Health-related quality of life in diabetic patients with diabetic retinopathy

Abstract

Introduction: Diabetic retinopathy (DR) is a major cause of blindness, so the impact on health related quality of life (HRQL) is
fundamental to assess the complete burden of this pathology. The present study has the aim of : a) assessing HRQL in diabetic
patients with diabetic retinopathy through the administration of the SF-12 questionnaire; b)evaluating what is the impact of the
associated treatments on the HRQL.
Methods: The study was an observational study carried out using a cross-sectional design in 2017.The patients were recruited in
the cities of Rome and Palermo in outpatients ambulatories of Diabetology and Ophthalmology. The SF-12 questionnaire was
administered to calculate two main indicators of HRQL, i.e., Physical composite score (PCS) and Mental composite score (MCS).
Results: 137 diabetic patients entered the study, 65% males, 65.7% married or cohabitant. The educational level was generally
low (37.2% with elementary school. The vast majority were patients with type 2 diabetes mellitus, with a median duration of the
pathology of ten years. 27.7% of the diabetic patients had a retinopathy. Those patients with Diabetic macular edema (DME) (38)
were treated with Dexamethasone implant (39.5%), Ranibizumab (28.9%), Aflibercept(7.9%), laser (15.8%). Concerning the
MCS and PCS, respectively, the highest scores are present among males (p = 0.009 and p = 0.007) and highly educated patients (p
= 0.025 and p = 0.023). No association was found between retinopathy and HRQL scores, both for MCS (p = 0.759) and PCS (p
= 0.120), even if the highest scores are for patients without retinopathy (43.4 for MCS and 42.1 for PCS). Limiting the analysis to
patients with DME only, MCS score was found higher in patients treated with Laser and Dexamethasone implant, and lower for
patients treated with Aflibercepy. However, only patients treated with Dexamethasone implant these results are statistically
significant (Beta= 6.685; p = 0.039).
Conclusion: This study confirmed that lowest HRQL scores are among patients with retinopathy. Moreover, diabetic patients as a
whole showed lowest HRQL scores if compared to the general Italian population. Our results shows the longer the diabetes the best
the HRQL for the MCS score and the worst the PCS scores. Finally, patients with DR treated for retinopathy had highest MCS
score if treated with laser and Dexamethasone implant, but only for Dexamethasone implant the results are statistically significant.,
while no association was found between type of treatment for retinopathy and PCS scores.