Meadows, K.

Mulhern, B.

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PDB73
HEALTH OUTCOMES AMONG TYPE 2 DIABETES PATIENTS WITH COMORBID
OBESITY IN BRAZIL
Orlic Z1, Dibonaventura MD2, Gupta S3, Pomerantz D3, Isherwood G1
1Kantar Health, Epsom, Surrey, UK, 2Kantar Health, New York, NY, USA, 3Kantar Health,
Princeton, NJ, USA
OBJECTIVES:The aimof the current studywas to assess the patient characteristics,
treatment patterns and health outcomes of adult patients with type 2 diabetes
(T2D) with and without comorbid obesity in Brazil.METHODS: Data were obtained
from the Brazil 2011 National Health and Wellness Survey, a self-reported patient
survey of the adult Brazilian population (N12,000). Obese T2D patients (n155)
were compared with non-obese T2D patients (n320) on demographics, HbA1c,
insulin usage, health behaviors and prevalence of hypertension and high choles-
terol. Differences amongst the two groups on levels of health status (assessed with
the SF-12) were also analyzed in a series ofmultiple regressions, controlling for the
effects of patients’ socioeconomic status.RESULTS:T2Dpatientsweremostlymale
(53.89%) and had a mean age of (54.97). A total of 87.79% of patients did not know
their HbA1c and only 16.21% were on an insulin, neither of which varied by pres-
ence of obesity. Obese T2D patients were significantly more likely to belong to B1
socioeconomic group and significantly less likely to belong to C1 socioeconomic
group than non-obese T2D patients (30% vs. 21% and 10% vs.19%, respectively, all
p0.05). Hypertensionwas significantlymore prevalent among obese T2D patients
than among non-obese T2D patients (61% vs. 43%, p.05). Adjusting for differences
in socioeconomic status, obese T2D patients reported significantly lower levels of
PCS (AdjustedMean (Madj)42.7 vs. 44.6, p.05) and had significantly lower health
utilities than non-obese T2D patients (Adjusted Mean (Madj)0.68 vs. 0.72, p.05).
CONCLUSIONS: Few patients in Brazil were aware of their HbA1c, suggesting a lack
of patient education. ObeseT2D patients were more likely to report comorbid hy-
pertension and worse health status yet were no more likely to use insulin than
their non-obese counterparts. Improved patient education and management of
obese T2D patients may improve health outcomes for these patients.
PDB74
PATIENT REPORTED ACCESS TO HEALTH CARE IN PATIENTS WITH DIABETES
AND OBESITY: STUDY ON MEDICAL PANEL EXPENDITURE SURVEY (2008)
Kakad SN1, Franzini L2
1University of Houston, Houston, TX, USA, 2University of Texas Health Science Center Houston,
School of Public Health, Houston, TX, USA
OBJECTIVES: Diabetes and obesity are escalating in adults which increase risk of
developing non communicable diseases. Studies on patients with diabetes and/or
obesity show that factors like patients in rural communities, type of insurance,
gender, race, age have reported difference in access to health care. In order to
understand health related issues it is important to study factors influencing access
to health care for co-occurrence of diabetes and obesity. The aim of this study is to
investigate the hypothesis that access to healthcare is different for diabetic pa-
tients with and without obesity. METHODS: Medical Expenditure Panel Survey
(MEPS) 2008 data was analyzed for diabetic patients with and without obesity.
Access to health care wasmeasured as patients who reported to have usual source
of care (USC) provider. Logistic regression and goodness of fit tests were conducted
to get the best fit model. All analysis was performed by using STATA 11. RESULTS:
A total of 2346 adult patients had diabetes; where 1193 (50.8%) had diabetes and
obesity while 1078 reported to have USC provider. Logistic regression analysis
shows that patients with both diabetes and obesity had better access to health care
(OR1.3432, p0.037) compared to only diabetic patients. Patients with public in-
surance (OR 3.9877 P0.000), who report that it is sometimes easy to get needed
health care (OR1.56 P0.031) and have excellent perceived health status
(OR3.416, P0.001) are more likely to report higher access to healthcare. Age was
the only demographic factor found statistically significant showing older adults (54
to 85) had better access to health care (OR2.081, p0.002).CONCLUSIONS:Comor-
bidities are associatedwith higher access to healthcare. This could be due to higher
utilization of healthcare by patients with comorbid conditions, older age and pro-
viders focusing more on treatment of diseases than prevention.
PDB75
THE VALIDATION OF THE DIABETES HEALTH PROFILE (DHP-18) AND THE
DEVELOPMENT OF A BRIEF MEASURE OF HEALTH RELATED QUALITY OF LIFE
IN DIABETES (DHP-12)
Mulhern B1, Meadows K2
1University of Sheffield, Sheffield, South Yorkshire, UK, 2DHP Research & Consultancy Ltd,
London, UK
OBJECTIVES: The Diabetes Health Profile (DHP-18) is widely used to assess health
related quality of life in diabetes across three domains (psychological distress,
barriers to activity and disinhibited eating). The first aim of this study is to validate
the three domain conceptual framework of the DHP-18. The second aim is to use
psychometric and Rasch analyses to develop a new brief version of the diabetes
health profile (DHP-12) that is based on the same conceptual framework and has
equivalent psychometric performance to the DHP-18. METHODS: Factor analysis
was used to investigate the conceptual framework of the DHP-18. Multivariate
regression and item level psychometric analyses were used to select items for the
DHP-12, and Rasch analysis was used to investigate the performance of the se-
lected items. The psychometric performance of the DHP-12 and DHP-18 was also
compared. The data usedwas from a longitudinal study of health related quality of
life in diabetes in the United Kingdom. RESULTS: The three domain conceptual
framework of the DHP-18was confirmed. Regression analyses selected 12 items for
inclusion in the new brief instrument across the three domains (psychological
distress 4 items; Barriers to activity 5 items; disinhibited eating 3 items). Rasch
analysis showed that the performance of the items included in the briefmeasure is
satisfactory. The DHP-12 was found to be correlated with the DHP-18.
CONCLUSIONS: The DHP-18 is a valid measure of health related quality of life in
diabetes that provides a strong basis for the development of a shortermeasure that
can be used as a brief assessment to reduce respondent burden. Both the DHP-12
and DHP-18 can be used to assess health related quality of life in trials and studies
of both type 1 and type 2 diabetes.
PDB76
GAP ANALYSIS OF EXISTING DIABETES-SPECIFIC HEALTH-RELATED QUALITY
OF LIFE MEASURES FOR USE AMONG MULTI-ETHNIC ENGLISH-SPEAKING
ASIANS WITH DIABETES: AN INTERIM ANALYSIS
Koh O1, Lee J2, Goh SY3, Thumboo J3, Cheung YB4, Tai ES1, Singh A5, Wee HL5
1Yong Loo Lin School of Medicine, National University Health System, Singapore, 2Saw Swee
Hock School of Public Health, National University of Singapore, Singapore, 3Singapore General
Hospital, Singapore, 4Singapore Clinical Research Institute, Singapore, 5Faculty of Science,
National University of Singapore, Singapore
OBJECTIVES:To evaluate existing diabetes-specific patient reported outcome (PRO)
measures and the Patient Reported Outcomes Measurement Information System
(PROMIS) item banks in relation to their their ability to capture health-related
quality of life (HRQoL) domains that are relevant to multi-ethnic English speaking
Asians with Type 2 diabetes mellitus (T2DM). METHODS: Eligible patients were
recruited from a diabetes clinic in a Singapore tertiary care hospital to participate
in focus group discussions about how diabetes affect their HRQoL. Thematic anal-
ysis was performed to distil domains and sub-domains of HRQoL through open
coding by two independent coders followed by axial coding for category refine-
ment. These domains and sub-domains were then compared with items from
Diabetes Quality of Life Measure, Audit of Diabetes Dependent Quality of Life,
Diabetes Health Profile, Diabetes-39, the Comprehensive International Classifica-
tion of Functioning, Disability andHealthCore Set for Diabetes and PROMISVersion
1.0 item banks (all developed in the West). RESULTS: Of 79 T2DM patients ap-
proached, 18 participated in 6 focus groups (9 men; 10 Chinese, 2 Malays, 5 Indians
and 1 Eurasian; mean (SD) age: 46.8 (10.45) years). HRQoL issues in T2DM were
organized into 26 domains and 58 sub-domains. Existing DM-specific PRO mea-
sures did not capture cognitive functioning and restricted participation in religious
activities (domains) andmodified participation in social activities and engagement
of others (sub-domains). 13 of 26 domains and 19 of 58 sub-domains were ad-
dressed by the PROMIS Version 1.0 item banks (physical functioning, anxiety, de-
pression, anger, fatigue interference/experience, social role performance/satisfac-
tion, pain interference/quality/behavior). CONCLUSIONS: There is a significant
degree of overlap inHRQoL domains and sub-domains betweenWestern andAsian
populations but gaps exist. When using generic PROMIS item banks to assess
HRQoL among multi-ethnic Asian populations with T2DM, additional item banks
are needed to fill these gaps and increase content validity.
PDB77
HEALTH-RELATED QUALITY OF LIFE BY ASSESSMENT OF CARDIOVASCULAR
DISEASE (CVD) RISK IN PATIENTS WITH TYPE 2 DIABETES: KOREAN QUDIT OF
DIABETES-DEPENDENT QUALITY OF LIFE (KR-ADDQOL)
Kim DM1, Kim SG2, Lee WY3, Kim CH4, Kim CS5, Cho DH6, Won GJ7, Kim YJ8
1Hallym University Medical Center, Kangdong Sacred Heart Hospital, Seoul, South Korea, 2Korea
University Anam Hospial, Seoul, South Korea, 3Kangbuk Samsung Hospital, Seoul, South Korea,
4Sejong General Hospital, Bucheon-Si, Gyeonggi-do, South Korea, 5Hallym University Medical
Center, Kangdong Sacred Heart Hospital, Gyeonggi-do, South Korea, 6Chonnam National
University Hospital, Gwangju, South Korea, 7Yeungnam University Medical Center, Daegu, South
Korea, 8Pfizer Pharmaceuticals Korea Limited, Seoul, South Korea
OBJECTIVES: This study was conducted to explore how the assessment of CVD
risks impact health-related quality of life (HRQoL) in patients with type 2 diabetes.
METHODS: A prospective, multi-center observational study was carried out in Ko-
rea. CVD risks were assessed in patients with type 2 diabetes and aged  40 years
by carotid ultrasound (CUS). Before and 6 months after CUS, patients completed a
questionnaire on HRQoL using a diabetes-specific instrument: KR-ADDQoL that
estimates the impact of diabetes on 18 life domains. Each item includes both im-
pact (range: -3 [greatest] to 1 [least]), and importance (range: 0 [least] to 3 [most])
scores. These aremultiplied and summed to estimate the averageweighted impact
(AWI) scores, which is reflective of the impact of diabetes on QoL. RESULTS: The
mean present QoL of 622 patients (male 50.5%, mean age 60.09.5 years), was
0.490.92 (range: -3 [extremely bad] to 3 [excellent]) and diabetes-dependent QoL
was -1.480.98 (range: -3 [very much better] to 1 [worse]) at baseline. Patients
reported that family life is the most important (2.270.66) and stated the greatest
impact on freedom to eat (-1.760.93). At 6months after assessment of CVD risks,
the same domains were expressed as the most important and the greatest impact.
In terms of the change of impact degree of diabetes on life domains, it was lesser in
family life (from 2.27 to 2.19, P0.01), friendship and social life (from -2.30 to -2.14,
P0.02), but was greater in freedom to eat (from -4.33 to -4.07, P0.04). AWI of
diabetes considering all life domains was also a bit decreased (from -2.52 to -2.50
although it was not statistically significant. There were no differences in the
changes of the AWI according to CVD risk levels. CONCLUSIONS: The impact of
diabetes on HRQoL was positively changed after the assessment of CVD risks.
PDB78
VARIATION IN ATTACHMENT STYLE AND HEALTH OUTCOMES OF DIABETES
PATIENTS
Sansgiry S1, Naik AD1, Brown AC2, Latini DM3
1VA HSR&D Center of Excellence Michael E. DeBakey VA Medical Center; Baylor College of
Medicine, Houston, TX, USA, 2VA HSR&D Center of Excellence Michael E. DeBakey VA Medical
A184 V A L U E I N H E A L T H 1 5 ( 2 0 1 2 ) A 1 – A 2 5 6


PDB75 The Validation of the Diabetes Health Profile (DHP-18) and the Development of a Brief Measure of Health Related Quality of Life in Diabetes (DHP-12) 

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PDB75 The Validation of the Diabetes Health Profile (DHP-18) and the Development of a Brief Measure of Health Related Quality of Life in Diabetes (DHP-12)

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