Effect of Intensive Glycemic Lowering on Health-Related Quality of Life in Type 2 Diabetes ACCORD trial

• Type of Material: Article
• Authors: Roger T. Anderson, Pennsylvania State University; K.M. Venkat Narayan, Emory University; Patricia Feeney, Wake Forest University; David Goff, Jr, Wake Forest University; Mohammed K Ali, Emory University; Debra L. Simmons, Central Arkansas Veterans Healthcare System; Jo-Ann Sperl-Hillen, HealthPartners Research Foundation; Thomas Bigger, Columbia University; Robert Cuddihy, International Diabetes Center World Health Organization; Patrick J. O'Conner, HealthPartners Research Foundation; Ajay Sood, Case Western Reserve University; Ping Zhang, Centers for Disease Control and Prevention; Mark D. Sullivan, University of Washington
• Language: English
• Date: 2011-04-01
• Publisher: American Diabetes Association
• Publication Version: Final Published Version
• Copyright Statement: © 2011 by the American Diabetes Association.
• License: Creative Commons Attribution-NoDerivs-NonCommercial 1.0 Generic
• Final Published Version (URL): http://dx.doi.org/10.2337/dc10-1926
• Title of Journal or Parent Work: Diabetes Care
• ISSN: 0149-5992
• Volume: 34
• Issue: 4
• Start Page: 807
• End Page: 812
• Grant/Funding Information: The ACCORD study was supported by grants (N01-HC-95178, N01-HC-95179, N01-HC-95180, N01-HC-95181, N01-HC-95182, N01-HC-95183, N01-HC-95184, IAA-Y1-HC-9035, and IAA-Y1-HC-1010) from the National Heart, Lung, and Blood Institute; by other components of the National Institutes of Health, including the National Institute of Diabetes and Digestive and Kidney Diseases, the National Institute on Aging, and the National Eye Institute; by the Centers for Disease Control and Prevention; and by General Clinical Research Centers.
• Keywords: SEVERITY; MELLITUS; Endocrinology & Metabolism; Life Sciences & Biomedicine; CONTROL CARDIOVASCULAR RISK; SATISFACTION; UTILITY; DEPRESSION; Science & Technology
• Research Categories: Health Sciences, Public Health

Abstract

OBJECTIVE - To compare the effect of intensive versus standard glycemic control strategies on health-related quality of life (HRQL) in a substudy of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial. RESEARCH DESIGN AND METHODS - A randomly selected subsample of 2,053 ACCORD participants enrolled in the HRQL substudy was assessed at baseline and 12-, 36-, and 48-month visits. HRQL assessment included general health status (the 36-Item Short Form Health Survey [SF-36]), diabetes symptoms (the Diabetes Symptom Distress Checklist), depression (Patient Health Questionnaire [PHQ]-9), and treatment satisfaction (Diabetes Treatment Satisfaction Questionnaire [DTSQ]). Repeated-measures ANOVA models were used to estimate change in HRQL outcomes by treatment group over 48 months adjusting for model covariates. The effects of early discontinuation of the ACCORD intensive glycemic control arm on study results were explored. RESULTS-A total of 1,956 (95%) completed the self-report HRQL instrument(s) at baseline. The intensive arm had a larger decrease in SF-36 physical health component score than the standard arm (-1.6 vs. -1.1, P = 0.0345). Treatment satisfaction (DTSQ) showed larger improvement with intensive than standard (P = 0.0004). There were no differences in mean scores of the Diabetes Symptom Checklist and PHQ-9. Effects of participant transition following discontinuation of the intensive arm on HRQL were not significant. CONCLUSIONS - The ACCORD trial strategy of intensive glycemic control did not lead to benefits in HRQL and was associated with modest improvement in diabetes treatment satisfaction. Thus patient acceptability was apparently not compromised with intensive and complex interventions such as those used in ACCORD.