Quality of life of patients with diabetes mellitus -: An overview of research in primary health care in the Nordic countries

Objective. A review of articles on health-related quality of life (HRQoL) among diabetes patients in primary health care in the Nordic countries. Design. Search in PubMed and related sources. Used MeSH terms were: "Diabetes Mellitus'', "Quality of Life'', "Primary Health Care'', and "Scandinavia'' or "Denmark'', "Finland'', "Iceland'', "Norway'', or "Sweden''. Results. In total, 19 relevant articles were found, 9 from Finland and 10 from Sweden. HRQoL questionnaires used were from the Medical Outcomes Study, i.e. the SWED-QUAL in seven, SF-20 in four and SF-36 in one, NHP in two, GQL in two, GHQ in one, and own questionnaires in two. HRQoL was moderately affected in diabetic patients, with macrovascular diseases, especially coronary heart disease, and non-vascular diseases as the most consistently found and strongest predictors. Weaker predictors were microvascular complications, age, sex, metabolic level, and education. Other groups at higher risk of worse HRQoL were diabetes patients with psychiatric disorders, especially depression, and foreign-born patients. Good continuity of care was associated with better HRQoL. Conclusion. Diabetes affects the HRQoL through macrovascular complications and associated non-vascular comorbidity, and also by adding to the total burden of disease. Future research areas include transcultural and ethnic aspects, and effects of lifestyle interventions.