Diabetic Retinopathy Incidence, Progression, and Health-Related Quality of Life From the ACCORD Trial

We performed a retrospective cohort study to evaluate the association between health-related quality-of-life (HRQOL) measures and diabetic retinopathy (DR) progression among participants of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) clinical trial and the ACCORD Eye Study.

Retrospective cohort.

ACCORD (n = 6219) and ACCORD Eye (n = 1687) participants with type 2 diabetes mellitus with a glycated hemoglobin level of at least 7.5%.

HRQOL measures included the feeling thermometer (general health), Health Utilities Index Mark (HUI) 2 (aggregate score of sensation, mobility, cognition, self-care, emotion, pain, and fertility), HUI-3 (aggregate score of vision, hearing, speech, ambulation, dexterity, emotion, cognition, and pain), Patient Health Questionnaire-9 (PHQ-9) for depression, and Short Form-36, including the Aggregate Interference score derived from physical health and emotional problems (Brazier Index). Across all measures, a higher score indicated better HRQOL. Multivariable linear regression adjusted for baseline HRQOL scores as well as demographic and clinical covariates was used to compare the difference in final HRQOL scores after 4 years of follow-up between those who did and did not experience DR progression.

DR development was self-reported by participants in the ACCORD study. DR progression in the ACCORD Eye study was defined as a ≥3-step person scale increase on the Early Treatment of Diabetic Retinopathy Study scale or progression to proliferative DR requiring laser photocoagulation or vitrectomy.

Among ACCORD participants, those self-reporting DR development had a significantly lower score on the EuroQoL feeling thermometer by 3.68 points ([-4.91, -2.45], P < .001), HUI-2 by 0.02 points ([-0.03, -0.01], P = .005), HUI-3 by 0.04 points ([-0.06, -0.02], P < .001), and Brazier Index by 0.03 points ([-0.04, -0.01], P = .001) compared with those who did not report developing DR. Among ACCORD Eye participants, those with DR progression had a significantly lower score on HUI-3 by 0.05 points ([-0.09, -0.01], P = .022) compared with those who did not experience DR progression.

DR development was associated with worse subjective general health, worse HUI-2, worse HUI-3, as well as more interference from physical health and depression. DR progression was only associated with a decrease in HUI-3 by year 4.