This study described HRQoL of normal glycemic population, pre-diabetics and diabetics in China. Compared with EQ-VAS scores ranging from 61 to 79 in other EQ-5D surveys, result of the study of Chinese diabetics was 69.35, which was at an intermediate level. Compared with the data from other countries, the EQ-VAS score of Chinese diabetes population is slightly higher than Spanish and Poland patients’, which was 61.106 and 68.2 respectively [19-20]. The EQ-Index of this study was consistent with Zhou’s [21] research which showed EQ-Index value of Chinese diabetic patients ranking from 0.79 to 0.94, which means result of the study was still in the middle range. Compared with the EQ-Index of Spanish [19] and German [3] diabetes whose score was 0.742 and 0.80 respectively, EQ-Index of diabetes in the study was slightly higher. Prevalence of diabetes or prediabetes of male was higher than female in the study, but the differences was not statistically significant. The result of the study was consistent with results of some other studies in which prevalence of diabetes in female is lower than male in Chinese [9, 23, 24]. In the other words, men should pay more attention to their glycaemia status as well as life-style.
According to WHO statistics, there are hundreds of complications in patients with diabetes, such as diarrhea, periodontitis, coronary heart disease, heart rate irregularity, nephropathy, frequency of urination, sexual dysfunction, arteriosclerosis, numbness of hands and feet, constipation, dry skin, glaucoma, cataract, ulcer, cerebral ischemia, retinopathy, gangrene, etc. Literature shows 30% of chronic renal failure, 40% to 50% of blindness, 50% of cardiovascular and cerebrovascular diseases, and 60% of amputations are caused by diabetes [25]. Our study showed half of diabetics suffered complications, in which 32.25% diabetics had one kind of complication,19.50% diabetics had two kinds of complications, about 11.00% diabetics had more than three kinds of complications. Among all complications, macroangiopathy and microangiopathy were the main causes of disability or death in elderly diabetics. In this study, atherosclerosis accounted for 0.75% of diabetic patients with macrovascular disease, and incidence of retinopathy, neuropathy and anemia was 9.25%, 4.75% and 0.5% respectively. Therefore, diabetic patients should pay more attention to prevent macroangiopathy and microangiopathy, especially atherosclerosis, retinopathy, neuropathy and anemia.
In the survey, 52% patients had dietary and exercise controlling, but only 14% patients controlled continuously. Most patients misunderstood the way of controlling diet and exercise. For diet controlling, most patients only avoid oily food, sugar and sweets. They were lacked of awareness in calculating calories in foods and practicing separate eating. Therefor patient education of how to get a good dietary and exercise controlling is necessary.
From the survey, we observed that the quality of life in prediabetics was higher than that in normal glycemic people and diabetics. This results were different from a previous German survey showing that the quality of life gradually decreased as glycemic status deteriorated [3]. This may be due to some design defects in this study. The samples of the study were collected from three different populations. The samples of pre-diabetic group mainly came from people who went to the physical examination centers of tertiary hospitals and had more awareness and capabilities for self-health protection. At the same time, most of them had better jobs and accessed to health insurance easier. In the aspects of family income and education background, they had more advantageous than the diabetics and the normal glycaemic population, who were easier to maintain good physiological and mental state. However, after correcting each parameter of gender, age, BMI, alcohol consumption, family history of diabetes, and type of medical insurance by using covariance analysis, results still showed that the quality of life of pre-diabetic group was better than normal glycaemic population and diabetics. This is probably the result of that asymptomatic pre-diabetic patients have lower rates of anxiety or depression (30.30%) than other populations.
There were other limitations in this study, such as recall bias of the blood sugar indicator, diet, exercise, sleep and illness acquired by questionnaire. Furthermore, the study was a cross-sectional study that does not directly determine the causal relationship between changes in quality of life and the dynamic evolution of diabetes. And we did not discuss EQ-VAS score of diabetes subgroups due to the large differences of sample size in them.