Patient perceptions of quality of life with diabetes-related complications and treatments

OBJECTIVE - Understanding how individuals weigh the quality of life associated With complications and treatments is important in assessing the economic value of diabetes care and may provide insight into treatment adherence. We quantify patients' utilities (a measure of preference) for the full array of diabetes-related complications and treatments. RESEARCH DESIGN AND METHODS - We conducted interviews with a multiethnic sample of 701 adult patients living with diabetes who were attending Chicago area clinics. We elicited utilities (ratings on a 0-1 scale, where 0 represents death and I represents perfect health) for hypothetical health states by using time-tradeoff questions. We evaluated 9 complication states (e.g., diabetic retinopathy and blindness) and 10 treatment states (e.g., intensive glucose control vs. conventional glucose control and comprehensive diabetes care [i.e., intensive control of multiple risk factors]). RESULTS - End-stage complications had lower mean utilities than intermediate complications (e.g., blindness 0.38 [SD 0.35] vs. retinopathy 0.53 [0.36], P < 0.01), and end-stage complications had the lowest ratings among all health states. Intensive treatments had lower mean utilities than conventional treatments (e.g., intensive glucose control 0.67 [0.34] vs. conventional glucose control 0.76 [0.311, P < 0.0]), and the lowest rated treatment state was comprehensive diabetes care (0.64 [0.34]). Patients rated comprehensive treatment states similarly to intermediate complication states. CONCLUSIONS - End-stage complications have the greatest perceived burden on quality of life; however, comprehensive diabetes treatments also have significant negative quality-of-life effects. Acknowledging these effects of diabetes care will be important for future economic evaluations of novel drug combination therapies and innovations in drug delivery.