Patterns and correlates of Health-related Quality of Life among Type 2 Diabetes patients with multimorbidity
Background
Individuals with type 2 diabetes mellitus (T2DM) are likely to have co-morbid conditions affecting Health Related Quality Of Life (HRQOL). Few data are available on HRQOL in poorly controlled T2DM patients [glycated haemoglobin (HbA1c)>8%, and either: systolic Blood Pressure (BP)>140mmHg or Low-density Lipoprotein cholesterol (LDLc)>130mg/dl] in South Asia.
Aims
We examined the patterns and socio-demographic and clinical correlates of HRQOL among poorly controlled T2DM patients in South Asia. 
Methods
Data were used from the CARRS (Centre for Cardiometabolic Risk Reduction in South Asia) Trial baseline visit of 1146 T2DM patients attending ten diabetes clinics in India and Pakistan. At baseline visit (2011-12), HRQOL was assessed by the EQ5D-VAS (European Quality of life 5 dimension – Visual Analogue Scale) questionnaire. EQ-VAS measures health status on a scale of 0 (worst health status) – 100 (best possible health status). The socio-demographic data included age, sex, income, occupation and education. Clinical evaluations involved an assessment for cardiovascular diseases, micro-vascular complications (diabetic retinopathy, nephropathy and neuropathy), depression and other co-morbidities. All descriptive analyses i.e. percentage of patients reporting difficulties in each of the five EQ5D domains and mean EQ-VAS were reported stratified by socio-demographic factors and comorbidities.
Results
At baseline, EQ5D-VAS was completed for 1140 study participants and mean age was 54 years, 45% male, median disease duration: 7 years, HbA1c: 9.9%, BP: 144/82 mmHg, LDLc: 122.5 mg/dl. Mean EQ-VAS reported by the study participants was 70.0 (95% Confidence Interval: 68.8 – 71.1). Worse health status (EQ-VAS score) was reported by women vs. men (68.0 vs. 72.2), less educated vs. graduates (62.2 vs. 76.0), low-income vs. higher-income group (64.6 vs. 76.0), homemakers and retired vs. employed (66.6 vs. 73.3), those with higher(>15 years) vs. Less(<5years) disease duration (67.0 vs. 71.8), and presence of co-morbidities vs. without (59.6 vs. 76.4). Notably, a higher prevalence of anxiety/depression was found amongst females, less educated, low-income group, and in those with co-morbidities, ranging from 32.1% to 49.3%. (Table 1)
Discussion
In conclusion, consistent with published literature, socio-demographics factors as well as co-morbidities were equally important factors associated with HRQOL in poorly controlled South Asian T2DM patients.

Patterns and correlates of health related quality of life among type 2 diabetes patients with multimorbidity