Independent associations of mental health and diabetes complications with health-related quality of life: Evidence from a cross-sectional study.

Depression was the strongest independent predictor of reduced health-related quality of life in adults with diabetes.

• Elevated depressive symptoms were associated with lower EQ-5D utilities (β = -0.212, p < 0.01)
• Depression reduced HRQoL by up to 21%
• Depressive symptoms were assessed using the PHQ-8
• This association was independent of demographic, diabetes-related, and comorbidity factors in multivariable Tobit regression

Mental health variables explained a similar proportion of variance in HRQoL as diabetes-related complications.

• Mental health variables explained approximately 22% of variance in HRQoL
• Diabetes-related complications explained approximately 20% of variance in HRQoL
• Mental health factors included depression, diabetes distress, and fear of hypoglycaemia
• Blockwise multivariable models evaluated incremental explained variance across demographic, diabetes-related, comorbidity, and mental-health domains

Fear of hypoglycaemia and diabetes distress were independently associated with lower HRQoL.

• Fear of hypoglycaemia was associated with lower EQ-5D utilities (β = -0.085, p < 0.01)
• Diabetes distress was associated with lower EQ-5D utilities (β = -0.069, p < 0.01)
• Mental health factors overall showed associations with reduced HRQoL by up to 27%
• Fear of hypoglycaemia was assessed using the Hypoglycaemia Fear Survey (HFS-II) and diabetes distress using the Problem Areas in Diabetes (PAID) scale

Neuropathy and diabetic foot syndrome were independently associated with lower HRQoL among diabetes complications.

• Neuropathy was associated with lower EQ-5D utilities (β = -0.123, p < 0.01)
• Diabetic foot syndrome was associated with lower EQ-5D utilities (β = -0.078, p < 0.01)
• Clinical variables including complications were self-reported
• These associations remained significant in multivariable analyses controlling for other factors

Female sex and higher BMI were independently associated with lower HRQoL in adults with diabetes.

• Female sex was associated with lower EQ-5D utilities (β = -0.045, p < 0.01)
• Higher BMI was associated with lower EQ-5D utilities (β = -0.029, p < 0.01)
• Both associations were independent in multivariable analyses
• BMI was among self-reported clinical variables

The study sample consisted of 734 adults with diabetes in Germany, predominantly with type 1 diabetes.

• Of 1581 invitees, 734 completed the EQ-5D
• Mean age was 56 ± 14 years
• 73% of participants had type 1 diabetes
• Data were collected via cross-sectional online survey conducted between September 2024 and February 2025
• HRQoL was assessed using the EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L)