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Title: Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes
Authors: Tessa Riandini
Hwee Lin Wee 
Eric Y. H. Khoo 
Bee Choo Tai 
Wilson Wang 
Gerald C. H. Koh 
E. Shyong Tai 
Subramaniam Tavintharan
Kurumbian Chandran
Siew Wai Hwang
Kavita Venkataraman 
Keywords: Diabetic polyneuropathy
Functional status
Health-related quality of life
Muscle strength
Postural balance
Range of motion
Type 2 diabetes mellitus
Issue Date: 28-Nov-2017
Publisher: Springer-Verlag
Citation: Tessa Riandini, Hwee Lin Wee, Eric Y. H. Khoo, Bee Choo Tai, Wilson Wang, Gerald C. H. Koh, E. Shyong Tai, Subramaniam Tavintharan, Kurumbian Chandran, Siew Wai Hwang, Kavita Venkataraman (2017-11-28). Functional status mediates the association between peripheral neuropathy and health-related quality of life in individuals with diabetes. Acta Diabetologica 55 (2) : 155-164. ScholarBank@NUS Repository.
Abstract: Aims: To examine differences in health-related quality of life (HRQoL) between patients with and without diabetic peripheral neuropathy (DPN), and whether these differences can be explained by functional deficits. Methods: This was a cross-sectional study of 160 patients with type 2 diabetes mellitus, 80 with DPN and 80 without. Assessments included HRQoL (health utility score derived from EQ-5D-5L), functional status measurements [muscle strength, timed up and go (TUG), five times sit-to-stand (FTSTS), functional reach, body sway velocity] and self-reported balance confidence [Activities-specific Balance Confidence (ABC) scale]. Results: Mean utility scores were 0.67 ± 0.14 and 0.77 ± 0.16 in patients with and without DPN, respectively (p < 0.001). Patients with DPN had lower great toe extensor strength (6.4 ± 1.8 vs 7.6 ± 2.8 lbs, p = 0.001), greater body sway velocity (2.40 ± 1.31 vs 1.90 ± 0.52 mm/s, p = 0.002), slower TUG (12.1 ± 4.6 vs 10.1 ± 2.3 s, p < 0.001) and FTSTS (15.8 ± 5.8 vs 13.9 ± 5.4 s, p = 0.03) scores, and lower ABC score (73.4 ± 21.3 vs 82.6 ± 16.9, p = 0.003), compared to those without DPN. On stepwise multiple regression, DPN status, FTSTS, body sway velocity, BMI, diabetes duration, pain, and gender explained 38% of HRQoL variance. Addition of ABC score into the model explained 45% of variance. Results from structural equation modelling showed that DPN had direct effects on HRQoL and indirect effects through FTSTS, body sway velocity, and ABC score, with ?2 = 8.075 (p = 0.044), root mean square error of approximation = 0.103 (lower bound 0.015, upper bound 0.191), Comparative Fit Index = 0.966, Tucker–Lewis Index = 0.887, and Standardized Root Mean Square Residual = 0.053. Conclusions: Patients with DPN have worse HRQoL compared to patients without DPN, partly mediated by functional status parameters. Effective interventions targeting functional status may be beneficial in improving HRQoL in these patients.
Source Title: Acta Diabetologica
ISSN: 0940-5429
DOI: 10.1007/s00592-017-1077-8
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