Health-Related Quality of Life in Primary Care: Which Aspects Matter in Multimorbid Patients with Type 2 Diabetes Mellitus in a Community Setting?

PLoS One. 2017 Jan 26;12(1):e0170883. doi: 10.1371/journal.pone.0170883. eCollection 2017.


Background and objective: Knowledge about predictors of health-related quality of life for multimorbid patients with type 2 diabetes mellitus in primary care could help to improve quality and patient-centeredness of care in this specific group of patients. Thus, the aim of this study was to investigate the impact of several patient characteristics on health-related quality of life of multimorbid patients with type 2 diabetes mellitus in a community setting.

Research design and methods: A cross-sectional study with 32 primary care practice teams in Mannheim, Germany, and randomly selected multimorbid patients with type 2 diabetes mellitus (N = 495) was conducted. In order to analyze associations of various patient characteristics with health-related quality of life (EQ-5D index) a multilevel analysis was applied.

Results: After excluding patients with missing data, the cohort consisted of 404 eligible patients. The final multilevel model highlighted six out of 14 explanatory patient variables which were significantly associated with health-related quality of life: female gender (r = -0.0494; p = .0261), school education of nine years or less (r = -0.0609; p = .0006), (physical) mobility restrictions (r = -0.1074; p = .0003), presence of chronic pain (r = -0.0916; p = .0004), diabetes-related distress (r = -0.0133; p < .0001), and BMI (r = -0.0047; p = .0045).

Conclusion: The findings of this study suggest that increased diabetes-related distress, chronic pain, restrictions in (physical) mobility, female gender, as well as lower education and, increased BMI have a noteworthy impact on health-related quality of life in multimorbid patients with type 2 diabetes mellitus seen in primary care practices in a community setting. The highlighted aspects should gain much more attention when treating multimorbid patients with type 2 diabetes mellitus.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Anxiety / epidemiology
  • Anxiety / physiopathology
  • Anxiety / psychology*
  • Body Mass Index
  • Chronic Pain / epidemiology
  • Chronic Pain / physiopathology
  • Chronic Pain / psychology*
  • Community Health Services*
  • Comorbidity
  • Cross-Sectional Studies
  • Depression / epidemiology
  • Depression / physiopathology
  • Depression / psychology*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Diabetes Mellitus, Type 2 / physiopathology
  • Diabetes Mellitus, Type 2 / psychology*
  • Educational Status
  • Female
  • Germany / epidemiology
  • Humans
  • Male
  • Middle Aged
  • Mobility Limitation
  • Patient-Centered Care
  • Primary Health Care
  • Quality of Life / psychology*
  • Sex Factors
  • Surveys and Questionnaires

Grants and funding

This study was funded by the German Federal Ministry of Education and Research (Bundesministerium fuer Bildung und Forschung) (funding code: 01KQ1003B). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.