Quality of life in elderly people with type 2 diabetes using EQ-5D-5L tool: a case control study

Abstract
Background
According to the World Health Organization (WHO), quality of life is “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. Researchers have conceptualized quality of life on many levels, and there are multiple views on how it should be defined and measured. Chronic diseases like diabetes mellitus are known to compromise the HRQoL. Type 2 diabetes mellitus (DM) is a chronic metabolic disease known to affect HRQoL adversely. Two types of tools have been developed to measure HRQoL. Generic tools are general purpose measures used to assess HRQoL of communities and also for comparison between populations. The EQ-5D-5L consists of two pages—the EQ-5D-5L descriptive system and the EQ visual analog scale (EQ VAS). The descriptive system comprises the five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression).

Objectives
Assess of quality of life in elderly patients of type 2 diabetes mellitus as well as determine effects of factors related to diabetes and diabetic control on the quality of life of type 2 diabetes.

Methods
- Population of study and disease condition:
◦ A total of 60 participants were enrolled in this study, and all of the participants were among the geriatric group of people (age ≥ 60 years old).
◦ Thirty of them self-reported to have diabetes mellitus type 2, while the other 30 subjects were a control group (self-reported no to have diabetes mellitus).
◦ All participants were subjected to careful history taking, full clinical examination, in addition to laboratory investigation in the form of HBA1C.
◦ All participants had to fill in self-reported questionnaire which is used as a tool for the assessment of HRQOL named EQ-5D-5L (some patients were illiterate so the questionnaire was interviewed to them).
◦ All participants underwent interview questionnaires of the following HRQOL scales: geriatrics depression scale, ADL (activities of daily living scale), and IADL (instrumental activities of daily living scale).

Results
EQ-5D-5L score is significantly higher in diabetic patients than non-diabetics (p value < 0.001).
EQ VAS score is significantly lower in diabetic patients than non-diabetics (p value < 0.001).
ADL (activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001). 
IADL (independence in activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001).
Visual prop is impaired in diabetics more than non-diabetics (p value < 0.001).
Pain severity is mainly affected in diabetics more than non-diabetics.

Conclusion
Type 2 diabetes mellitus in elderly patients affects their health-related quality of life and their daily activities.
In our study, the HRQOL of uncontrolled diabetic patients were more negatively affected than that of the controlled diabetic patients.
Moreover, some of our diabetic patients were found to suffer from cognitive disorders (insomnia and depression) as a complication of diabetes.
We also found that the EQ-5D-5L of diabetic patients with comorbidities was higher than those without comorbidities and EQ-VAS was lower in comorbid diabetic patients.