Which Factors may reduce the Health-Related Quality of Life of Ecuadorian Patients with Diabetes?

Objective: To quantify the health-related quality of life (HRQoL) of patients with type 2 diabetes mellitus (DM) in Ecuador and to determine its association, or lack thereof, with demographic and clinical variables, particularly with the comorbidities and complications of DM.

Methods: This was an analytical cross-sectional study with 325 patients attending regular care at a primary health care center in Quito, Ecuador. HRQoL was measured using the EuroQol 5-dimension 3-level (EQ-5D-3L) questionnaire. The patients were screened for diabetic nephropathy, retinopathy, and peripheral artery disease (PAD). Clinical files were reviewed to obtain data regarding gender, age, time since diagnosis, type of treatment, glycemic control, and history (if any) of hypertension and/or dyslipidemia. Associations were verified using the Mann-Whitney U or Kruskal-Wallis test, and the confounding effects of the variables "age" and "gender" were controlled for using logistic regression analysis.

Results: The mean HRQoL for the population was 0.844 (±0.215) on the EQ-5D-3L index (EQ-Index) and 80.6 (±18.8) on the EQ visual analogue scale (EQ-VAS). The prevalence of DM complications was 1.8% for nephropathy, 14.8% for retinopathy, and 14.5% for PAD. Of the participating patients, 66.8% presented hypertension and 91.4%, dyslipidemia. Significant associations were found between lower scores on the EQ-Index and age (≥65 years) (0.84 vs. 0.87; p = 0.016), time since diagnosis (≥10 years) (0.81 vs. 0.87; p = 0.005), presence of hypertension (0.83 vs. 0.88; p = 0.017), and, after controlling for age and gender, presence of nephropathy. For the EQ-VAS, only time since diagnosis (≥10 years) was associated with a lower score (77.99 vs. 82.97; p = 0.043).

Conclusion: Older age, longer disease duration, hypertension, and nephropathy are associated with having a lower HRQoL, in patients with type 2 DM in Quito, Ecuador.