Personal impact of type 2 diabetes decreased over 5 years: implications for motivating patients

Quality of Life and Value Assessment in Health Care

Proposals for health care cost containment emphasize high-value care as a way to control spending without compromising quality. When used in this context, 'value' refers to outcomes in relation to cost. To determine where health spending yields the most value, it is necessary to compare the benefits provided by different treatments. While many studies focus narrowly on health gains in assessing value, the notion of benefit is sometimes broadened to include overall quality of life. This paper explores the implications of using subjective quality of life measures for value assessment. This approach is claimed to be more respectful of patients and better capture the perspectival nature of quality of life. Even if this is correct, though, subjective measurement also raises challenging issues of interpersonal comparability when used to study health outcomes. Because such measures do not readily distinguish benefits due to medical interventions from benefits due to personal or other factors, they are not easily applied to the assessment of treatment value. I argue that when the outcome of interest in value assessment is broadened to include quality of life, the cost side of these measures should also be broadened. I show how one philosophical theory of well-being, Jason Raibley's "agential flourishing" theory, can be adapted for use in quality of life research to better fit the needs and aims of value assessment in health care. Finally, I briefly note some implications of this argument for debates about fairness in health care allocations.

Living with a long-term condition: Understanding well-being for individuals with thrombophilia or asthma

A range of literature has explored the experience of living with a long-term condition (LTC), and frequently treats such experiences and conditions as problematic. In contrast, other research has demonstrated that it may be possible to adapt and achieve well-being, even when living with such a condition. This tends to focus on meaning and the qualitative experience of living with an LTC, and offers alternative perspectives, often of the same or similar conditions. As a result of these conflicting views, this study chose to consider two conditions which, though they may lead to life-threatening illness on occasion, do not appear to impact significantly the lives of all those affected on a daily basis. The aim of this research was to explore and explain how people make sense of two long-term, potentially life-threatening health conditions, namely, thrombophilia and asthma. In doing so, it specifically considered the contribution made by information about the condition. A constructivist grounded theory approach was adopted; this enabled the generation of a theory regarding how people make sense of their LTC, whilst acknowledging the social circumstances in which this was situated. Semi-structured interviews were conducted with 16 participants who had given consent to take part in the research. The findings demonstrate that participants undergo a two-stage process—gaining knowledge and living with a long-term condition. The theory based on these findings indicates that those who are knowledgeable about their condition, making informed decisions in relation to it, and accept their condition are able to live with it, whilst those who do not accept their condition do not fully adapt to it or integrate it into their lives.

Independent and combined effect of diet and exercise in adults with prediabetes

Prediabetes is defined as impaired fasting glucose and/or impaired glucose tolerance. Impaired fasting glucose is usually defined as fasting blood glucose between 5.6 mmol/L and 6.9 mmol/L (100.8-124.2 mg/dL), and impaired glucose tolerance is the 2-hour oral glucose tolerance test of 7.8-11.0 mmol/L (140.4-198.0 mg/dL). Most individuals with prediabetes are overweight or obese and are at greater risk of type 2 diabetes (T2D). The first line of treatment for individuals with prediabetes is lifestyle modification, including diet and exercise. The aim of this review, through the revision of primarily randomized control trials, is to discuss the independent and combined effect of diet and exercise on the incidence of T2D, glycemic control, and weight loss in adults with prediabetes. Based on the available literature, lifestyle modification combining both diet and exercise is effective at reducing the incidence of T2D and improving glycemic control, even without a significant reduction in body weight. Thus, it is unclear whether weight loss, through lifestyle modification, is a cornerstone for improving glycemic control in individuals with prediabetes. The independent effect of diet or exercise alone on the improvement in glycemic control and/or reduction in body weight in individuals with prediabetes still requires more studies to draw a clear conclusion, considering the quality and quantity of available studies. As of now, the best diet and/or exercise program to improve glycemic control and body weight in adults with prediabetes is unknown.