Outline

  • Abstract
  • Aims
  • Methods
  • Results
  • Conclusions
  • Keywords
  • 1. Introduction
  • 2. Material and Methods
  • 2.1. Study Design and Population
  • 2.2. Data Collection and Definitions
  • 2.3. Statistical Analysis
  • 3. Results
  • 4. Discussion
  • References

رئوس مطالب

  • چکیده
  • اهداف
  • روش ها
  • نتایج
  • نتیجه گیری
  • کلید واژه ها
  • 1. مقدمه
  • 2. مواد و روش ها
  • 2.1. طرح مطالعه و جمعیت
  • 2.2. جمع آوری داده ها و تعاریف
  • 2.3. تحلیل آماری
  • 3. نتایج
  • 4. بحث

Abstract

Aims Diabetic complications, and in particular diabetic foot ulcers (DFUs), are associated with low health-related quality of life (HRQoL). We evaluated whether the presence of diabetic complications also influenced the improvement of HRQoL during DFU treatment.

Methods 1088 patients presenting for DFU treatment at the centers participating in the Eurodiale study were followed prospectively up to one year. HRQoL was measured both at presentation and after healing or at end of follow up, using EQ-5D: a standardized instrument consisting of five domains and a summary index. The influence of diabetic comorbidity on the course of HRQoL was evaluated for each of the EQ-5D outcomes in multi-level linear regression analyses, adjusting for baseline characteristics.

Results HRQoL improved in all EQ-5D outcomes over the course of treatment for those DFUs that healed. The few significant differences in the development of HRQoL between patients with and without comorbidity showed a more beneficial development for patients with comorbidity in DFUs that did not heal or healed slowly.

Conclusions Comorbidity does not hamper improvement of HRQoL in DFU treatment. On the contrary, HRQoL improved sometimes more in patients with certain comorbidity with hard-to-heal ulcers.

Keywords: - - - -

Discussion

The present communication is to the best of our knowledge the first study into the role of comorbidity on the course of HRQoL during treatment of DFUs. We show, in accordance with previous investigations,7,12,13 that HRQoL improved in all domains in patients with a DFU in whom the ulcer healed, but also that non-healing was not associated with a further decline of the already poor HRQoL. The data indicate that, although the presence of comorbidity is associated with a poor HRQoL at baseline, these comorbidities did not influence negatively the course of HRQoL. In contrast, the presence of certain comorbidities was actually associated with a larger improvement in HRQoL during the treatment period, notably in ulcers that took longer time to heal or did not heal within the one-year follow-up.

The presence of comorbidity was associated with worse HRQoL at initial presentation with a new DFU, in accordance with previous investigations.16 This low HRQoL at baseline implies a greater improvement potential during follow-up, which may in part be the explanation for the larger improvement of HRQoL in the presence of comorbidity, as seen in some of the results. This is reinforced by the fact that these larger improvements were predominantly seen in the ulcers that did not heal, which are tentatively the ulcers that – untreated – affect HRQoL most. Low HRQoL at presentation may be a consequence of the comorbidity or the ulcer per se as well as lack of adequate treatment prior to presentation and late referral to the diabetic foot clinic.

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