A Longitudinal Study on the Association Between Diabetic Foot Disease and Health-Related Quality of Life in Adults With Type 2 Diabetes

  • Haoyu Zhao
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada

    School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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  • Nathan S. McClure
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada

    School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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  • Jeffrey A. Johnson
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada

    School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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  • Allison Soprovich
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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  • Fatima Al Sayah
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
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  • Dean T. Eurich
    Correspondence
    Address for correspondence: Dean T. Eurich PhD, Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, School of Public Health, University of Alberta, Edmonton, Alberta T6G 2E1, Canada..
    Affiliations
    Alliance for Canadian Health Outcome Research in Diabetes, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada

    School of Public Health, 2-040 Li Ka Shing Centre for Health Research Innovation, University of Alberta, Edmonton, Alberta, Canada
    Search for articles by this author
Published:August 25, 2019DOI:https://doi.org/10.1016/j.jcjd.2019.08.008

      Abstract

      Objectives

      The aim of this study was to assess the association between diabetic foot disease and health-related quality of life (HRQOL) during a 2-year follow up among people with type 2 diabetes in Alberta.

      Methods

      A type 2 diabetes cohort was established (2011‒2013); those with self-reported diabetic foot disease were identified. HRQOL was assessed at baseline and 1 and 2 years. Scores from the 12-item Short Form Physical Component Summary (PCS) and Mental Component Summary (MCS) and the EuroQol 5-Dimension 5-Level (EQ-5D-5L) instrument were collected. The association between diabetic foot disease and changes in HRQOL was assessed using the general linear mixed model after adjustment for sociodemographics, previous health-care use, Elixhauser comorbidities index, baseline health status and diabetes-specific behaviours.

      Results

      Among the cohort (n=969), average age was 64.3 (standard deviation, 10.0) years and 55% were male. Overall, 265 (27.4%) participants reported having diabetic foot disease. Those with diabetic foot disease reported lower HRQOL in comparison to those without diabetic foot disease at baseline: PCS, 8.44 (95% confidence interval [CI], 7.06 to 9.82); MCS, 4.33 (95% CI, 2.99 to 5.67) and EQ-5D-5L index score, 0.12 (95% CI, 0.09 to 0.14). After adjustment, no differences were observed in the score changes at year 2 (PCS, 0.16 [95% CI, -0.88 to 1.21]; MCS, 0.36 [95% CI, -0.77 to 1.50]; EQ-5D-5L index score, 0.004 [95% CI, -0.01 to 0.02]).

      Conclusions

      Although participants with diabetic foot disease reported lower HRQOL at baseline, they had similar changes compared to those without diabetic foot disease during the 2-year follow up. Efforts to maintain general health and early intervention to prevent diabetic foot disease may help to avoid initial deterioration of physical health and HRQOL.

      RÉSUMÉ

      Objectifs

      Le but de cette étude était d'évaluer l'association entre une condition de pied diabétique et la qualité de vie liée à la santé (QVLS) au cours d'un suivi de deux ans chez les personnes atteintes de diabète de type 2 en Alberta.
      Méthodes: Une cohorte de diabétiques de type 2 a été établie (2011-2013); ceux qui avaient déclaré eux-mêmes un pied diabétique ont été identifiés. La QVLS a été évaluée au départ et après une période de 1 et 2 ans. Les notes obtenues aux 12 points du questionnaire abrégé du Bilan de Santé Physique (BSP) et du Bilan de Santé Mentale (BSM) en 12 points, ainsi que celles de l'instrument descriptif à 5 dimensions de 5 niveaux EuroQol (EQ-5D-5L). L'association entre une condition de pied diabétique et les changements de la QVLS a été évaluée à l'aide du modèle linéaire mixte généralisé après ajustement pour les facteurs sociodémographiques, de l'utilisation antérieure de soins de santé, de l'indice de comorbidités Elixhauser, de l'état de santé initial et des comportements propres au diabète.
      Résultats: Dans la cohorte (n=969), l'âge moyen était de 64.3 ans (écart-type, 10.0) et 55% étaient des hommes. Dans l'ensemble, 265 participants (27.4%) ont déclaré souffrir d'un pied diabétique. Les personnes atteintes d'un pied diabétique ont déclaré une QVLS inférieure à celle des personnes sans pied diabétique au début de l'étude: BSP, 8.44 (intervalle de confiance à 95%[IC], 7.06 à 9.82); BSM, 4.33 (IC à 95%, 2.99 à 5.67); et indice EQ-5D-5L, 0,12 (IC à 95%, 0.09 à 0.14). Après ajustement, aucune différence n'a été observée dans les changements de score après 2 ans (BSP, 016[IC à 95%, -0.88 à 1.21]; BSM, 0.36 [IC à 95%, -0.77 à 1.50]; indice EQ-5D-5L, 0.004[IC à 95%, -0.01 à 0.02]).

      Conclusions

      Bien que les participants atteints d'un pied diabétique aient déclaré initialement une QVLS inférieure, ils ont connu des changements semblables à ceux des participants sans pied diabétique au cours du suivi de deux ans. Les efforts visant à maintenir l'état de santé général et une intervention précoce pour prévenir le pied diabétique peuvent aider à éviter la détérioration initiale de la santé physique et de la QVLS.

      Keywords

      Mots clés

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      References

        • Emerging Risk Factors Collaboration
        • Sarwar N.
        • Gao P.
        • Seshasai S.R.
        • et al.
        Diabetes mellitus, fasting blood glucose concentration, and risk of vascular disease: A collaborative meta-analysis of 102 prospective studies.
        Lancet. 2010; 375: 2215-2222
        • International Diabetes Federation
        Diabetes: Facts and figures 2015.
        2015 (https://www.idf.org/aboutdiabetes/what-is-diabetes. Accessed September 23, 2019)
        • International Diabetes Federation
        IDF diabetes atlas.
        2017 (8th edition) (Accessed September 23, 2019)
        • O'Brien J.A.
        • Patrick A.R.
        • Caro J.J.
        Cost of managing complications resulting from type 2 diabetes mellitus in Canada.
        BMC Health Serv Res. 2003; 3: 7
        • Adler A.I.
        • Boyko E.J.
        • Ahroni J.H.
        • Smith D.G.
        Lower-extremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers.
        Diabetes Care. 1999; 22: 1029-1035
        • Shang P.
        • Lu J.
        • Jing Y.
        • Tang S.
        • Zhu D.
        • Bi Y.
        Global epidemiology of diabetic foot ulceration: A systematic review and meta-analysis.
        Ann Med. 2017; 49: 106-116
        • US Centers for Disease Control and Prevention
        National diabetes statistics report.
        CDC, Atlanta, GA2017
        • Sanjari M.
        • Safari S.
        • Shokoohi M.
        • et al.
        A cross-sectional study in Kerman, Iran, on the effect of diabetic foot ulcer on health-related quality of life.
        Int J Low Extrem Wounds. 2011; 10: 200-206
        • Chapman Z.
        • Shuttleworth C.M.
        • Huber J.W.
        High levels of anxiety and depression in diabetic patients with Charcot foot.
        J Foot Ankle Res. 2014; 7: 22
        • Jaksa P.J.
        • Mahoney J.L.
        Quality of life in patients with diabetic foot ulcers: Validation of the Cardiff Wound Impact Schedule in a Canadian population.
        Int Wound J. 2010; 7: 502-507
        • Siersma V.
        • Thorsen H.
        • Holstein E.P.
        • et al.
        Health-related quality of life predicts major amputation and death, but not healing, in people with diabetes presenting with foot ulcers: The Eurodiale Study.
        Diabetes Care. 2014; 37: 694‒700
        • Moulik P.K.
        • Mtonga R.
        • Gill G.V.
        Amputation and mortality in new-onset diabetic foot ulcers stratified by etiology.
        Diabetes Care. 2003; 26: 491-494
      1. Patrick DL, Erickson P. Assessing health-related quality of life for clinical decision-making. In: Quality of life assessment: Key issues in the 1990s. Dordrecht: Springer, 1993, pg. 11–63.

        • Kaplan R.M.
        • Ries A.L.
        Quality of life: Concept and definition.
        COPD. 2007; 4: 263-271
        • Huang I.C.
        • Hwang C.C.
        • Wu M.Y.
        • Lin W.
        • Leite W.
        • Wu A.W.
        Diabetes-specific or generic measures for health-related quality of life? Evidence from psychometric validation of the D-39 and SF-36.
        Value Health. 2008; 11: 450-461
        • Neto P.
        • Lima P.
        • Santos F.
        • Jesus L.
        • Lima R.
        • Santos L.
        Quality of life of people with diabetic foot.
        Revista Da Rede De Enfermagem Do Nordeste. 2016; 17: 191-197
        • Ribu L.
        • Hanestad R.B.
        • Moum K.
        • Birkeland K.
        • Rustoen T.
        A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population.
        Qual Life Res. 2007; 16: 179-189
        • Tennvall G.R.
        • Apelqvist J.
        • Eneroth M.
        Costs of deep foot infections in patients with diabetes mellitus.
        Pharmacoeconomics. 2000; 18: 225-238
        • Goodridge D.
        • Trepman E.
        • Embil J.M.
        Health-related quality of life in diabetic patients with foot ulcers: Literature review.
        J Wound Ostomy Continence Nurs. 2005; 32: 368-377
        • Sayah A.F.
        • Majumdar R.S.
        • Soprovich A.
        • et al.
        The Alberta's Caring for Diabetes (ABCD) Study: Rationale, design and baseline characteristics of a prospective cohort of adults with type 2 diabetes.
        Can J Diabetes. 2015; 39: S113-S119
        • Toobert D.J.
        • Hampson S.E.
        • Glasgow R.E.
        The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale.
        Diabetes Care. 2000; 23: 943-950
        • Godin G.
        • Shephard R.J.
        A simple method to assess exercise behavior in the community.
        Can J Appl Sport Sci. 1985; 10: 141-146
        • Ware J.
        • Kosinski M.
        • Keller S.D.
        A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity.
        Med Care. 1996; 34: 220-233
        • Herdman M.
        • Gudex C.
        • Lloyd A.
        • et al.
        Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L).
        Qual Life Res. 2011; 20: 1727-1736
        • Xie F.
        • Pullenayegum E.
        • Gaebel K.
        • et al.
        A time trade-off-derived value set of the EQ-5D-5L for Canada.
        Med Care. 2016; 54: 98-105
        • Stewart L.A.
        • Greenfield S.
        • Hays D.R.
        • et al.
        Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study.
        JAMA. 1989; : 262907-262913
        • Kathe N.
        • Hayes J.C.
        • Bhandari R.N.
        • Payakachat N.
        Assessment of reliability and validity of SF-12v2 among a diabetic population.
        Value Health. 2018; 21: 432-440
        • Mulhern B.
        • Meadows K.
        The construct validity and responsiveness of the EQ-5D, SF-6D and Diabetes Health Profile-18 in type 2 diabetes.
        Health Qual Life Outcomes. 2014; 12: 42
        • Diggle P.
        Analysis of longitudinal data.
        in: 2nd ed. Oxford statistical science series. Oxford University Press, Oxford2002 (, pg. 379)
        • Vickers A.J.
        • Altman D.G.
        Statistics notes: Analysing controlled trials with baseline and follow up measurements.
        BMJ. 2001; 323: 1123-1124
        • Elixhauser A.
        • Steiner C.
        • Harris R.
        • Coffey M.R.
        Comorbidity measures for use with administrative data.
        Med Care. 1998; 36: 8-27
      2. SAS version 9.4 for Windows. SAS Institute, Cary2013
        • Little R.J.A.
        • Rubin D.B.
        Statistical analysis with missing data.
        in: 2nd ed. Wiley series in probability and statistics. 2nd ed. Wiley, Hoboken, NJ2002 (pg. xv)
        • Burdine N.J.
        • Felix R.J.M.
        • Abel L.A.
        • Wiltraut J.C.
        • Musselman J.Y.
        The SF-12 as a population health measure: An exploratory examination of potential for application.
        Health Serv Res. 2000; 35: 885-904
      3. Szende A, Janssen B, Cabases J (Eds). Self-reported population health: an international perspective based on EQ-5D. Dordrecht: Springer, 2014, pg. 19–30.

        • Altenburg N.
        • Joraschky P.
        • Barthel A.
        • et al.
        Alcohol consumption and other psycho-social conditions as important factors in the development of diabetic foot ulcers.
        Diabet Med. 2011; 28: 168-174
        • Samsa G.
        • Edelman D.
        • Rothman L.M.
        • Williams R.G.
        • Lipscomb J.
        • Matchar D.
        Determining clinically important differences in health status measures: a general approach with illustration to the Health Utilities Index Mark II.
        Pharmacoeconomics. 1999; 15: 141-155
        • Sayah A.F.
        • Soprovich A.
        • Qiu W.
        • Edwards L.A.
        • Johnson A.J.
        Diabetic foot disease, self-care and clinical monitoring in adults with type 2 diabetes: The Alberta's Caring for Diabetes (ABCD) Cohort Study.
        Can J Diabetes. 2015; 39: S120-S126
        • Hogg F.
        • Peach G.
        • Price P.
        • Thompson M.
        • Hinchliffe J.R.
        Measures of health-related quality of life in diabetes-related foot disease: A systematic review.
        Diabetologia. 2012; 55: 552-565
        • Frykberg G.R.
        • Zgonis T.
        • Armstrong G.D.
        • et al.
        Diabetic foot disorders. A clinical practice guideline (2006 revision).
        J Foot Ankle Surg. 2006; 45: S1-S66
        • Singh N.
        • Armstrong D.G.
        • Lipsky B.A.
        Preventing foot ulcers in patients with diabetes.
        JAMA. 2005; 293: 217-228
        • Ribu L.
        • Birkeland K.
        • Hanestadc R.B.
        • Moum T.
        • Rustoen T.
        A longitudinal study of patients with diabetes and foot ulcers and their health-related quality of life: Wound healing and quality-of-life changes.
        J Diabetes Complications. 2008; 22: 400-407
        • Nabuurs-Franssen H.M.
        • Huijberts S.P.M.
        • Kruseman C.N.A.
        • Willems J.
        • Schaper C.N.
        Health-related quality of life of diabetic foot ulcer patients and their caregivers.
        Diabetologia. 2005; 48: 1906-1910
        • Kang H.
        The prevention and handling of the missing data.
        Korean J Anesthesiol. 2013; 64: 402-406