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Published online March 4, 2008
Diabetes Care 31:932-933, 2008
DOI: 10.2337/dc07-2072
© 2008 by the American Diabetes Association
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Epidemiology/Health Services Research
Original Research

Prediction of Mortality in Type 2 Diabetes From Health-Related Quality of Life (ZODIAC-4)

Nanne Kleefstra, MD1,2, Gijs W.D. Landman, MD3, Sebastiaan T. Houweling, MD, PHD2,4, Lielith J. Ubink-Veltmaat, MD, PHD5, Susan J.J. Logtenberg, MD1, Betty Meyboom-de Jong, MD, PHD6, James C. Coyne, PHD7, Klaas H. Groenier, PHD6 and Henk J.G. Bilo, MD, PHD1,8

1 Diabetes Centre, Isala Clinics, Zwolle, the Netherlands
2 Langerhans Medical Research Group, Zwolle, the Netherlands
3 Department of Internal Medicine, Isala Clinics, Zwolle, the Netherlands
4 General Practice Sleeuwijk, Sleeuwijk, the Netherlands
5 General Practice ‘t Veen, Hattem, the Netherlands
6 Department of General Practice, University of Groningen, Groningen, the Netherlands
7 Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
8 Department of Internal Medicine, University Medical Center Groningen, Groningen, the Netherlands

Corresponding author: Nanne Kleefstra, Diabetes Centre, Isala Clinics, Zwolle, Netherlands. E-mail: kleefstra{at}langerhans.com

OBJECTIVE—To investigate the relationship between health-related quality of life (HRQOL) and mortality in type 2 diabetes.

RESEARCH DESIGN AND METHODS—In 1998, 1,143 primary care patients with type 2 diabetes participated in the Zwolle Outpatient Diabetes project Integrating Available Care (ZODIAC) study. At baseline, HRQOL was assessed with the RAND-36 and, after almost 6 years, life status was retrieved. Cox proportional hazards modeling was used to investigate the association between HRQOL (continuous data) and mortality with adjustment for selected confounders (smoking, age, sex, diabetes duration, A1C, renal function, BMI, blood pressure, HDL cholesterol, and macrovascular complications).

RESULTS—The Physical Component Summary of the RAND-36 was inversely associated with mortality (hazard ratio [HR] 0.979 [95% CI 0.966–0.992]), as were two separate RAND-36 dimensions.

CONCLUSIONS—This study found that HRQOL is an independent marker of mortality and emphasizes the importance of looking beyond clinical parameters in patients with type 2 diabetes.

Abbreviations: HRQOL, health-related quality of life • MCS, mental component summary • PCS, physical component summary • ZODIAC, Zwolle Outpatient Diabetes project Integrating Available Care


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