Assessing Health Related Quality of Life in Persons with Diabetes: A Comparison of Generic Measures

Leslie J. Hinyard*, 1, Caroline M. Geremakis2
1 Saint Louis University Center for Health Outcomes Research, St. Louis, MO, USA
2 HealthCore, Wilmington, Delaware, USA

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© Hinyard and Geremakis; Licensee Bentham Open

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution-Non-Commercial 4.0 International Public License (CC BY-NC 4.0) (, which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Saint Louis University Center for Outcomes Research, 3545 Lafayette Ave, Room 409, St. Louis, MO, 63104, USA; Tel: 314-977-9473; Fax: 314-977-1101; E-mail:



Generic measures of Health Related Quality of Life (HRQoL) are commonly used to assess HRQoL in diabetic populations; however, it is unclear which generic instrument is best suited for assessing HRQoL in a population of patients with diabetes.


To evaluate the differences in estimated HRQoL in a population-based sample of individuals with diabetes and within levels of diabetes severity across generic measures of HRQoL.


Subjects were identified from the National Health Measurement Study (NHMS). Diabetes severity was defined as no diabetes, diabetes without insulin, and diabetes with use of insulin. Unadjusted and adjusted mean differences between the diabetes severity groups were estimated for 11 generic HRQoL measures. Unadjusted and adjusted mean differences between diabetes severity groups were estimated. Effect sizes were calculated to estimate standardized group differences.


Across all measures, persons on insulin demonstrated lower HRQoL scores compared to those not taking insulin. The HALex was tha only measure that identified a significant difference in HRQoL scores between persons with diabetes without insulin management and those taking insulin in adjusted models. The HALex demonstrated the largest effect size for all severity group comparisons.


Across all HRQoL measures the largest differences were seen between persons with diabetes taking insulin and persons without diabetes. The HALex was the only measure that when controlling for both demographic characteristics and comorbid conditions demonstrated a significant difference between diabetes with and without insulin management indicating potential usefulness for researchers interested in examining differences in cross-sectional samples of persons with diabetes.

Keywords: Diabetes, EQ-5D, Health related quality of life, Health utilities index, Health activities and limitations index, SF-36.