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Quantifying health-related quality of life in Malaysian type 2 diabetes: focusing on complication types and severity

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Abstract

Purpose

There is a knowledge gap of health utility values for Type 2 Diabetes Mellitus (T2DM) complications in Malaysia. This study aimed to estimate EQ-5D-5L utility values and evaluate health-related quality of life (HRQoL) for Malaysian T2DM associated with complications and clinical characteristics.

Methods

A cross-sectional study was conducted on T2DM patients at a tertiary hospital outpatient using the Malay and English version of the EQ-5D-5L questionnaire. Health utility values were derived using the Malaysian EQ-5D-5L value set. Ordinary least squares (OLS) multivariable regression model was used to estimate the health utility decrements associated with T2DM-related complications and clinical characteristics.

Results

A total of 513 T2DM patients were recruited. Overall, pain was the most affected of all five EQ-5D-5L dimensions. Patients with foot ulcer, amputation, severe heart failure and frequent hypoglycemia reported more problems collectively in all EQ-5D-5L dimensions. Older age, lower education level, longer duration of T2DM, urine protein creatine index (UPCI) > 0.02 g/mmol, and injection therapy were significantly associated with lower EQ-5D-5L utility values (p < 0.004, Bonferroni adjusted). The lowest unadjusted utility values were reported for severe heart failure 0.65 (interquartile range, IQR 0.50), frequent hypoglycemia 0.74 (0.22) and being amputated 0.78 (0.47). In the multivariable regression model after controlling for sociodemographic and clinical characteristics, the largest utility value decrement was observed for amputation (− 0.158, SE 0.087, p = 0.05), frequent hypoglycemia (− 0.101, SE 0.030, p = 0.001), myocardial infarction (-0.050, SE 0.022, p = 0.022) and obesity (-0.034, SE 0.016, p = 0.029).

Conclusion

Larger utility value decrements were found for severe stages of complications. These findings suggest the value of defining severity of complications in utility elicitation studies. The utility decrement quantified for different T2DM complication severity will be useful for economic evaluations within diabetic-related fields.

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Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

The authors would like to express gratitude to the staffs of Endocrine Clinic and Health Information Department, National University of Malaysia Hospital (Hospital UKM) for their diligent assistance throughout the study recruitment process. Special thanks to Pharmacy Department for their great support in providing the facility to perform preliminary screening before clinic days. Special appreciation to Professor Dr Shamsul Azhar Shah and Professor Dr Mohd Rizal Abdul Manaf from Department of Community Health, Faculty of Medicine for their expertise and guidance in statistical analysis. We appreciate all study patients who willingly provided invaluable data for the study.

Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Authors and Affiliations

  1. Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Science, Universiti Sains Malaysia, 11800, Gelugor, Pulau Pinang, Malaysia

    Michelle Hwee Pheng Tan, Siew Chin Ong & Annushiah Vasan Thakumar

  2. Pharmacy Department, Hospital Canselor Tuanku Muhriz, Universiti Kebangsaan Malaysia, 56000, Cheras, Kuala Lumpur, Malaysia

    Michelle Hwee Pheng Tan

  3. Department of Medicine, Universiti Kebangsaan Malaysia, UKM, 43600, Bangi, Selangor, Malaysia

    Norlaila Mustafa

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  2. Siew Chin Ong
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  3. Annushiah Vasan Thakumar
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  4. Norlaila Mustafa
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Contributions

MTHP: contributed to the conception and design of the study, material preparation, data collection, data analysis and drafted the manuscript. SCO: contributed to the conception, design of the study, and supervised the project. NM: contributed the study design and AVT: guided data analysis and discussion. All authors read and approved the final manuscript.

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Correspondence to Siew Chin Ong.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

All procedures performed in this study involving human participants, including how informed consent was obtained, comply with the ethical standards of the institution and was granted approval by Research Ethics Committee, The National University of Malaysia, UKM (3 August 2021/Protocol code: PPII111I8/JEP-2021-600).

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Informed consent was obtained from all individual patients included in the study.

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Tan, M.H.P., Ong, S.C., Vasan Thakumar, A. et al. Quantifying health-related quality of life in Malaysian type 2 diabetes: focusing on complication types and severity. Qual Life Res 32, 1925–1941 (2023). https://doi.org/10.1007/s11136-023-03360-x

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