A Comparison of the Health Utilities Indices Mark 2 and Mark 3 in Type 2 Diabetes

PURPOSE: Past research into health-related quality of life (HRQL) in diabetes using preference-based measures, such as the Health Utilities Index Mark 2 (HUI2) or the Health Utilities Index Mark 3 (HUI3), is sparse. Important differences between the HUI2 and HUI3 could lead to differences in their abilities to capture HRQL deficits in type 2 diabetes. This analysis compared the extent to which the HUI2 and HUI3 detect differences associated with varying levels of disease severity or advancement in type 2 diabetes. METHODS. This analysis was conducted as part of using baseline, cross-sectional data from a larger, prospective, controlled study of an intervention to improve care for individuals with type 2 diabetes in rural communities in Alberta, Canada. The HU12 and HUI3 were self-administered to 372 community-dwelling individuals with type 2 diabetes. RESULTS: Relative to HUI2 scores, larger differences in overall HUI3 scores were seen for comparisons for individuals presumed to have more advanced disease. The pain attribute of the HUI3 categorized a larger proportion of individuals as moderately to severely impaired (41.5% v. 24.2%, P < 0.001), as did the emotion attribute (20.5% v. 7.7%, P < 0.001). For individuals with negative overall HUI3 scores, differences between overall HUI2 and HUI3 scores persisted after rescaling (mean difference = 0.33, P = 0.009). CONCLUSIONS: The greater range of possible scores on the HUI3, its relative ability to assess the utility of states worse than dead, and its relative superiority in discriminating moderate to severe impairment from mild or no impairment might favor its use over the HUI2 in type 2 diabetes.