Impact of diabetes on health-related quality of life in a population study in Japan

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Abstract

Diabetes may impact on health-related quality of life (HRQOL). The aim of this population-based study was to confirm this influence. We examined 2135 residents aged ≥30 years in an entire community, who had no history of cancer or cardiovascular disease and did not require care for daily activity. The response rate was 87.8%. The status of diabetes, other chronic diseases and life practices were assessed by self-reported questionnaires, in which HRQOL was evaluated by the Japanese version SF-36, based on five sub-scales of the domain. Diabetes had been diagnosed in 165 (7.7%) of the study population. Comparison of data, adjusted for sex, age, living alone and employment status between non-diabetics and subjects with diabetes treated by pharmacological therapy had odds ratios (ORs) between the lowest quartiles of sub-scale scores of 1.90 for physical role, 2.51 for general health, and 1.79 for emotional role. The OR for lower general health was also increased in people using only lifestyle modification for treatment of diabetes. Although the OR for mental health was worse in the lifestyle modification group it was not increased in people with diabetes on pharmacological therapy. These associations remained almost unchanged after adjustment for the covariates. The sub-scales of physical and emotional roles and general health were decreased significantly in diabetics with duration of disease between 10 and 19 years or ≥20 years. Our study showed treatment of diabetes clearly influenced HRQOL, with this influence being dependent on the duration of diabetes and primarily affecting physical rather than mental health.

Introduction

A government report in Japan stressed that there are 16.2 million people with either diabetes or suspected diabetes in the country and that the number has increased by 3 million in the last 5 years [1]. It is well established that this rapid increase in the number of people with diabetes will increase the risk of cardiovascular disease in this population [2], [3], [4].

Numerous studies have also suggested diabetes is associated with depressive conditions [5], [6], [7]. The impact of diabetes on general health was demonstrated in a collaborative study in eight countries that found a clear relationship between chronic disease conditions including diabetes and health-related quality of life (HRQOL) [8]. Furthermore, the Atherosclerosis Risk in Communities (ARIC) Study reported that a depressive mode predicted incident diabetes [6], a relationship, explained in part, by the knowledge that people with depression are more likely to have risk factors for diabetes.

It is therefore evident that outpatients or hospitalized patients with diabetes have worse mental conditions. However, reports on the effect of diabetes on HRQOL in a population are few, and are particularly scarce in Asian populations. As diabetes management varies between patients it is important to evaluate HRQOL conditions in cases of diagnosed diabetes, controlled for both health practices and other chronic diseases.

In the present study, we examined the association between diabetes conditions and HRQOL in a rural community in Japan. The study investigated the effect of diabetes on HRQOL in this entire population and focused on diabetes status including social factors, management and duration of diabetes.

Section snippets

Study population

In 2002, we surveyed all residents (n = 2870) aged ≥30 years in Matama town, Japan using self-reported questionnaires on health practices, history of chronic diseases and HRQOL. Of them, 238 people who were in hospitals or nursing homes, or who were unable to fill out the questionnaire due to disabilities were excluded from the study. Matama is located in a rural area in Oita prefecture on the Kyushu Island of Japan and in 2000 had a total population of 3940. The 2000 census reported that the

Results

Of the 2135 residents investigated, 165 (7.7%) reported they had been diagnosed with diabetes by doctors. Of this group, 47 (2.2%) had no diabetes care, 49 (2.3%) had undergone lifestyle modification only, and 69 (3.2%) were receiving pharmacological therapy. Five of the patients on pharmacological therapy were taking insulin.

Table 1 shows population characteristics including social factors and health practices grouped according to diabetes status. As the proportion of males and mean age were

Discussion

Although previous studies have demonstrated a strong association between diabetes and HRQOL levels [7], [14], [15], [16], there is only a small amount of population-based data in Japan despite the prevalence of diabetes increasing throughout this country [1]. Considering this increase in the prevalence of diabetes, considerable concern has arisen as to the effect of this unfavorable trend on HRQOL in the Japanese population.

In this study, we found that people taking diabetes medications had

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