Obese versus non-obese patients with type 2 diabetes: patient-reported outcomes and utility of weight change

ABSTRACT Introduction: This study (1) used patient-reported outcome measures to assess and compare the health status of type 2 diabetes patients with and without obesity and (2) assessed the value of weight change among obese and non-obese subgroups, using standard gamble (SG) utility methodology. Methods: Among a sample with type 2 diabetes in the United Kingdom, individuals with obesity (BMI ≥ 30 kg/m2) were identified and compared to non-obese patients. Patients completed the EQ‑5D, Psychological General Well-Being Index, Appraisal of Diabetes Symptoms, and Diabetes Symptom Checklist – Revised (DSC‑R). SG interviews assessed the utility of the ‘basic’ type 2 diabetes health state anchored to respondents’ body weight, as well as health states with altered weight. Results: A total of 129 patients (74 obese; 55 non-obese) completed interviews (mean age 55.9 years; 64.3% male). Obese patients reported lower health status (EQ‑5D VAS; between-group difference: p < 0.001) and greater symptom impact (several DSC‑R scales, p < 0.05). Utilities of the basic health state were 0.86 (obese) and 0.91 (non-obese; p = 0.02). Hypothetical health states with higher weight received lower utilities, whereas reduced weight was associated with increased utility. There was a between-group difference in the disutility associated with 5% higher weight (obese 0.068; non-obese 0.051; p = 0.03). Discussion: Compared with non-obese patients, the obese group reported lower health status and greater symptom impact. SG interviews found an inverse relationship between weight and utility. Furthermore, obese patients with type 2 diabetes may value weight change differently than non-obese patients. Study limitations include the sample size and the use of a patient sample, rather than a sample selected from the general population. Overall, the results demonstrate that utilities can differ by patient subgroups, even among patients with the same diagnosis.