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Epidemiology/Health Services Research
Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study
  1. Edward Zimbudzi1,2,
  2. Clement Lo1,3,
  3. Sanjeeva Ranasinha1,
  4. Helena Teede1,3,
  5. Tim Usherwood4,5,
  6. Kevan R Polkinghorne2,6,
  7. Greg Fulcher7,8,
  8. Martin Gallagher4,9,
  9. Steven Jan4,10,
  10. Alan Cass4,11,
  11. Rowan Walker12,
  12. Grant Russell13,
  13. Greg Johnson14,
  14. Peter G Kerr2,6,
  15. Sophia Zoungas1,4
  1. 1 School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
  2. 2 Department of Nephrology, Monash Health, Clayton, Victoria, Australia
  3. 3 Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
  4. 4 The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
  5. 5 Department of General Practice, The University of Sydney, Sydney, New South Wales, Australia
  6. 6 School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
  7. 7 Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital School, St Leonards, New South Wales, Australia
  8. 8 Northern Clinical School, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
  9. 9 Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
  10. 10 Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  11. 11 Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
  12. 12 Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia
  13. 13 Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Clayton, Victoria, Australia
  14. 14 Diabetes Australia, Canberra, Australian Capital Territory, Australia
  1. Correspondence to Professor Sophia Zoungas; sophia.zoungas{at}monash.edu

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.

  • quality of Life
  • chronic kidney disease
  • type 2 diabetes
http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjdrc-2019-000842

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    Footnotes

    • Contributors EZ, CL and SZ conceptualized the study. EZ, CL, SR and SZ performed data curation. EZ designed the analysis in consultation with CL, SR, HT, TU, KRP, PGK, GF, MG, SJ, AC, RW, GR, GJ and SZ. EZ drafted the original draft and all authors reviewed and edited the final manuscript.

    • Funding This work was supported by a National Health and Medical Research Council, Australia (NHMRC) Partnership Grant (ID 1055175) between the following health services, research institutes and national consumer stakeholder groups: Alfred Health; Concord Hospital; Royal North Shore Hospital; Monash Health; Monash Centre for Health Research and Implementation, Monash University; The George Institute for Global Health, University of Sydney; Diabetes Australia; and Kidney Health Australia. An Australian Postgraduate Award Scholarship supported CL. HT was supported by an NHMRC, Practitioner Fellowship. An NHMRC Senior Research Fellowship supported SZ.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval Monash University and Monash Health Human Ethics Review Committees.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information. No additional data available.