Abstract
Purpose :
We performed a post hoc analysis to evaluate the association between health-related quality-of-life (HRQOL) measures and diabetic retinopathy (DR) progression among participants of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial and the ACCORD Eye Study.
Methods :
HRQOL measures administered to ACCORD and ACCORD Eye participants included the feeling thermometer (general health), Health Utilities Index Mark (HUIM) 2 (aggregate score of sensation, mobility, cognition, self-care, emotion, pain, and fertility), HUIM 3 (aggregate score of vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain), Patient Health Questionnaire-9 (PHQ-9) for depression, Short Form-36 (SF-36) aggregate mental health, SF-36 aggregate physical health, and the SF-36D Aggregate Interference score derived from physical health and emotional problems (Brazier Index). Across all measures, a higher score indicated better HRQOL. DR progression was defined as a ≥3-step person scale increase on the Early Treatment of Diabetic Retinopathy Study scale or progression to proliferative DR requiring laser photocoagulation or vitrectomy. Multivariate linear regression adjusted for baseline HRQOL scores as well as demographic and clinical covariates was used to compare the difference in final HRQOL scores after 4 years of follow-up between those who did and did not experience DR progression.
Results :
Among ACCORD Eye participants, those who experienced DR progression by year 4 had a lower HUIM 3 by 0.05 points (p=0.008) compared to those who did not (Table 1). Among ACCORD participants who did not have DR at baseline, those who experienced progression by year 4 had a significantly lower score on the feeling thermometer by 4.23 points (p<0.001), HUIM 3 by 0.04 points (p=0.009), and Brazier Index by 0.02 points (p=0.043) compared to those who did not progress. Baseline visual acuity was associated with an increase in HUIM 2 by 0.001 points (p=0.033) for every letter increase among ACCORD participants.
Conclusions :
DR progression was associated with worse subjective general health, worse aggregate self-assessment of vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain, as well as more interference from physical health and emotional problems. However, baseline visual acuity was not a significant predictor for a change in most HRQOL measures after four years of follow up.
This abstract was presented at the 2024 ARVO Annual Meeting, held in Seattle, WA, May 5-9, 2024.