Health-related quality of life, visual functioning, and depression in a type 1 diabetes population: Wisconsin Epidemiologic Study of Diabetic Retinopathy

The purpose of this study was to investigate the association of changes in socioeconomic, behavioral, and diabetes-related factors with quality of life and depression in a population with type 1 diabetes from the Wisconsin Epidemiologic Study of Diabetic Retinopathy (WESDR). Individuals who participated in the 14-year (1995-6, WESDR 4) and 25-year (2005-7 WESDR 6) follow-up visits were included in the analysis. Quality of life was measured using the Short Form 36 (SF-36) and the National Eye Institute Vision Function Questionnaire-25 (VFQ-25) at both visits and depression was assessed using the Center for Epidemiologic Study Depression scale (CES-D) only during the 2005-7 visit. Our results showed that there was a decrease of quality of life scores after 10 years of follow-up. The only domain that showed an increase after 10 years was mental health and this trend was captured by both questionnaires The development of complications, especially cardiovascular disease, had a significant influence on quality of life of individuals with type 1 diabetes. Loss of visual acuity, more than the development of diabetic retinopathy, had a negative impact in the SF-36 domains related to physical and emotional roles and also on most of the VFQ-25 scores. The long-term complication that showed the strongest association with depression measured by the CES-D scale was neuropathy. Unemployment was one of the strongest factors related to poorer quality of life in this population, and it also influenced changes in vision-related quality of life scores. In addition, individuals who were not working also had higher chances of having depression in our cross-sectional analysis of the WESDR 6 data. Our findings reinforce the necessity of adequate control of micro and macrovascular complications in individuals with diabetes. The changes in employment status were also strongly associated with poorer quality of life and suggest the benefits of preventing complications and keeping people in the workforce.