Effect of Multifactorial Intervention on Quality of Life and Cost-Effectiveness in Newly Diagnosed Type 2 Diabetic Patients_Chinese Journal of Evidence-Based Medicine

Authors：

LIU Zhiwen , ZHOU Zhiguang , CHEN Xiaoyan , TANG Weili , PENG Jian , FENG Qiong , NING Jie , HE Xia

Institute of Metabolism and Endocrinology; Department of Endocrinology; Center of Dibetes Mellitus; Xiangya 2nd Hospital; Central South University; Changsha 410011; China;

Corresponding author：

Keywords：

Type 2 diabetes mellitus; Quality of life; Intensive intervention; SF-36 health questionary; Pharmacoeconomics

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Objective 　To explore the effects on quality of life (QOL), the targeted rates of metabolic parameters and cost-effectiveness in newly diagnosed type 2 diabetic patients who underwent multifactorial intensive intervention.
Methods 　One hundred and twenty seven cases in an intensive intervention and 125 cases in a conventional intervention group were investigated by using the SF-36 questionnaire. The comparison of QOL and the targeted rates of metabolic parameters between the two groups were made. We assessed the influence factors of QOL by stepwise regression analysis and evaluated the efficiency by pharmacoeconomic cost-effectiveness analysis.
Results 　The targeted rates of blood glucose, blood lipid and blood pressure with intensive policies were significantly higher than those with conventional policy (P＜0.05). The intensive group’s role limitations due to physical problems (RP), general health (GH), vitality (VT), role limitation due to emotional problems (RE) and total scores after 6 months intervention were significantly higher than those of baseline (P＜0.05). The vitality scores and health transition (HT) of the intensive group were better than those of the conventional group after 6 months intervention. But the QOL scores of the conventional group were not improved after intervention. The difference of QOL’s total scores after intervention was related to that of HbA1c. The total cost-effectiveness rate of blood glucose, blood lipid, blood pressure control and the total cost-effectiveness rate of QOL with intensive policy were higher than those with the conventional policy.
Conclusions 　Quality of life and the targeted rates of blood glucose, blood lipid and blood pressure in newly diagnosed type 2 diabetic patients with multifactorial intensive intervention policy are better and more economic than those with conventional policy.

Citation： LIU Zhiwen,ZHOU Zhiguang,CHEN Xiaoyan,TANG Weili,PENG Jian,FENG Qiong,NING Jie,HE Xia. Effect of Multifactorial Intervention on Quality of Life and Cost-Effectiveness in Newly Diagnosed Type 2 Diabetic Patients. Chinese Journal of Evidence-Based Medicine, 2005, 05(5): 386-390. doi: Copy

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11.	McMurray SD, Johnson G, Davis S, McDougall K Q. Diabetes education and care management significantly improve patient outcomes in the dialysis unit[J]. Am J Kidney Dis, 2002; 40(3): 566-575.
12.	Nicollerat JA. Implications of the United Kingdom Prospective Diabetes Study (UKPDS) results on patient management[J]. Diabetes Educ, 2000; 26(Suppl): 8-10.
13.	UKPDS.Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37)[J]. Diabetes Care, 1999; 22(7): 1125-1136.
14.	Hanefeld M, Fischer S, Schmechel H, Rothe G, Schulze J, Dude H, Schwanebeck U, Julius U. Diabetes Intervention Study. Multi-intervention trial in newly diagnosed NIDDM[J]. Diabetes Care, 1991; 14(4): 308-317.

1. Bruno G, Merletti F, Biggeri A, Bargero G, Ferrero S, Runzo C, Prina Cerai S, Pagano G, Cavallo-Perin P. Metabolic syndrome as a predictor of all-cause and cardiovascular mortality in type 2 diabetes: The Casale Monferrato Study[J]. Diabetes Care, 2004; 27(11): 2689-2694.
2. Manuel DG, Schultz SE. Health-related quality of life and health-adjusted life expectancy of people with diabetes in Ontario, Canada,1996-1997[J]. Diabetes Care, 2004; 27(2): 407-414.
3. Redekop WK,Koopmanschap MA,Stolk RP. Health-related quality of life and treatment satisfaction in Dutch patients with type 2 diabetes[J]. Diabetes Care, 2002; 25(3): 458-463.
4. UK Prospective Diabetes Study (UKPDS) Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes (UKPDS 38) [J]. BMJ, 1998; 317(7160): 703-713.
5. Abraira C, Duckworth W, McCarren M, Emanuele N, Arca D, Reda D, Henderson W. Design of the cooperative study on glycemic control and complications in diabetes mellitus type 2: Veterans Affairs Diabetes Trial[J]. Diabetes Complications, 2003;17(6): 314-322.
6. Gaede PH, Jepsen PV, Larsen JN, Jensen GV, Parving HH, Pedersen OB. The Steno-2 study. Intensive multifactorial intervention reduces the occurrence of cardiovascular disease in patients with type 2 diabetes[J]. Ugeskr Laeger, 2003; 165(26): 2658-2661.
7. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes[J]. N Engl J Med, 2003; 348(5): 383-393.
8. Gray A, Raikou M, McGuire A, Fenn P, Stevens R, Cull C, Stratton I, Adler A, Holman R, Turner R. Cost effectiveness of an intensive blood glucose control policy in patients with type 2 diabetes: economic analysis alongside randomised controlled trial (UKPDS 41)[J]. BMJ, 2000; 320(7 246): 1373-1378.
9. Diabetes Control and Complications Trial (DCCT). Influence of intensive diabetes treatment on quality-of-life outcomes in the diabetes control and complications trial[J]. Diabetes Care, 1996; 19(3): 195-203.
10. Maddigan SL, Majumdar SR, Guirguis LM, Lewanczuk RZ, Lee TK, Toth EL, Johnson JA. Improvements in patient-reported outcomes associated with an intervention to enhance quality of care for rural patients with type 2 diabetes: Results of a controlled trial[J].Diabetes Care, 2004; 27(6): 1306-1312.
11. McMurray SD, Johnson G, Davis S, McDougall K Q. Diabetes education and care management significantly improve patient outcomes in the dialysis unit[J]. Am J Kidney Dis, 2002; 40(3): 566-575.
12. Nicollerat JA. Implications of the United Kingdom Prospective Diabetes Study (UKPDS) results on patient management[J]. Diabetes Educ, 2000; 26(Suppl): 8-10.
13. UKPDS.Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37)[J]. Diabetes Care, 1999; 22(7): 1125-1136.
14. Hanefeld M, Fischer S, Schmechel H, Rothe G, Schulze J, Dude H, Schwanebeck U, Julius U. Diabetes Intervention Study. Multi-intervention trial in newly diagnosed NIDDM[J]. Diabetes Care, 1991; 14(4): 308-317.

Chinese Journal of Evidence-Based Medicine

Effect of Multifactorial Intervention on Quality of Life and Cost-Effectiveness in Newly Diagnosed Type 2 Diabetic Patients

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