Health-related quality of life is an independent marker of mortality in diabetes patients

Poor health-related quality of life was associated with higher overall mortality in patients with type 2 diabetes after six years of follow-up, according to findings from a study published recently in Diabetes Care.

Researchers from the University of Pennsylvania School of Medicine and various sites in the Netherlands assessed 1,143 primary care type 2 diabetes patients who participated in the Zwolle Outpatient Diabetes Project Integrating Available Care (ZODIAC) study in 1998.

Results of the study showed that patients with low health-related quality of life had a 2.1-fold increased mortality risk compared with patients with a higher health-related quality of life. The researchers also assessed health-related quality of life with the Physical Component Summary of the RAND-36, which revealed an inverse association with mortality (HR 0.979). Two of the nine RAND-36 health dimensions were especially related to mortality — physical functioning and general health perception. The physical functioning dimension was also linked with cardiovascular mortality.

These findings emphasize the importance of looking beyond clinical parameters in these patients, according to the researchers.

This article makes a point that I find completely obvious — impaired ability to carry out activities of daily life indicates that something is wrong. I am actually surprised that this had never been documented before. It is troubling, and in my opinion emblematic of the evidence-based medicine movement, that considerable resources are being expanded to replicate in patients with diabetes what has been shown to be true in patients without chronic diseases. On the positive side, it is reassuring that a methodologically rigorous investigation has confirmed common sense. I hope that this article will have its greatest impact on insurance companies and others in administrative roles, which practicing endocrinologists will find that the results simply confirm their experience. The administrators need to acknowledge that even without using a quality of life instrument, clinicians can distinguish degrees of illness.

– Robert D. Blank, MD, PhD

Endocrine Today Editorial Board member

For more information:

Diabetes Care. 2008;31:932-933.