Comments on Speightet al.’s ‘Not all roads lead to Rome-a review of quality of life measurement in adults with diabetes’

We welcome Speight et al.’s review of quality of life measurement in adults with diabetes [1]. The discussion of the importance of differentiating quality of life from constructs such as health status, well-being and treatment satisfaction is useful in addressing a continuing confusion in the literature. Also we are pleased to see the positive reviews of the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire (DTSQ) and Well-Being Questionnaire (W-BQ12). However, we would like to comment on remarks about the ADDQoL and provide updates on all three measures. Speight et al. cited the Food and Drug Administration (FDA) 2006 draft guidelines on Patient Reported Outcome measures which advised against questions requiring judgements about hypothetical situations. While this advice is sound in some instances, there are major benefits of the design of ADDQoL items which ask respondents how aspects of their life would change if they did not have diabetes (see response to FDA draft guidance by Clare Bradley published at http://www.fda.gov/ohrms/dockets/dockets/06d0044/06d-0044-EC18-Attach-1.pdf. A direct question about the impact of diabetes often elicits optimistic coping responses suggesting little or no impact while asking ‘but what if you didn’t have diabetes?’ would elicit a more realistic response.