Date Published: January 26, 2017
Publisher: Public Library of Science
Author(s): Martina Kamradt, Johannes Krisam, Marion Kiel, Markus Qreini, Werner Besier, Joachim Szecsenyi, Dominik Ose, Iratxe Puebla.
Knowledge about predictors of health-related quality of life for multimorbid patients with type 2 diabetes mellitus in primary care could help to improve quality and patient-centeredness of care in this specific group of patients. Thus, the aim of this study was to investigate the impact of several patient characteristics on health-related quality of life of multimorbid patients with type 2 diabetes mellitus in a community setting.
A cross-sectional study with 32 primary care practice teams in Mannheim, Germany, and randomly selected multimorbid patients with type 2 diabetes mellitus (N = 495) was conducted. In order to analyze associations of various patient characteristics with health-related quality of life (EQ-5D index) a multilevel analysis was applied.
After excluding patients with missing data, the cohort consisted of 404 eligible patients. The final multilevel model highlighted six out of 14 explanatory patient variables which were significantly associated with health-related quality of life: female gender (r = -0.0494; p = .0261), school education of nine years or less (r = -0.0609; p = .0006), (physical) mobility restrictions (r = -0.1074; p = .0003), presence of chronic pain (r = -0.0916; p = .0004), diabetes-related distress (r = -0.0133; p < .0001), and BMI (r = -0.0047; p = .0045). The findings of this study suggest that increased diabetes-related distress, chronic pain, restrictions in (physical) mobility, female gender, as well as lower education and, increased BMI have a noteworthy impact on health-related quality of life in multimorbid patients with type 2 diabetes mellitus seen in primary care practices in a community setting. The highlighted aspects should gain much more attention when treating multimorbid patients with type 2 diabetes mellitus.
To date the presence of multimorbidity, defined as the co-occurrence of two or more chronic conditions , is very common especially among older patients aged 65 years and older . A recent systematic review of observational studies indicated that the prevalence of multimorbidity ranges between 15% to more than 95% in the general population . Especially in patients with diabetes mellitus the presence of additional chronic conditions is typical, so according to the Medical Expenditure Panel Survey of 2004, most adults with diabetes mellitus had at least one (nearly 90%) and about 15% had at least four co-occurring chronic conditions . Multimorbidity in general is known to negatively affect several health outcomes including mortality, hospitalization, and readmission  thus leads to greater use and costs of healthcare . Moreover, the presence of multiple co-occurring chronic conditions can complicate care by competing for time, attention, and other resources which might lower quality of healthcare .
This analysis is part of a larger trial (GEDIMAplus) and described in detail by Bozorgmehr and colleagues . This study was approved by the ethics committee of the Medical Faculty of the University of Heidelberg, Germany, (S-590/2013) as well as by the ethics committee of the Medical Association Baden-Württemberg, Germany, (B-F-2014-007). All participating patients gave written informed consent. Moreover, the trial is registered with the Current Controlled Trails (ISRCTN 83908315).
The aim of this study was to provide comprehensive data on the impact of various patient characteristics on HRQoL of multimorbid patients with type 2 diabetes mellitus in a community setting. Interesting findings that emerged from the data were the differences of general HRQoL in patients with and without the presence of particular additional chronic conditions next to type 2 diabetes in this specific group of patients. The comparison of patients with and without chronic heart failure (ICD 10: I50), depression (ICD 10: F32-F33), Parkinson’s disease (ICD 10: G20), and chronic pain (ICD 10: R52) as well as a combination of these conditions next to type 2 diabetes revealed significant differences in the EQ-5D indexes between both groups. The study also provides considerable insight to predictors of HRQoL in multimorbid patients. The conducted multilevel analysis highlighted six explanatory patient variables which were significantly associated with HRQoL measured by the EQ-5D index. The female gender, a school education of nine years or less, (physical) mobility restrictions, and the presence of chronic pain were significantly associated with a decrease in HRQoL in multimorbid patients with diabetes mellitus. An increase in diabetes-related distress and BMI was likewise associated with a cutback in HRQoL. However, it is interesting to note that age, the number of chronic conditions, physician-diagnosed depression, insulin treatment, and the HbA1c-value showed no significant association with HRQoL in this group of patients. Taken together, the final MLM was able to explain 25.6% of the variance in HRQoL.