Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study

Edward Zimbudzi; Clement Lo; Sanjeeva Ranasinha; Helena Teede; Tim Usherwood; Kevan R Polkinghorne; Greg Fulcher; Martin Gallagher; Steven Jan; Alan Cass; Rowan Walker; Grant Russell; Greg Johnson; Peter G Kerr; Sophia Zoungas

doi:10.1136/bmjdrc-2019-000842

Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study

BMJ Open Diabetes Res Care. 2020 Jan;8(1):e000842. doi: 10.1136/bmjdrc-2019-000842.

Authors

Edward Zimbudzi^{1

2}, Clement Lo^{1

3}, Sanjeeva Ranasinha¹, Helena Teede^{1

3}, Tim Usherwood^{4

5}, Kevan R Polkinghorne^{2

6}, Greg Fulcher^{7

8}, Martin Gallagher^{4

9}, Steven Jan^{4

10}, Alan Cass^{4

11}, Rowan Walker¹², Grant Russell¹³, Greg Johnson¹⁴, Peter G Kerr^{2

6}, Sophia Zoungas^{15

4}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia.
² Department of Nephrology, Monash Health, Clayton, Victoria, Australia.
³ Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia.
⁴ The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia.
⁵ Department of General Practice, The University of Sydney, Sydney, New South Wales, Australia.
⁶ School of Clinical Sciences, Monash University, Clayton, Victoria, Australia.
⁷ Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital School, St Leonards, New South Wales, Australia.
⁸ Northern Clinical School, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia.
⁹ Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
¹⁰ Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
¹¹ Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
¹² Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia.
¹³ Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Clayton, Victoria, Australia.
¹⁴ Diabetes Australia, Canberra, Australian Capital Territory, Australia.
¹⁵ School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia [email protected].

Abstract

Objective: To evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD).

Research design and methods: A longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (stage 3a or worse) who attended a new diabetes kidney disease service was conducted at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Kidney Disease Quality of Life (KDQOL-36) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12-month scores. A subgroup analysis examined the effects by patient gender. Multiple regression analysis examined the factors associated with changes in scores.

Results: 179 patients, 36% of whom were female, with baseline mean±SD age of 65.9±11.3 years, were studied. Across all subscales, HRQOL did not significantly change over time (p value for all mean differences >0.05). However, on subgroup analysis, symptom problem list and physical composite summary scores increased among women (MD=9.0, 95% CI 1.25 to 16.67; p=0.02 and MD=4.5, 95% CI 0.57 to 8.42; p=0.03 respectively) and physical composite scores decreased among men (MD=-3.35, 95% CI -6.26 to -0.44; p=0.03).

Conclusion: The HRQOL of patients with comorbid diabetes and CKD attending a new codesigned, integrated diabetes and kidney disease model of care was maintained over 12 months. Given that HRQOL is known to deteriorate over time in this high-risk population, the impact of these findings on clinical outcomes warrants further investigation.

Keywords: chronic kidney disease; quality of Life; type 2 diabetes.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Australia / epidemiology
Comorbidity
Delivery of Health Care, Integrated / methods
Delivery of Health Care, Integrated / organization & administration*
Diabetes Mellitus / epidemiology*
Female
Follow-Up Studies
Humans
Incidence
Longitudinal Studies
Male
Prognosis
Quality of Health Care / standards*
Quality of Life*
Renal Insufficiency, Chronic / epidemiology*
Surveys and Questionnaires