Procena uticaja hipoglikemije i indeksa telesne mase na kvalitet života kod obolelih od šećerne bolesti tipa 2
Sažetak
Uvod/Cilj. Noviji podaci sugerišu da gojazne osobe sa dijabetesom tip 2 (DMT2) češće imaju lošiju kontrolu glikemije i češće komplikacije poput neuropatije, kao i višu stopu mortaliteta u odnosu na obolele od dijabetesa sa normalnom telesnom masom. Cilj istraživanja bio je da se utvrdi učestalost hipoglikemijskih epizoda, odredi vrednost indeksa telesne mase (ITM) i proceni njihov uticaj na kvalitet života (QL) kod obolelih od DMT2 korišćenjem upitnika EuroQoL-EQ 5-dimensional (EQ-5D) nakon korekcije za starost, trajanje dijabetesa melitusa i prisustvo kasnih komplikacija bolesti. Metode. Ovom kliničko-epidemiolo-škom studijom preseka obuhvaćena su 269 uzastopno selektovana bolesnika oba pola, sa postavljenom dijagnozom DMT2 trajanja dužeg od jedne godine. Standardizovana verzija upitnika EQ-5D trećeg nivoa – EQ-5D-3L na srpskom jeziku i EQ vizuelna analogna skala (EQ-VAS) korišćeni su za procenu kvaliteta života u vezi sa zdravljem. Rezultati. Prosečna starost ispitanika iznosila je 65,1 ± 9,3 godina. Hipoglikemija je zabeležena kod 71%, gojaznost kod 43.9% i hronične komplikacije kod 88.8% isptanika. Polovina bolesnika nije dostigla ciljne vrednosti glikoziliranog hemoglobina (HbA1c) (HbA1c < 7%). Hipoglikemija je bila značajno češća kod mlađih bolesnika u trenutku postavljanja dijagnoze (54,19 vs 57,59) a ređa kod visokobrazovanih ispitanika (7,3% vs 35,1%). Bolesnici sa hipoglikemijom imali su veću ocenu za bol i nelagodnost (1,86 vs 1,68) u EQ-5D upitniku, niže vrednosti VAS skora (55,99 vs 62,44) i EQ-5D indeksa (0,85 vs 0,87) u odnosu na one sa dobrom kontrolom glikemije. Gojazni ispitanici su uglavnom bili ženskog pola, sa povišenim vrednostima sistolnog i dijastolnog pritiska, povišenim trigliceridima, obimom struka, ocenom za anksioznost i depresiju (2,01 vs 1,80) i većim brojem epizoda hipoglikemija na godišnjem nivou. Nakon korekcije za doprinoseće faktore, ispitanici sa hipoglikemijom imali su 2 035 puta veću šansu za teži stepen bola i nelagodnosti. Sa povećanjem ITM, šansa za probleme mobilnosti, anksioznost/depresiju povećala se 1,05 puta. Hipoglikemija je bila značajno povezana sa nižim vrednostima VAS skora (b = -0.13). Povećanje vrednosti ITM bilo je statistički značajno povezano sa nižim vrednostima EQ 5D indeksa (b = -1,78). Učestalost hipoglikemije nije bila povezana sa vrednostima VAS skorom i EQ 5D indeksa. Zaključak. Rezultati su pokazali značajnu povezanost hipoglikemije i gojaznosti sa smanjenim QL, procenjenim na osnovu EQ-5D upitnika. Korekcija životnih stilova usmerenih ka smanjenju gojaznosti i hipoglikemije uz optimalnu terapiju, može značajno poboljšati QL vezan za zdravlje kod bolesnika sa DMT2.
Reference
Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014; 103(2): 137−49.
Tamayo T, Rosenbauer J, Wild SH, Spijkerman AM, Baan C, Forouhi NG, et al. Diabetes in Europe: An update. Diabetes Res Clin Pract 2014; 103(2): 206−17.
Incidence and mortality of diabetes in Serbia 2011. Serbian Diabetes Registry Report N. 6. Belgrade: Institute of Public Health of Serbia "Dr Milan Jovanovic Batut"; 2011. (Serbian)
El-Kebbi IM, Cook CB, Ziemer DC, Miller CD, Gallina DL, Phillips LS. Association of younger age with poor glycemic control and obesity in urban african americans with type 2 diabetes. Arch Intern Med 2003; 163(1): 69−75.
Nguyen NT, Nguyen XT, Lane J, Wang P. Relationship between obesity and diabetes in a US adult population: Findings from the National Health and Nutrition Examination Survey, 1999-2006. Obes Surg 2011; 21(3): 351−5.
Abate N. Obesity and cardiovascular disease. Pathogenetic role of the metabolic syndrome and therapeutic implications. J Diabetes Complications 2000; 14(3): 154−74.
Miranda-Massari JR, Gonzalez MJ, Fernando AS, Cidre C, Paz IM, Charvel J, et al. Metabolic Correction as a tool to improve diabetes type 2 management. Bol Asoc Med P R 2015; 107(2): 54−9.
Dennett SL, Boye KS, Yurgin NR. The impact of body weight on patient utilities with or without type 2 diabetes: A review of the medical literature. Value Health 2008; 11(3): 478−86.
Vexiau P, Mavros P, Krishnarajah G, Lyu R, Yin D. Hypoglycemia in patients with type 2 diabetes treated with a combination of metformin and sulphonylurea therapy in France. Diabetes Obes Metab 2008; 10(1): 16−24.
Lundkvist J, Berne C, Bolinder B, Jönsson L. The economic and quality of life impact of hypoglycemia. Eur J Health Econ 2005; 6(3): 197−202.
Rodbard HW, Jellinger PS, Davidson JA, Einhorn D, Garber AJ, Grunberger G, et al. Statement by an American Association of Clinical Endocrinologists/American College of Endocrinology consensus panel on type 2 diabetes mellitus: An algorithm for glycemic control. Endocr Pract 2009; 15(6): 540−59.
Stargardt T, Gonder-Frederick L, Krobot KJ, Alexander CM. Fear of hypoglycaemia: Defining a minimum clinically important difference in patients with type 2 diabetes. Health Quality Life Outcomes 2009; 7(1): 91.
Heintz E, Wiréhn A, Peebo BB, Rosenqvist U, Levin L. QALY weights for diabetic retinopathy: A comparison of health state valuations with HUI-3, EQ-5D, EQ-VAS, and TTO. Value Health 2012; 15(3): 475−84.
Schram MT, Baan CA, Pouwer F. Depression and quality of life in patients with diabetes: A systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev 2009; 5(2): 112−9.
Brazier J, Roberts J, Deverill M. The estimation of a preference-based measure of health from the SF-36. J Health Econ 2002; 21(2): 271−92.
Wang C, Lin C, Huang T, Chien M, Hsieh S, Huang Y, et al. Inertia on hypoglycemia: Highlight from a Taiwan subgroup analysis of Real-Life Effectiveness and Care Patterns of Diabetes Management (RECAP-DM) study. Diabetes Res Clin Pract 2012; 98(1): 61−7.
Greiner W, Claes C, Busschbach JJ, Schulenburg-Graf JM. Validating the EQ-5D with time trade off for the German population. Eur J Health Econom 2005; 6(2): 124−30.
American Diabetes Association Workgroup on Hypoglycemia. Defining and reporting hypoglycemia in diabetes: A report from the American Diabetes Association Workgroup on Hypoglycemia. Diabetes Care 2005; 28: 1245−9.
WHO. Obesity: preventing and managing the global epidemic. Report of a WHO Consultation. Geneva: WHO Technical Report Series 894; 2000.
Pickering TG, Hall JE, Appel LJ, Falkner BE, Graves J, Hill MN, et al. Recommendations for blood pressure measurement in humans and experimental animals: Part 1: Blood pressure measurement in humans: a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Associatio. Circulation 2005; 111(5): 697−716.
Lee WJ, Song K, Noh JH, Choi YJ, Jo M. Health-related quality of life using the EuroQol 5D questionnaire in Korean patients with type 2 diabetes. J Korean Med Sci 2012; 27(3): 255−60.
Rabin R, Charro F. EQ-5D: A measure of health status from the EuroQol Group. Ann Med 2001; 33(5): 337−43.
Grandy S, Fox KM. EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Health Qual Life Outcomes 2008; 6(1): 18.
Pettersson B, Rosenqvist U, Deleskog A, Journath G, Wändell P. Self-reported experience of hypoglycemia among adults with type 2 diabetes mellitus (Exhype). Diabetes Res Clin Pract 2011; 92(1): 19−25.
Donnelly LA, Morris AD, Frier BM, Ellis JD, Donnan PT, Durrant R. DARTS/MEMO Collaboration. Frequency and predictors of hypoglycaemia in type 1 and insulin-treated type 2 diabetes: A population based study. Diabet Med 2005; 22(6): 449−55.
UKPDS. UK prospective study of therapies of maturity-onset diabetes. I. Effect of diet, sulphonylurea, insulin or biguanide therapy on fasting plasma glucose and body weight over one year. Diabetologia 1983; 24(6): 404−11.
Williams SA, Pollack MF, Dibonaventura M. Effects of hypoglycemia on health-related quality of life, treatment satisfaction and healthcare resource utilization in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract 2011; 91(3): 363−70.
Amiel SA, Dixon T, Mann R, Jameson K. Hypoglycaemia in Type 2 diabetes. Diabet Med 2008; 25(3): 245−54.
Ji L, Zou D, Liu L, Qian L, Kadziola Z, Babineaux S, et al. Increasing body mass index identifies Chinese patients with type 2 diabetes mellitus at risk of poor outcomes. J Diabetes Complications 2015; 29(4): 488−96.
Grandy S, Chapman HR, Fox MK. for the SHIELD Study Group. Quality of life and depression of people living with type 2 diabetes mellitus and those at low and high risk for type 2 diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Int J Clin Pract 2008; 62(4): 562−8.
Litwak L, Goh SY, Hussein Z, Malek R, Prusty V, Khamseh EM. Prevalence of diabetes complications in people with type 2 diabetes mellitus and its association with baseline characteristics in the multinational A1chieve study. Diabetol Metab Syndr 2013; 5(1): 57.
Hunger M, Schunk M, Meisinger C, Peters A, Holle R. Estimation of the relationship between body mass index and EQ-5D health utilities in individuals with type 2 diabetes: Evidence from the population-based KORA studies. J Diabetes Complications 2012; 26(5): 413−8.