To estimate the quality of life decrement associated with complications of type 2 diabetes, we combined public-use data on type 2 diabetes patients from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, its follow-on ACCORDION study, and the Action for Health in Diabetes (Look AHEAD) trial. The ACCORD trial administered the Health Utilities Index Mark 3 (HUI-3) instrument periodically, while the Look AHEAD trial administered the HUI-3 every 6 months. Measurements less than 1 year after a complication were associated with the complication event, and measurements more than 1 year after a complication were associated with a history of the complication. We used a fixed-effects model and included controls for BMI, duration of diabetes, and smoking. In total, there were 99,594 person-visit observations in our estimation sample, representing 14,899 unique persons with an average follow-up of 7.5 years. All complication events and complication history indicators negatively affected quality of life. The largest effects were observed for stroke (event year: 0.086; history: 0.056), congestive heart failure (event year: 0.043; history: 0.054), eGFR<30 mg/g (event year: 0.059), and myocardial infarction (MI) (event year: 0.024) (p<0.05). More modest effects were observed for revascularization (event year: 0.014), and eGFR<60 mg/g (event year: 0.008; history: 0.010) (p<0.05). Decrements for angina, history of angina, history of MI, history of revascularization, and history of eGFR<30 mg/g were not statistically significant. This combined analysis of the ACCORD, ACCORDION, and Look AHEAD trials illustrates the negative health impacts of diabetes complications in the year they occur and in subsequent years. Some complications had a large and persistent negative impact on quality of life, such as stroke and eGFR<30 mg/g. In some cases, the quality of life decrement was larger in subsequent years (CHF and angina), possibly because of the chronic and progressive nature of these complications.
S. Neuwahl: None. T.J. Hoerger: Research Support; Self; Sanofi.
Centers for Disease Control and Prevention