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      Health-Related Quality of Life Using the EuroQol 5D Questionnaire in Korean Patients with Type 2 Diabetes

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          Abstract

          We aimed; 1) to determine the validity of the EuroQol 5D (EQ-5D) for the health-related quality of life (HRQOL) of Korean patients with type 2 diabetes, and 2) to identify associated factors of the HRQOL of these patients. Follow-up surveys were conducted for consecutive patients with type 2 diabetes. HRQOL was assessed using the EQ-5D and the Short Form-36 (SF-36). The validity of EQ-5D was assessed with the perspectives of known group, convergent and discriminant validity. Additionally, a linear mixed model using a backward elimination was used for identify associated factors. Of the 1,072 patients included in the first survey, 858 (80.0%) completed the questionnaires in the follow-up. In the known group validity, the problem rates in each EQ-5D dimension were highest among women, elderly people, and less-educated subjects. The Spearman's ρ between the EQ-5D and the SF-36 scales were larger in the comparable dimensions than those in the less comparable dimensions. In the final model, we found that sex, age, education, body mass index, atrial fibrillation, stroke, and retinopathy were statistically significant. Our data suggest that the EQ-5D is a valid tool for Korean patients with type 2 diabetes and that various factors could affect their HRQOL.

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          Most cited references11

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          South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states.

          This study establishes the South Korean population-based preference weights for EQ-5D based on values elicited from a representative national sample using the time trade-off (TTO) method. The data for this paper came from a South Korean EQ-5D valuation study where 1307 representative respondents were invited to participate and a total of 101 health states defined by the EQ-5D descriptive system were directly valued. Both aggregate and individual level modeling were conducted to generate values for all 243 health states defined by EQ-5D. Various regression techniques and model specifications were also examined in order to produce the best fit model. Final model selection was based on minimizing the difference between the observed and estimated value for each health state. The N3 model yielded the best fit for the observed TTO value at the aggregate level. It had a mean absolute error of 0.029 and only 15 predictions out of 101 had errors exceeding 0.05 in absolute magnitude. The study successfully establishes South Korean population-based preference weights for the EQ-5D. The value set derived here is based on a representative population sample, limiting the interpolation space and possessing better model performance. Thus, this EQ-5D value set should be given preference for use with the South Korean population.
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            The Epidemiology of Diabetes in Korea

            Diabetes is an increasing global health problem worldwide. Diabetes and its complications have become a major cause of morbidity and mortality in Korea. The prevalence of diabetes in Korea has increased six- to seven-fold from 1.5% to 9.9% in the past 40 years. The prevalence of impaired fasting glucose also increased to about 20% in 2009. The International Diabetes Federation has estimated that the prevalence of diabetes will rise to 11.4% in 2030. Possible risk factors for diabetes in Korea are age, male gender, obesity, prediabetes, gestational diabetes, smoking, decreased physical activity, and short sleep duration. With increasing obesity, especially in childhood, and improved longevity, the prevalence of diabetes is expected to dramatically increase more than previously estimated. Therefore, public efforts to introduce healthy lifestyle changes and diabetic prevention programs are necessary to reduce the global epidemic of diabetes.
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              Valuing health-related quality of life in diabetes.

              Cost-utility analyses use information on health utilities to compare medical treatments that have different clinical outcomes and impacts on survival. The purpose of this study was to describe the health utilities associated with diabetes and its treatments, complications, and comorbidities. We studied 2,048 subjects with type 1 and type 2 diabetes recruited from specialty clinics at a university medical center. We administered a questionnaire to each individual to assess demographic characteristics, type and duration of diabetes, treatments, complications, and comorbidities, and we used the Self-Administered Quality of Well Being index (QWB-SA) to calculate a health utility score. We then created regression models to fit the QWB-SA-derived health utility scores to indicator variables for type 1 and type 2 diabetes and each demographic variable, treatment, and complication. The coefficients were arranged in clinically meaningful ways to develop models to describe penalties from the health utility scores for nonobese diabetic men without additional treatments, complications, or comorbidities. The utility scores for nonobese diet-controlled men and women with type 2 diabetes and no microvascular, neuropathic, or cardiovascular complications were 0.69 and 0.65, respectively. The utility scores for men and women with type 1 diabetes and no complications were slightly lower (0.67 and 0.64, respectively). Blindness, dialysis, symptomatic neuropathy, foot ulcers, amputation, debilitating stroke, and congestive heart failure were associated with lower utility scores. Major diabetes complications are associated with worse health-related quality of life. The health utility scores provided should facilitate studies of the health burden of diabetes and the cost-utility of alternative strategies for the prevention and treatment of diabetes.
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                Author and article information

                Journal
                J Korean Med Sci
                JKMS
                Journal of Korean Medical Science
                The Korean Academy of Medical Sciences
                1011-8934
                1598-6357
                March 2012
                23 February 2012
                : 27
                : 3
                : 255-260
                Affiliations
                [1 ]Department of Internal Medicine, University of Ulsan College of Medicine, Seoul, Korea.
                [2 ]Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Korea.
                [3 ]Department of Internal Medicine, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea.
                [4 ]Department of Regulatory Affairs & Market Access, Sanofi-Aventis Korea Co. Ltd., Seoul, Korea.
                [5 ]Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, Korea.
                Author notes
                Address for Correspondence: Min-Woo Jo, MD. Department of Preventive Medicine, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul 138-736, Korea. Tel: +82.2-3010-4264, Fax: +82.2-477-2898, mdjominwoo@ 123456paran.com
                Article
                10.3346/jkms.2012.27.3.255
                3286771
                22379335
                8319a1fe-e22b-4d81-bd04-c72fb21e70ba
                © 2012 The Korean Academy of Medical Sciences.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 19 October 2011
                : 02 January 2012
                Categories
                Original Article
                Endocrinology, Nutrition & Metabolism

                Medicine
                eq-5d,health-related quality of life,diabetes mellitus, type 2
                Medicine
                eq-5d, health-related quality of life, diabetes mellitus, type 2

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