Health-Related Quality of Life and Treatment Satisfaction in Dutch Patients With Type 2 Diabetes W. KEN REDEKOP, PHD 1 MARC A. KOOPMANSCHAP, PHD 1 RONALD P. STOLK, MD, PHD 2 GUY E. H. M. RUTTEN, MD, PHD 2 BRUCE H. R. WOLFFENBUTTEL, MD, PHD 3 LOUIS W. NIESSEN, MD 1 OBJECTIVE — To estimate the health-related quality of life (HRQOL) and treatment satis- faction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associated with quality of life and treatment satisfaction. RESEARCH DESIGN AND METHODS — For a sample of 1,348 type 2 diabetes pa- tients, recruited by 29 general practitioners, we collected data regarding HRQOL. This study was performed as part of a larger European study (Cost of Diabetes in Europe – Type 2 [CODE-2]). We used a generic instrument (Euroqol 5D) to measure HRQOL. Treatment satisfaction was assessed using the Diabetes Treatment Satisfaction Questionnaire. RESULTS — Patients without complications had an HRQOL (0.74) only slightly lower than similarly aged persons in the general population. Insulin therapy, obesity, and complications were associated with a lower HRQOL, independent of age and sex. Although higher fasting blood glucose and HbA 1c levels were negatively associated with HRQOL, these factors were not sig- nificant after adjustment for other factors using multivariate analysis. Overall treatment satisfac- tion was very high. Younger patients, patients using insulin, and patients with higher HbA 1c levels were less satisfied with the treatment than other patients. CONCLUSIONS — Obesity and the presence of complications are important determinants of HRQOL in patients with type 2 diabetes. Diabetes Care 25:458 – 463, 2002 T ype 2 diabetes is a chronic disease that affects a patient’s general health and well-being in various ways. For example, severe dietary restriction and daily self-administration of oral medica- tions or insulin may adversely affect an individual’s health-related quality of life (HRQOL). In addition, the long-term complications of diabetes, such as ne- phropathy, neuropathy, heart disease, and stroke, with their considerable impact on health, may also have a negative effect on quality of life, as shown in the U.K. Prospec- tive Diabetes Study (UKPDS) study and a recent review (1,2). The aim of this study was to deter- mine the HRQOL and treatment satis- faction for patients with type 2 diabetes in the Netherlands and to examine which patient characteristics are associ- ated with quality of life and treatment satisfaction. This study was initiated as part of the Cost of Diabetes in Europe – Type 2 (CODE-2) study, a large study of type 2 diabetes patients in eight Eu- ropean countries (3,4). RESEARCH DESIGN AND METHODS The CODE-2 study The CODE-2 study was performed to provide comprehensive data on costs and quality of life and involved 7,635 patients in eight European countries. Full details have been presented by Jonsson et al. (3). A sample of Dutch type 2 diabetes pa- tients, recruited by a representative sam- ple of 29 Dutch general practitioners, completed questionnaires regarding qual- ity of life and treatment satisfaction. Infor- mation regarding medical costs was also collected and has already been reported (5). The general practitioners, randomly selected from a computerized database, identified all type 2 diabetic patients in their practice (n = 1,371). HRQOL measurement To measure HRQOL, we used the Euroqol 5-D instrument (6). The Euroqol 5-D is a widely used and validated generic instru- ment that has five dimensions: mobility, self care, usual activities, pain/discomfort, and anxiety/depression. Each dimension has three levels: no limitations, some limita- tions, and severe limitations. As a result, there are 243 possible sets of values for the Euroqol 5-D (i.e., 3 5 ). All of these pos- sible health states have been valued by the general public in the U.K. using the so- called York A-1 tariff, by means of a large- scale time trade-off study (7). These “valuations” of the health states represent utility values, an indication of their level of desirability or undesirability. The set of possible values has a range of -0.549 to 1, where 1 indicates perfect health, 0 in- dicates death, and -0.549 indicates the worst possible health state that is viewed by the general public as considerably worse than death. The utility values found in the U.K. study have since been vali- dated for the Netherlands (8). The val- uations of patients’ health states are ●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●●● From the 1 Institute for Medical Technology Assessment (iMTA), Erasmus University, Rotterdam, the Neth- erlands; the 2 Julius Center for General Practice and Patient-Oriented Research, University Medical Center, Utrecht, the Netherlands; and 3 Academic Center Maastricht, Maastricht, the Netherlands. Address correspondence and reprint requests to Ken Redekop, Institute for Medical Technology Assess- ment, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands. E-mail: redekop@bmg.eur.nl. Received for publication 20 July 2001 and accepted in revised form 7 November 2001. Abbreviations: CODE-2, Cost of Diabetes in Europe – Type 2; DTSQ, Diabetes Treatment Satisfaction Questionnaire; HRQOL, health-related quality of life; VAS, visual analog scale. A table elsewhere in this issue shows conventional and Syste `me International (SI) units and conversion factors for many substances. Epidemiology/Health Services/Psychosocial Research O R I G I N A L A R T I C L E 458 DIABETES CARE, VOLUME 25, NUMBER 3, MARCH 2002