Assessment of handicap in chronic dialysis diabetic patients (Uremidiab section study)
Borgel F, Benhamou PY, Zmirou D, Balducci F, Halimi S, Cordonnier D
Neuro-Rehabilitation Unit, University Hospital of Grenoble, France
As part of a large epidemiological study concerning 494 diabetic patients undergoing dialysis throughout France--the so-called Uremidiab section study--we collected data with the aim of describing objective as well as subjective aspects of quality of survival. Questionnaires were completed from medical records and from direct interviews by trained collectors. The data included: (a) medical status and impairments; (b) functional status with the Barthel index for basic activities of daily living; (c) subjective aspects through self-estimation of fatigue, pain, care burden, quality of life and working capacity. Only 21% of the patients had type 1 diabetes and more than 71% were currently insulin-treated. Among the various long-term complications registered, visual impairment was a prominent feature: 25% of the patients were blind and the best eye vision scored 0.8 or more for only 20%. The differences found between the two types of diabetes are discussed. As a result of these impairments, functional status was poor even when considering basic activities, with a mean Barthel index (BI) of 80 +/- 19. Type 2 patients and those patients undergoing continuous ambulatory peritoneal dialysis had significantly lower BI. The results are discussed in the light of the literature. Compared with a group of 121 non-dialyzed diabetics, patients scored higher for fatigue and pain, but not for care burden and quality of life.
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