Health-related quality of life associated with diabetic retinopathy in patients at a public primary care service in southern Brazil

Ben, Ângela Jornada; Souza, Camila Furtado de; Locatelli, Franciele; Rosses, Ana Paula Oliveira; Szortika, Adriana; Araujo, Aline Lutz de; Carvalho, Gabriela de; Lavinsky, Daniel; Neyeloff, Jeruza Lavanholi; Neumann, Cristina Rolim

doi:10.20945/2359-3997000000223

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Archives of Endocrinology and Metabolism

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original article • Arch. Endocrinol. Metab. 64 (5) • Sep-Oct 2020 • https://doi.org/10.20945/2359-3997000000223 copy

Health-related quality of life associated with diabetic retinopathy in patients at a public primary care service in southern Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective

This study aimed to establish the utility values of different health states associated with diabetic retinopathy in a Brazilian sample to provide input to model-based economic evaluations.

Subjects and methods

This cross-sectional study was performed in a sample of patients with type 2 diabetes mellitus (T2D) who underwent teleophthalmology screening at a primary care service from 2014 to 2016. Five diabetic retinopathy health states were defined: absent, non-sight-threatening, sight-threatening, and bilateral blindness. Utility values were estimated using the Brazilian EuroQol five dimensions (EQ-5D) tariffs. Descriptive statistics were calculated. Analysis of covariance was performed to adjust the utility values for potential confounders.

Results

The study included 206 patients. The mean (± standard deviation [SD]) utility value was 0.765 ± 0.19 (95% confidence interval [CI], 0.740–0.790). The adjusted mean utility value was 0.748 (95% CI, 0.698–0.798) in patients without diabetic retinopathy, 0.752 (95% CI, 0.679–0.825) in those with non-sight-threatening state, 0.628 (95% CI, 0.521–0.736) in those with sight-threatening state, and 0.355 (95% CI, 0.105–0.606) in those with bilateral blindness. A significant utility decrement was found between patients without diabetic retinopathy and those with a sight-threatening health state (0.748 vs. 0.628, respectively, p = 0.04).

Conclusions

The findings suggest that a later diabetic retinopathy health state is associated with a decrement in utility value compared with the absence of retinopathy in patients with T2D. The results may be useful as preliminary input to model-based economic evaluations. Further research is needed to investigate the impact of diabetic retinopathy on health-related quality of life in a sample more representative of the Brazilian population.

EQ-5D; health-related quality of life; utility values; diabetic retinopathy

Characteristics	NoDR	Non-STDR	STDR	BB
n (%)	157 (76.2)	32 (15.5)	15 (7.3)	2 (1.0)
Age, mean (SD)	63.9 (11.0)	60.0 (8.8)	66.5 (9.1)	63.3 (6.1)
Female, n (%)	104 (66.2)	12 (37.5)	7 (46.7)	2 (100)
White, n (%)	135 (86.0)	23 (71.9)	15 (100)	2 (100)
Education level, n (%)
No/primary education	44 (28.0)	6 (18.8)	1 (6.7)	1 (50)
Secondary education	76 (48.4)	17 (53.1)	10 (66.7)	1 (50)
Higher education	37 (23.6)	9 (28.1)	4 (26.7)	0
HbA1c, mean value in % (SD)	7.5 (1.9)	8.4 (2.1)	8.5 (1.5)	8.8 (3.1)
Controlled DM, n (%)	88 (56.1)	11 (34.4)	3 (20.0)	1 (50.0)
DM duration in years, median (IQR)	5 (2-10)	6 (3-13)	16 (5-25)	18 (10-26)
Insulin treatment, n (%)	28 (17.8)	15 (46.9)	12 (80.0)	2 (100)
Controlled hypertension, n (%)	89 (69.0)	15 (57.7)	9 (69.2)	1 (50.0)
Dyslipidemia, n (%)	112 (71.3)	23 (71.9)	11 (73.3)	2 (100)
Macrovascular complications, n (%)	36 (22.9)	11 (34.4)	5 (33.3)	0
Microvascular complications, n (%)	100 (63.7)	21 (65.6)	14 (93.3)	2 (100)
Ophthalmic diseases, n (%)	34 (21.7)	3 (9.4)	2 (13.3)	0
Other comorbidities, n (%)	38 (24.2)	3 (9.4)	6 (40.0)	1 (50.0)
EQ-5D utility, mean (SD)	0.773 (0.17)	0.801 (0.21)	0.658 (0.25)	0.356 (0.21)
EQVAS, median (IQR)	80 (60-90)	75 (70-80)	70 (50-80)	65 (50-80)

	Mean (95% CI)	p value	Adjusted mean* (95% CI)	F	p value
Sex
Female	0.727 (0.695 – 0.760)	0.001	0.572 (0.487 – 0.658)	14475	0.001
Male	0.824 (0.783 – 0.864)		0.671 (0.581 – 0.759)
Skin color
White	0.753 (0.724 – 0.781)	0.020	0.601 (0.524 – 0.678)	1290	0.258
2Non-white	0.836 (0.772 – 0.900)		0.641 (0.539 – 0.744)
DM treatment
Diet	0.779 (0.693 – 0.866)	0.283	NA	NA	NA
Oral medications	0.778 (0.748 – 0.808)
Insulin	0.731 (0.671 – 0.791)
Controlled DM
Yes	0.774 (0.743 – 0.806)	0.359	NA	NA	NA
No	0.756 (0.714 – 0.798)
Controlled hypertension
Yes	0.756 (0.723 – 0.789)	0.549	NA	NA	NA
No	0.774 (0.771 – 0.832)
Dyslipidemia
Yes	0.751 (0.720 – 0.782)	0.123	NA	NA	NA
No	0.801 (0.752 – 0.850)
Macrovascular complications
Yes	0.687 (0.629 – 0.746)	0.001	0.563 (0.468 – 0.657)	15786	0.001
No	0.791 (0.764 – 0.819)		0.679 (0.598 – 0.761)
Microvascular complications
Yes	0.745 (0.711 – 0.780)	0.060		0.872	0.352
No	0.804 (0.767 – 0.842)
Other comorbidities
Yes	0.709 (0.653 – 0.765)	0.020	0.608 (0.529 – 0.687)	1757	0.187
No	0.782 (0.753 – 0.811)		0.634 (0.538 – 0.731)
Ophthalmic diseases
Yes	0.714 (0.659 – 0.769)	0.060		2188	0.141
No	0.777 (0.748 – 0.806)
DR health states
NoDR	0.773 (0.746 – 0.800)	0.001	0.748 (0.698 – 0.798)**	5041	0.002
Non-STDR	0.801 (0.726 – 0.875)		0.752 (0.679 – 0.825)**
STDR	0.658 (0.521 – 0.794)		0.628 (0.521 – 0.736)
BB	0.356 (0.061 – 0.651)		0.355 (0.105 – 0.606)**

		NoDR n (%)	Non-STDR n (%)	STDR n (%)	BB n (%)	p value*
		n =157	n =32	n =15	n = 2
Mobility	No problems	110 (70.1)	21 (65.6)	7 (46.7)	0	0.055
	Some problems	46 (29.3)	11 (34.4)	7 (46.7)	2 (100)
	Extreme problems	1 (0.6)	0	1 (6.7)	0
Self-care	No problems	142 (90.4)	28 (87.5)	10 (66.7)	0	0.01
	Some problems	13 (8.3)	4 (12.5)	4 (2.7)	0
	Extreme problems	2 (1.3)	0	1 (6.7)	2 (100)
Usual activities	No problems	115 (73.2)	26 (81.3)	7 (46.7)	1 (50.0)	0.01
	Some problems	39 (24.8)	5 (15.6)	6 (40.0)	0
	Extreme problems	3 (1.9)	1 (3.1)	2 (13.3)	1 (50.0)
Pain/discomfort	No problems	61 (38.8)	15 (46.9)	6 (40.0)	1 (50.0)	0.97
	Some problems	91 (58.0)	16 (50.0)	8 (53.3)	1 (50.0)
	Extreme problems	5 (3.2)	1 (3.1)	1 (6.7)	0
Anxiety/depression	No problems	80 (51.0)	19 (59.4)	8 (53.3)	0	0.26
	Some problems	67 (42.7)	10 (31.3)	6 (40.0)	1 (50.0)
	Extreme problems	10 (6.4)	3 (9.4)	1 (6.7)	1 (50.0)

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[1] Correspondence to: Ângela Jornada Ben Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, the Netherlands De Boelelaan 1081, 1081 HV, Amsterdam, the Netherlands a.jornadaben@vu.nl