Diabetes and its impact on health-related quality of life: a life table analysis.

PURPOSE: To investigate the health burden of diabetes and determine its impact on health-related quality of life (HRQOL) in a population with a high prevalence of chronic conditions. METHODS: A representative sample of the Canadian province of Newfoundland and Labrador (NL) was used to estimate prevalence of diabetes and mean health utility index (HUI), a utility-based measure of HRQOL. Diabetes-deleted life expectancy (LE) and health-adjusted life expectancy (HALE) were derived to measure HRQOL. RESULTS: Diabetic individuals comprised 6.8% of the sample and accounted for 14% of total deaths from 2001 to 2005. Life Expectancy at age 15 was 61.3 years for men and 66.7 years for women, of which 53.0 and 57.0 years, respectively, were spent with perfect health (86.4 and 85.5%). Eliminating diabetes would extend both the overall LE and HALE for men by 1.3 and 1.4 years, and women by 2.0 and 1.7 years, respectively. People with diabetes had a significantly lower HRQOL than people without diabetes (mean HUI: 0.78 vs. 0.88, P < 0.01). CONCLUSION: The burden of illness from diabetes in NL is considerable. Using cause-eliminated LE and HALE provides a robust approach for assessing HRQOL that may have important implications for diabetes surveillance, prevention, and management strategies.

Does higher continuity of family physician care reduce hospitalizations in elderly people with diabetes?

The objective of this study was to investigate the relationship between continuity of family physician (FP) care and inpatient hospitalizations in elderly people with diabetes who have universally-insured health care. We constructed a population-based retrospective cohort study using a sample of 1143 people aged 65 years or older with newly diagnosed diabetes who were selected from a longitudinal surveillance database in the province of Newfoundland and Labrador (NL), Canada. Continuity of FP care was estimated by 3 chronological indices (Continuity of Care [COC], Usual Provider Continuity [UPC], and Sequential Continuity [SECON]) using administrative physician claims data. Age, sex, number of chronic conditions, and income were used as control variables. People with high continuity had lower crude rates of hospitalization than those with lower continuity. Log-linear regression analysis showed that higher continuity was associated with decreased rates of hospitalization in an unadjusted model [rate ratio (95% confidence interval)]; COC: 0.73 (0.61-0.86); UPC: 0.71 (0.59-0.86); SECON: 0.64 (0.52-0.78), and after adjusting for control variables; COC: 0.82 (0.69-0.97); UPC: 0.82 (0.68-0.98); SECON: 0.75 (0.61-0.91). Other significant predictors of reduced hospitalizations were female sex, fewer chronic conditions, and higher income. The findings suggest that high levels of continuity of FP care are associated with reduced hospitalizations in elderly people with diabetes within a universally-insured health care system.