Hemoglobin A1c improvements and better diabetes-specific quality of life among participants completing diabetes self-management programs: a nested cohort study.
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BACKGROUND: Numerous primary care innovations emphasize patient-centered processes of care. Within the context of these innovations, greater understanding is needed of the relationship between improvements in clinical endpoints and patient-centered outcomes. To address this gap, we evaluated the association between glycosylated hemoglobin (HbA1c) and diabetes-specific quality of life among patients completing diabetes self-management programs. METHODS: We conducted a retrospective cohort study nested within a randomized comparative effectiveness trial of diabetes self-management interventions in 75 diabetic patients. Multiple linear regression models were developed to examine the relationship between change in HbA1c from baseline to one-year follow-up and Diabetes-39 (a diabetes-specific quality of life measure) at one year. RESULTS: HbA1c levels improved for the overall cohort from baseline to one-year follow-up (t (74)=3.09, p=.0029). One-year follow up HbA1c was correlated with worse overall quality of life (r=0.33, p=0.004). Improvements in HbA1c from baseline to one-year follow-up were associated with greater D-39 diabetes control ( = 0.23, p=.04) and D-39 sexual functioning ( = 0.25, p=.03) quality of life subscales. CONCLUSIONS: Improvements in HbA1c among participants completing a diabetes self-management program were associated with better diabetes-specific quality of life. Innovations in primary care that engage patients in self-management and improve clinical biomarkers, such as HbA1c, may also be associated with better quality of life, a key outcome from the patient perspective.
