Background: Assessing the valuation of diabetes in a low-income country such as Haiti is novel and may improve culturally sensitive values-based counseling. Objectives: To assess how Haitians with diabetes value quality of life with disability and diabetes.

Methods: Cross-sectional study in Haiti of adult participants with diabetes type 1 (T1D) and type 2 (T2D), recruited from diabetes clinics. We asked “If born tomorrow, how many years of disabled life (y) would you trade to avoid lifelong disability” for 4 hypothetical scenarios of mild, moderate, severe and profound disability and 4 hypothetical scenarios of T1D and T2D with and without complications (T1D, T2D, T1D+C and T2D+C). Utility scores were calculated as: (life span - y)/life span, where death = 0 and full life without disability = 1 with >0 indicating better than death (BTD) and <0 indicating worse than death (WTD). We also evaluated religiosity, support and perceived rejection.

Results: One hundred adults with diabetes (65% female, 57% T1D, mean age 26±14y for T1D and 46±18y for T2D) participated. On 5-point Likert scales, scores for religiosity were 4.2±0.8; instrumental support 3.5±0.9; emotional support 3.1±0.9; and perceived rejection 2.2±0.9. Utilities were >0 (BTD) for mild and moderate, and <0 (WTD) for severe and profound disabilities. Patients with T1D valued all diabetes scenarios as >0 (BTD). Patients with T2D valued T2D and T2D+C scenarios as <0 (WTD) and assigned lower utilities to scenarios T1D (p=0.01), T2D (p=0.03) and T2D+C (p=0.01) but not T1D+C (p=0.16). Having T2D and lower religiosity predicted lower utilities for scenarios T2D (p=0.002 and p<.0001) and T2D+C (p=0.0009 and p=0.0006) after adjusting for age, sex, support and rejection.

Conclusions: In Haiti, major disabilities are valued as worse than death. Patients with T1D and T2D value T1D as better than death, whereas patients with T2D, but not T1D, perceive T2D as worse than death. Stronger religious beliefs but not other measures of support influence the valuation of quality of life with diabetes.

Disclosure

C. Belanger-Bishinga: None. C. Partridge: None. E. Jean Baptiste: None. M. Charles Larco: None. P. Larco: None. J.E. von Oettingen: None. K. Altenor: None.

© 2019 by the American Diabetes Association.
2019
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