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Assessment of Long-term Complications due to Type 2 Diabetes Using Patient Self-report: The Diabetes Complications Index

Fincke, B. Graeme MD; Clark, Jack A. PhD; Linzer, Mark MD; Spiro, Avron III PhD; Miller, Donald R. ScD; Lee, Austin PhD; Kazis, Lewis E. ScD

Journal of Ambulatory Care Management: July-September 2005 - Volume 28 - Issue 3 - p 262–273

This study aims to develop a patient-based measure of the complications of type 2 diabetes that can be used in examining its relationship with health-related quality of life (HRQOL) and utilization of health services. Using questions analogous to those typically employed by clinicians, we developed a 17-item questionnaire to identify prior diagnoses and current symptoms of 6 common complications of type 2 diabetes. We administered it to 419 patients with type 2 diabetes who were part of the Veterans Health Study, a larger prospective investigation of veterans receiving ambulatory care. From the responses, we calculated a simple sum of the 6 complications. We examined the correlation of this Diabetes Complications Index (DCI) with use of diabetes-related medical resources, outpatient doctor visits, HRQOL, duration of diabetes, and the degree to which patients perceived their health to be diminished by diabetes. The DCI was significantly correlated with the degree to which patients perceived their health to be diminished by diabetes (r = 0.35, P = .0001), utilization of diabetes-related resources (model R2 = 0.15, P = .0001), outpatient doctor visits (model R2 = .08, P = .001), and duration of diabetes (r = 0.11, P = .04). It had a good correlation with aspects of HRQOL that reflect physical function when controlling for age and comorbid conditions (model R2 = 0.23, P = .0001). The DCI shows promise as an efficient method for assessing the effects of type 2 diabetes on HRQOL and predicting utilization of medical resources.

Center for Health Quality, Outcomes and Economic Research (CHQOER), Edith Nourse Rogers Memorial Veterans Hospital, Bedford, Mass (Drs Fincke, Clark, Spiro, Miller, Lee, and Kazis); Health Services Department, Boston University School of Public Health, Boston, Mass (Drs Fincke, Clark, and Kazis); Section of General Internal Medicine, Department of Medicine, University of Wisconsin School of Medicine, Madison (Dr Linzer); Normative Aging Study, Boston VA Healthcare System, Boston, Mass (Dr Spiro); Department of Epidemiology, Boston University School of Public Health, Boston, Mass (Dr Spiro); and Department of Mathematics, Boston University, Boston, Mass (Dr Lee).

Corresponding author and reprints: B. Graeme Fincke, MD, Edith Nourse Rogers Memorial Veterans Hospital (152), 200 Springs Rd, Bldg 70, Bedford, MA 01730 (e-mail:

SF-36® is a registered trademark of the Medical Outcomes Trust.

Supported by grant SDR 91006.S from the Health Services Research and Development Service, Department of Veterans Affairs, Washington, DC.

Please address requests for copy of instruments with scoring algorithms to Dr Fincke.

© 2005 Lippincott Williams & Wilkins, Inc.