos, Marcela Haas Pizarro, Bianca S. V. Barros & Marilia Brito Gomes

  2. Department of Ophthalmology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil

    Laura G. Nunes de Melo

  3. Histocompatibility and Cryopreservation Laboratory (HLA), State University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Luis Cristovão Porto

  4. DNA Diagnostic Laboratory (LDD), State University of Rio Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil

    Dayse A. Silva

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  1. Deborah Conte Santos
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  2. Marcela Haas Pizarro
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  3. Bianca S. V. Barros
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  4. Laura G. Nunes de Melo
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Correspondence to Deborah Conte Santos.

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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.

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

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Santos, D.C., Pizarro, M.H., Barros, B.S.V. et al. Does ancestry influence health-related quality of life in type 1 diabetes patients? A nationwide study in Brazil. Acta Diabetol 55, 377–385 (2018). https://doi.org/10.1007/s00592-017-1096-5

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