Disease-specific health-related quality of life instruments among adults diabetic: A systematic review

Diabetes Res Clin Pract. 2008 May;80(2):171-84. doi: 10.1016/j.diabres.2007.12.020. Epub 2008 Feb 14.


This paper provides a systematic review on health-related quality of life (HRQoL) measures in diabetic patients. For each included study, a description of the measure and its psychometric findings is provided. To evaluate these measures, a databases search (Medline, Scopus and Proqolid) was undertaken to identify relevant publications. Instruments were assessed according to predefined inclusion and exclusion criteria. Sixteen instruments met the inclusion criteria among 1049 references produced: appraisal of diabetes scale (ADS), audit of diabetes-dependent quality of life (ADDQoL), diabetes-39 (D-39), diabetes care profile (DCP), diabetes distress scale (DDS), diabetes health profile (DHP-1, DHP-18), diabetes impact measurement scales (DIMS), diabetes quality of life measure (DQOL), diabetes quality of life clinical trial questionnaire-revised (DQLCTQ-R), diabetes-specific quality of life scale (DSQOLS), elderly diabetes burden scale (EDBS), insulin delivery system rating questionnaire (IDSRQ), quality of life with diabetes questionnaire (LQD), problem areas in diabetes scale (PAID), questionnaire on stress in diabetic patients-revised (QSD-R) and well-being enquiry for diabetics (WED). All those instruments have been developed in northern countries. The shortest instrument (ADS) has seven items and the longest (IDSRQ) has 67 items. ADDQoL was widely translated followed by DHP and PAID. Only authors of ADS and DIMS have not involved patients in the construction of instruments. The authors of instruments: ADS, ADDQoL, DHP, D-39, and PAID reported the item-total correlation which is ranged from 0.28 to 0.84. The ADS, DQOL, EDBS, IDSRQ, LQD, PAID, QSD-R, and WED have been assessed for test-retest reliability which varies between 0.27 and 0.99. The DQLCTQ-R, DQOL and IDSRQ were not subjected to factor analysis. Responsiveness was assessed in PAID with effect sizes and ranged from 0.32 to 0.65 for interventions. Four domains were responsive to clinical change in metabolic control in DQLCTQ-R. The other instruments were not been formally assessed for responsiveness. This review found evidence that the instruments: ADDQoL, D-39, DDS, DHP1/18, DSQOLS, EDBS and QSD-R had adequate psychometric properties. For future research, responsiveness should be a priority and further study is also required to examine the effect of ethnicity and to determine the validity of these scales in developing countries.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Adult
  • Diabetes Mellitus / physiopathology*
  • Diabetes Mellitus / psychology
  • Health Status
  • Humans
  • Patient Selection
  • Quality of Life*
  • Research Design
  • Stress, Psychological / epidemiology
  • Surveys and Questionnaires