Time Trade-Off法を用いた外来通院中の糖尿病患者のHR QOL（Health-R elated QOL）の評価

The Evaluation of HRQOL in Out-Patinets with Diabetes by Time Trade-Off Method

要旨

　糖尿病患者のHRQOLをTime Trade-Off（TTO）法を用いて評価するために，外来通院中の患者100名に，TTO法と半構成的面接法を用いて，TTO値とその値を低下させる要因を，年齢，身体的症状，否定的感情，治療法，HbA1C%から検討した．患者を生存期間が短くなっても健康な状態で生きたい交換者，現在の糖尿病の状態のままで生きたい非交換者の2群に分けた時，次のような結果が得られた．①年齢，身体的自覚症状，否定的感情は健康な生存期間との交換要因となったが，交換者のTTO値に差はなかった．②3大合併症，治療法，HbA1C%の改善は，交換要因ではなかった．③合併症は交換要因ではなかったが，交換者のTTO値を有意に低下させた．④役割期待を含む社会的要因が，交換・非交換の理由になっていた．今後，TTO値を低下させる機序について，患者の役割期待の関係からも検討する必要性が示唆された．

Abstract

　Purpose：This study aimed to investigate two on problems on HRQOL of patients with diabetes, Time Trade-Off method was used. First,why would out-patients trade their remaining life with disease for a short life without disease? Second, what factors affect the patient's preference of the health state (TTO values)?

　Method：One hundred out-patients with diabetes were recruited from the out-patients clinic in a general hospital. Patients were asked individually about each item of TTO. The TTO value was measured.

　Results：(1) 44.3% of patients would be willing to trade their life-time with disease for the life-time without disease (Trade-Off Group), but 55.7% of patients would not be willing to do so (No Trade-Off Group). (2)The mean TTO value of the Trade-Off Group was 0.43±0.31. (3) The number of patients with physical disabilities and negative feelings about daily life in the Trade-Off Group were significantly greater than those in the No Trade-Off Group (p＜.01). (4) There were no differences in the numbers of insulin-treated patients and the mean scores of HbA _1c% between the Trade-Off group and the No Trade-Off group. (5)The TTO values of patients with complications were significantly lower in comparison with those of the patients without complications (p＜.01). (6)Some social reasons were recognized for the preference of the health state of the two groups.

　Conclusion：The present study found some new findings and suggested necessary cares for HRQOL in patients with diabetes. However, it is necessary to further investigate the influence of social factors on the TTO value and HRQOL.