Healthy Lifestyle Habits and Health-Related Quality of Life in Diabetes

  • C. Li
  • E. S. Ford
Reference work entry


The prevalence of diabetes has continued to rise in the Unites States. Diabetes has significant impact on  health-related quality of life (HRQOL). Thus, improving HRQOL has been an important aspect of health care management in the diabetic population. In this chapter, we systematically reviewed 20 studies on the correlates of HRQOL in diabetes published between 1998 and 2008. Diabetes-related complications, older age, female sex, black or Native American race/ethnicity, longer  duration of diabetes, insulin therapy, obesity, smoking, and physical inactivity are associated with the impairment of HRQOL in diabetes. Micro- and macro-vascular complications appear to be the strongest correlates of HRQOL. Therefore, intervention strategies aimed at preventing or delaying the occurrence of these complications may lead to improvement of HRQOL.  Healthy lifestyle habits have been associated with improvement of HRQOL. Because people with diabetes are more likely to be non-smokers and to consume more fruits and vegetables but less likely to reach the recommended level of physical activity than those without diabetes, efforts are needed to promote the adoption of healthy lifestyle habits in order to improve HRQOL in diabetes. As an illustration, we provide updated prevalence estimates of impaired HRQOL among people with diabetes and demonstrate how the healthy lifestyle habits are associated with HRQOL using a large population-based sample.


Insulin Therapy Vigorous Physical Activity Behavioral Risk Factor Surveillance System Intermittent Claudication Macrovascular Complication 

List of Abbreviations:


Beck depression inventory


body mass index


 behavioral risk factor surveillance system


Centers for Disease Control and Prevention


confidence interval


cardiovascular disease


 diabetes mellitus


diabetes specific qualify of life scale


diabetes-quality of life


euroQOL-5 dimensions


euroQOL-visual analogue scale


European quality of life scale


fruit and vegetable consumption


healthy lifestyle habits


health-related quality of life


health utility index


insulin dependent diabetes mellitus


leisure-time physical activity


non-insulin dependent diabetes mellitus


not smoking


prevalence ratio


quality of life


quality of well-being index-self administered version


standard error


short form-20


short form-36


survey data analysis


Swedish health-related quality of life scale


type 1 diabetes mellitus


type 2 diabetes mellitus


United Kingdom


United States


World Health Organization



We thank the Behavioral Risk Factor Surveillance System state coordinators for their assistance in data collection.


  1. Andresen EM, Catlin TK, Wyrwich KW, Jackson-Thompson J. (2003). J Epidemiol Community Health. 57: 339–343.PubMedCrossRefGoogle Scholar
  2. Brown DW, Balluz LS, Giles WH, Beckles GL, Moriarty DG, Ford ES, Mokdad AH. (2004). Diabetes Res Clin Pract. 65: 105–115.PubMedCrossRefGoogle Scholar
  3. Brunton SA, Davis SN, Renda SM. (2006). Clin Cornerstone. 8 (Suppl. 2): S19–S26.PubMedCrossRefGoogle Scholar
  4. Camacho F, Anderson RT, Bell RA, Goff DC Jr, Duren-Winfield V, Doss DD, Balkrishnan R. (2002). Qual Life Res. 11: 783–796.PubMedCrossRefGoogle Scholar
  5. Centers for Disease Control and Prevention. (1998). JAMA. 279: 1772–1773.CrossRefGoogle Scholar
  6. Centers for Disease Control and Prevention. (2005). National Diabetes Fact Sheet: General Information and National Estimates on Diabetes in the United States, 2005. U.S. Department of Health and Human Services, Center for Disease Control and Prevention, Atlanta, GA.Google Scholar
  7. Centers for Disease Control and Prevention. (2006). Behavioral Risk Factor Surveillance System User's Guide. Centers for Disease Control and Prevention, Atlanta, GA.Google Scholar
  8. Centers for Disease Control and Prevention. (2008). 2007 Summary Data Quality Report Available at Accessed 19 May 2008.
  9. Chyun DA, Melkus GD, Katten DM, Price WJ, Davey JA, Grey N, Heller G, Wackers FJ. (2006). Biol Res Nurs. 7: 279–288.PubMedCrossRefGoogle Scholar
  10. Coffey JT, Brandle M, Zhou H, Marriott D, Burke R, Tabaei BP, Engelgau MM, Kaplan RM, Herman WH. (2002). Diabetes Care. 25: 2238–2243.PubMedCrossRefGoogle Scholar
  11. Ford ES, Moriarty DG, Zack MM, Mokdad AH, Chapman DP. (2001). Obes Res. 9: 21–31.PubMedCrossRefGoogle Scholar
  12. Ghanbari A, Yekta ZP, Roushan ZA, Lakeh NM. (2005). Public Health Nurs. 22: 311–322.PubMedCrossRefGoogle Scholar
  13. Haffner SM, Lehto S, Ronnemaa T, Pyorala K, Laakso M. (1998). N Engl J Med. 339: 229–234.PubMedCrossRefGoogle Scholar
  14. Hanninen J, Takala J, Keinanen-Kiukaanniemi S. (1998). Diabetes Res Clin Pract. 42: 17–27.PubMedCrossRefGoogle Scholar
  15. Hart HE, Redekop WK, Berg M, Bilo HJ, Meyboom-de JB. (2005). J Clin Epidemiol. 58: 1158–1164.PubMedCrossRefGoogle Scholar
  16. Holmes J, McGill S, Kind P, Bottomley J, Gillam S, Murphy M. (2000). Value Health. 3 (Suppl. 1): 47–51.PubMedCrossRefGoogle Scholar
  17. Huang MC, Hung CH. (2007). J Nurs Res. 15: 193–201.PubMedGoogle Scholar
  18. Idris I, Thomson GA, Sharma JC. (2006). Int J Clin Pract. 60: 48–56.PubMedCrossRefGoogle Scholar
  19. Li C, Ford ES, Mokdad AH, Jiles R, Giles WH. (2007). Diabetes Care. 30: 1770–1776.PubMedCrossRefGoogle Scholar
  20. Lloyd A, Sawyer W, Hopkinson P. (2001). Value Health. 4: 392–400.PubMedCrossRefGoogle Scholar
  21. Maddigan SL, Feeny DH, Majumdar SR, Farris KB, Johnson JA. (2006). Am J Public Health. 96: 1649–1655.PubMedCrossRefGoogle Scholar
  22. Milazzo-Sayre LJ, Henderson MJ, Manderscheid RW. (1997). In: Bonnie RJ, Monahan J (eds.) Mental Disorder, Work Disability, and the Law. University of Chicao Press, Chicago, IL.Google Scholar
  23. Misra R, Lager J. (2008). J Diabetes Complicat. 22: 217–223.PubMedCrossRefGoogle Scholar
  24. Mokdad AH, Ford ES, Bowman BA, Dietz WH, Vinicor F, Bales VS, Marks JS. (2003). JAMA. 289: 76–79.PubMedCrossRefGoogle Scholar
  25. Moriarty DG, Zack MM, Kobau R. (2003). Health Qual Life Outcomes. 1: 37.PubMedCrossRefGoogle Scholar
  26. Newschaffer CJ. (1998). Validation of Behavioral Risk Factor Surveillance System (BRFSS) HRQOL Measures in a Statewide Sample. U.S. Department of Health and Human Services, Public Health Service, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Atlanta.Google Scholar
  27. Nicolucci A, Cucinotta D, Squatrito S, Lapolla A, Musacchio N, Leotta S, Vitali L, Bulotta A, Nicoziani P, Coronel G. (2008). Nutr Metab Cardiovasc Dis. Apr 29. [Epub ahead of print] PMID: 18450436.Google Scholar
  28. Norris SL. (2005). Curr Diab Rep. 5: 124–130.PubMedCrossRefGoogle Scholar
  29. Papadopoulos AA, Kontodimopoulos N, Frydas A, Ikonomakis E, Niakas D. (2007). BMC Public Health. 7: 186.PubMedCrossRefGoogle Scholar
  30. Pate RR, Pratt M, Blair SN, Haskell WL, Macera CA, Bouchard C, Buchner D, Ettinger W, Heath GW, King AC. (1995). JAMA. 273: 402–407.PubMedCrossRefGoogle Scholar
  31. Rejeski WJ, Lang W, Neiberg RH, Van DB, Foster GD, Maciejewski ML, Rubin R, Williamson DF. (2006). Obesity (Silver Spring). 14: 870–883.CrossRefGoogle Scholar
  32. Rubin RR, Peyrot M. (1999). Diabetes Metab Res Rev. 15: 205–218.PubMedCrossRefGoogle Scholar
  33. Shiu AT, Thompson DR, Wong RY. (2008). J Clin Nurs. 17: 125–132.PubMedCrossRefGoogle Scholar
  34. Skov T, Deddens J, Petersen MR, Endahl L. (1998). Int J Epidemiol. 27: 91–95.PubMedCrossRefGoogle Scholar
  35. Strine TW, Chapman DP, Kobau R, Balluz L, Mokdad AH. (2004). Psychiatr Serv. 55: 1408–1413.PubMedCrossRefGoogle Scholar
  36. Strine TW, Okoro CA, Chapman DP, Balluz LS, Ford ES, Ajani UA, Mokdad AH. (2005). Am J Prev Med. 28: 182–187.PubMedCrossRefGoogle Scholar
  37. Tang WL, Wang YM, Du WM, Cheng NN, Chen BY. (2006). Pharmacoepidemiol Drug Saf. 15: 123–130.PubMedCrossRefGoogle Scholar
  38. Testa MA, Simonson DC. (1996). N Engl J Med. 334: 835–840.PubMedCrossRefGoogle Scholar
  39. Toet J, Raat H, van Ameijden EJ. (2006). Qual Life Res. 15: 179–184.PubMedCrossRefGoogle Scholar
  40. UK Prospective Diabetes Study. (1998). Lancet. 352: 837–853.CrossRefGoogle Scholar
  41. UK Prospective Diabetes Study Group. (1999). Diabetes Care. 22: 1125–1136.CrossRefGoogle Scholar
  42. US Department of Health and Human Services. (2000). Healthy People 2010. U.S. Government Printing Office, Washington, DC.Google Scholar
  43. Valensi P, Girod I, Baron F, Moreau-Defarges T, Guillon P. (2005). Diabetes Metab. 31: 263–271.PubMedCrossRefGoogle Scholar
  44. Wexler DJ, Grant RW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, Blais MA, Meigs JB. (2006). Diabetologia. 49: 1489–1497.PubMedCrossRefGoogle Scholar
  45. World Health Organization. (1995). Physical Status: The Use and Interpretation of Anthropometry. Report of a WHO Expert Committee. Technical Report Series No. 854. World Health Organization, Geneva, Switzerland.Google Scholar
  46. Zhao G, Ford ES, Li C, Mokdad AH. (2008). Diabet Med. 25: 221–227.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media LLC 2010

Authors and Affiliations

  • C. Li
    • 1
  • E. S. Ford
    • 1
  1. 1.Behavioral Surveillance Branch, Division of Adult and Community Health, National Center for Chronic Disease Prevention and Health PromotionCenters for Disease Control and PreventionAtlantaUSA

Personalised recommendations