Low health-related quality of life is strongly linked to upper extremity impairments in type 1 diabetes with a long duration

Abstract

Purpose

To compare health-related quality of life (HRQOL) in type 1 diabetes and non-diabetic controls and possible links to upper extremity impairments (UEIs). Prevalence of sick-leave and causes were investigated.

Materials and methods

This Swedish population-based case-control study included type 1 diabetes patients <67 years old and with a diabetes duration ≥20 years. Participants completed a postal questionnaire including Short Form 36, and questions regarding UEIs, and sick-leave.

Results

In total, 773 patients, aged 50 ± 10 years (diabetes duration 35 ± 10 years), and 708 non-diabetic controls, aged 54 ± 9 years, completed the study. Patients reported significantly lower HRQOL compared with controls. The difference was greatest for general health, vitality, and bodily pain. Patients with shoulder or hand but not finger impairments scored significantly lower than asymptomatic patients. The prevalence of sick leave was higher in patients vs. controls (23% vs. 9%, p < 0.001), and nearly half cited impairments from back, muscles, or joints as the main reason.

Conclusions

Health-related quality of life is lower in type 1 diabetes than controls and in patients with shoulder and hand impairments than in asymptomatic. Musculoskeletal impairments (back/muscle/joints) have impact on work ability. Identification of UEIs is important for initiating preventative-, therapeutic-, and rehabilitative interventions.

Implications for rehabilitation

• Upper extremity impairments (UEIs) that are common in type 1 diabetes, and associated with reduced health-related quality of life, should preferably be screened for on a regular basis along with other known diabetes complications.

• Early identification of UEIs is important to improve health by initiating preventive as well as therapeutic multi-professional rehabilitative interventions.

• Sick leave is higher in type 1 diabetes than in controls. Musculoskeletal impairments, including the back, muscles, and joints, are a common cause for sick leave warranting further studies.

Keywords:

• Quality of life
• type 1 diabetes
• upper extremity impairments
• work ability
• disability

Acknowledgements

The authors are grateful to all patients who participated in our study by answering a questionnaire and donating blood samples. We thank all colleagues in south-east Sweden who assisted with the recruitment of patients.

Prior presentations: Parts of this study were presented in abstract form at the 54th Annual Meeting of the European Association for the Study of Diabetes, Berlin, Germany, 1–5 October 2018.

Disclosure statement

No potential conflicts of interest were reported by the authors.

Author contributions

KG, HA, CH, IT, MBL and AS researched the literature and designed the study, collected and reviewed the data and made the statistical analysis. KG wrote the first draft of the article. All authors approved the final version of the report. AS is the guarantor of this work and as such, had full access to all data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Additional information

Funding

This work was supported by the Medical Research Council South-east Sweden (FORSS), The County Council, and Stiftelseförvaltningen of Region Östergötland, Sweden.