Health and quality of life outcomes impairment of quality of life in type 2 diabetes mellitus: a cross-sectional study

The social determinants of health-related quality of life among people with chronic disease: a systematic literature review

PURPOSE

This systematic review investigates the relationship between Social Determinants of Health (SDoH) and Health-Related Quality of Life (HRQoL) among individuals with chronic diseases. SDoH refer to the conditions in which people live, work, and interact, which are associated with health outcomes and inequalities. Understanding these determinants in the context of chronic diseases is essential for developing targeted interventions to improve their HRQoL.

METHODS

We conducted a systematic review following PRISMA guidelines, searching PubMed, Web of Science, and Embase for original research articles published in English during the last 10 years. Studies included quantitative assessments of the relationship between SDoH and HRQoL in chronic disease populations. 38 studies met the eligibility criteria and were included in the analysis.

RESULTS

Significant bivariate associations between SDoH and HRQoL were observed. Younger age, male gender, higher social support, being married, higher education level, employment, higher income, and urban living were generally linked to better HRQoL. Multivariate analyses identified higher education and income as consistent predictors of better HRQoL when considered alongside other SDoH. Urbanization, age, and gender showed some mixed associations with HRQoL, highlighting the need for context-specific interventions.

CONCLUSION

The findings underscore the critical role of SDoH in HRQoL among chronic disease populations. Policies aimed at improving HRQoL should consider multiple SDoH, particularly focusing on patients with low educational attainment living in low-income areas. However, variability in sample sizes and HRQoL measures complicate comparison. The predominance of cross-sectional studies limits the understanding of time-related effects, thus, future research should prioritize longitudinal studies.

Evaluation of quality of life and eating behavior in outpatients with type 2 diabetes mellitus and/or systemic arterial hypertension: a cross-sectional study

To evaluate the quality of life and eating behavior of patients with type 2 diabetes mellitus and/or systemic arterial hypertension treated at a specialized outpatient service in southern Brazil. The cross-sectional study included adults and elderly individuals previously diagnosed with type 2 diabetes mellitus and/or systemic arterial hypertension. The WHOQOL-bref instrument was used to obtain quality of life. Eating behavior was assessed using the Three-factor Eating Questionnaire-R21. Multiple linear regression and Spearman's correlation were used to examine the relationship between quality of life and eating behavior. And the Mann-Whitney U-test, Kruskal-Wallis and multiple linear regression to verify the relationship between quality of life, behavior, sociodemographic and clinical. E o Spearman's correlation coefficient was used to examine the relationship between quality of life and eating behavior. A significance level of 5% was adopted for all analyses. A total of 326 participants were included, with a mean age of 57.0 ± 12.2 years, the majority of whom were females (70.9%) and adults (53.4%). Females exhibited worse quality of life, as observed in the domains of 'psychological' (p = 0.000), 'environmental' (p = 0.033), and general quality of life (p = 0.017). In addition, associations were also observed between quality of life and age, education level, and sleep duration. Sleeping less than 8 hours/day was the predictor that most contributed to the decrease in quality of life scores. Cognitive restriction was the dimension of eating behavior with the highest score (44.4); however, only uncontrolled eating (p = 0.000) and emotional eating (p = 0.000) were associated with age. Self-perception of quality of life changed according to gender, age group, sleep duration and eating behavior. The quality of life was inversely correlated with emotional eating and uncontrolled eating.

Concept analysis of diabetes-related quality of life

BACKGROUND

Quality of life (QoL) is a common indicator of outcomes in people living with diabetes, but the concept of diabetes-related QoL (DRQoL) remains unclear. Clarifying core knowledge of DRQoL was the goal of this paper.

METHODS

A concept analysis was conducted according to Walker and Avant's framework. A systematic search of the published literature was conducted between 2002 and 2022 based on resource availability, current relevancy, and the quality of recent studies. Three major databases were used to identify the attributes, antecedents, consequences, and measures for DRQoL. Only articles investigating DRQoL among adult or elderly people living with diabetes that were published in English in peer-reviewed journals were analyzed.

RESULTS

In total, 4342 articles were screened, and only 401 articles underwent eligibility assessment. A total of 183 articles were included in the analysis. Most (59.78%) of them were observational studies and DRQoL as a primary outcome. We identified four critical components of DRQoL: (a) general health, (b) diabetes-related satisfaction, (c) diabetes impact, and (d) diabetes self-management. The antecedents were classified according to their contributions to DRQoL as follows: 25 positive-induced, 4 neutral-based, and 19 negative-induced antecedents. The consequences of DRQoL were mortality risk, personal health, satisfaction with health care, hospitalization risk, and failure to return to work. The referents varied widely, and 32 tools were found for DRQoL measurement. Furthermore, 12 scales for disease-specific DRQoL and 17 tools for general QoL were identified.

CONCLUSION

This paper provides a definition of DRQoL as well as its attributes, antecedents, consequences, and measures in adults with diabetes. The attributes of DRQoL included general health, diabetes-related satisfaction, diabetes impact, and diabetes self-management. A comprehensive understanding of DRQoL can improve the quality of care and can aid in the recognition of the needs of care among people living with diabetes.

Predictive factors of sexual dysfunction and quality of life among type 2 diabetes outpatients in southern Iran: a cross-sectional survey

OBJECTIVES

This study was conducted to determine the predictors of sexual dysfunction and quality of life (QOL) in patients with type 2 diabetes (T2D). Sexual dysfunction is a long-term consequence of diabetes that is widely ignored in personal management, even though it can have an adverse effect on QOL.

DESIGN

This research was designed as a cross-sectional study.

SETTING

12 diabetes centres and clinics in Shiraz, south of Iran.

PARTICIPANTS

390 male patients with T2D mellitus participated in this project. The inclusion criteria were being 30-65 years, having a history of diabetes of at least 1 year, having fasting blood sugar and glycosylated haemoglobin tests and being willing to participate in the study. Patients with medication treatment for mental disorders, a history of heart disease and renal failure were excluded.

PRIMARY OUTCOME MEASURES

QOL and erectile dysfunction (ED). The questionnaires were the Audit of Diabetes-Dependent QOL (ADDQOL) and the International Index of Erectile Function (IIEF-15). Data were reported using descriptive and analytical statistics methods.

RESULT

The participants' mean age was 48.35±9.27 years. The average weighted impact (AWI) score of ADDQOL for the participants was -3.01, indicating the negative influence of diabetes on their QOL. The mean value of the total score of sexual dysfunction was 42.79±22.75, and the rates of mild, mild to moderate, moderate and severe ED were 19%, 17.7%, 17.2% and 24.6%, respectively. Sexual dysfunction was significantly related to age (OR=1.06; 95% CI: 1.02 to 1.09), diabetes duration (OR=1.04, 95% CI: 1.01 to 1.07), HbA1c (OR=1.45, 95% CI: 1.07 to 1.95), BMI (OR=1.10, 95% CI: 1.03 to 1.16), marital status (married: OR=2.30, 95% CI: 1.40 to 3.77), without diabetes complication (OR=0.17, 95% CI: 0.08 to 0.31) and insulin therapy (OR=2.86, 95% CI: 1.67 to 4.92). ADDQOL was significantly related to age (OR=1.049), HbA1c (OR=2.192), marital status (married: OR=2.089), educational level (high school certificate: OR=0.337, university degree: OR=0.295), diabetes complication (no complication: OR=0.372) and insulin therapy (OR=3.82). AWI was correlated with the total score of IIEF-15 (r=0.78, p value <0.001).

CONCLUSION

To improve the QOL of diabetic patients, it is suggested that all the predictors of sexual dysfunction, such as glycaemic control, obesity, diabetes complications and duration, should be considered in diabetic management guidelines.

Assessment of the Quality of Life of Patients with Diabetes and Prediabetes in Poland: A Cross-Sectional Study

Background: Diabetes mellitus is one of the greatest public health challenges worldwide and one of the major conditions contributing to a poorer quality of life. The main factors that may deteriorate quality of life among patients with diabetes include age, financial status, educational background, quality of healthcare services and presence of disease complications. This study aimed to assess the quality of life among patients with type 1 and type 2 diabetes and prediabetes in Poland using the example of the Podlaskie Province, taking into account selected sociodemographic variables. Methods: A total of 874 patients participated in the study, including 448 women (55.8%) and 386 men (44.2%). The study was conducted from July 2022 to July 2023 among participants of the "Zatrzymaj cukrzycę! Polski Rejestr Diabetologiczny PolReD" ("Stop Diabetes! Polish Diabetes Registry (PolRed)") project or those hospitalised in the Department of Endocrinology, Diabetology and Internal Medicine at the University Clinical Hospital in Bialystok. The study used a diagnostic survey method using a survey questionnaire developed by the authors and the 36-Item Short Form Survey (SF-36). Results: The overall study group had the highest level of quality of life assessment in the domains of social functioning (M = 69.48; SD ± 28.07), physical functioning (M = 64.54; SD ± 31.57) and role limitations due to emotional problems (M = 62.40; SD ± 45.21), and the lowest level of quality of life in the domain of general health perceptions (M = 42.21; SD ± 12.77). Age was found to be negatively correlated in all quality of life domains analysed (r = -0.438; p < 0.001)-quality of life decreased with age in all investigated domains. Men had a statistically significantly (p < 0.05) higher quality of life in each analysed domain (M = 43.52-74.08; SD ± 12.68-44.09) compared to women (M = 41.18-65.88; SD ± 12.76-46.08). Place of residence also exhibited a statistically significant (p < 0.05) differentiated quality of life in terms of physical functioning. Conclusions: The assessment of quality of life among patients with type 1 and type 2 diabetes and those diagnosed with prediabetes from the Podlaskie Province depends on the type of hyperglycaemic disorder. The assessment of quality of life among patients with type 1 and type 2 diabetes and prediabetes is determined by specific socio-demographic factors, including, above all, age and gender. Respondents with type 1 diabetes have a higher quality of life in terms of role limitations due to physical health, role limitations due to emotional problems, pain (bodily pain) and general health compared to respondents with type 2 diabetes.

Enhancing patient-centered care: Evaluating quality of life in type 2 diabetes management

AIMS

To evaluate quality of life (QoL) in patients with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study included 151 T2DM patients at the Clinical Centre of Montenegro. The Ferrans and Powers Quality of Life Index (QLI), validated for the Montenegrin population, assessed QoL across five domains. Participants rated items on a Likert scale from 1 (very dissatisfied) to 5 (very satisfied). Data were analysed using SPSS version 22.

RESULTS

The cohort included 51% women, with a mean age of 60.05 ±  11.63 years. Of the patients, 42% had diabetes for over a decade, and 64% had no additional health conditions. Overall, patients reported satisfactory QoL, especially in self-care and glucose management, though dissatisfaction was high regarding sexual life. Emotional support from family, housing, and friendships significantly contributed to life satisfaction, while financial concerns and job dissatisfaction were common. QoL showed no significant gender differences but declined with age and was notably lower in patients with comorbidities.

CONCLUSION

Patients with T2DM report generally satisfactory QoL, with notable concerns in socio-economic and health-related areas. Routine QoL assessments in clinical practice can improve communication, aid in early complication detection, and enable timely interventions to enhance patient outcomes.

Latent class analysis of the capacity of countries to manage diabetes and its relationship with diabetes-related deaths and healthcare costs

BACKGROUND

The prevalence of diabetes is escalating globally, underscoring the need for comprehensive evidence to inform health systems in effectively addressing this epidemic. The purpose of this study was to examine the patterns of countries' capacity to manage diabetes using latent class analysis (LCA) and to determine whether the patterns are associated with diabetes-related deaths and healthcare costs.

METHODS

Eight indicators of country-level capacity were drawn from the World Health Organization Global Health Observatory dataset: the widespread availability of hemoglobin A1C (HbA1c) testing, existence of diabetes registry, national diabetes management guidelines, national strategy for diabetes care, blood glucose testing, diabetic retinopathy screening, sulfonylureas, and metformin in the public health sector. We performed LCA of these indicators, testing 1-5 class solutions, and selecting the best model based on Bayesian Information Criteria (BIC), entropy, corrected Akaike Information Criteria (cAIC), as well as theoretical interpretability. Multivariable linear regression was used to assess the association between capacity to manage diabetes (based on the latent class a country belongs) and diabetes-related deaths and healthcare costs.

RESULTS

We included 194 countries in this secondary analysis. Countries were classified into "high capacity" (88.7%) and "limited capacity" (11.3%) countries based on the two-class solution of the LCA (entropy = 0.91, cAIC = 1895.93, BIC = 1862.93). Limited capacity countries were mostly in Africa. Limited capacity countries had significantly higher percentage of their deaths attributable to diabetes (adjusted beta = 1.34; 95% CI: 0.15, 2.53; p = 0.027) compared to high capacity countries even after adjusting for income status and diabetes prevalence.

CONCLUSIONS

Our findings support the report by the Lancet commission on diabetes, which suggests that differences in diabetes outcomes among countries may be explained by variations in the capacity of and investments made in their health systems. Future studies should evaluate initiatives such as the WHO Global Diabetes Compact that are currently underway to improve the capacity of resource-limited countries.

Improving Clinical Preparedness: Community Health Nurses and Early Hypoglycemia Prediction in Type 2 Diabetes Using Hybrid Machine Learning Techniques

OBJECTIVES

The aim of the study was to analyze the data of diabetic patients regarding warning signs of hypoglycemia to predict it at an early stage using various novel machine learning (ML) algorithms. Individual interviews with diabetic patients were conducted over 6 months to acquire information regarding their experience with hypoglycemic episodes.

DESIGN

This information included warning signs of hypoglycemia, such as incoherent speech, exhaustion, weakness, and other clinically relevant cases of low blood sugar. Researchers used supervised, unsupervised, and hybrid techniques. In supervised techniques, researchers applied regression, while in hybrid classification ML techniques were used. In a 5-fold cross-validation approach, the prediction performance of seven models was examined using the area under the receiver operating characteristic curve (AUROC). We analyzed the data of 290 diabetic patients with low blood sugar episodes.

RESULTS

Our investigation discovered that gradient boosting and neural networks performed better in regression, with accuracies of 0.416 and 0.417, respectively. In classification models, gradient boosting, AdaBoost, and random forest performed better overall, with AUC scores of 0.821, 0.814, and 0.821, individually. Precision values were 0.779, 0.775, and 0.776 for gradient boosting, AdaBoost, and random forest, respectively.

CONCLUSION

AdaBoost and Gradient Boosting models, in particular, outperformed all others in predicting the probability of clinically severe hypoglycemia. These techniques enable community health nurses to predict hypoglycemia at an early stage and provide the necessary therapies to patients to prevent complications resulting from hypoglycemia.

Correlation of ageing with Health related-quality of life of patients in 13 groups of disease in Poland

Background Age is a non-modifiable risk factor important in the etiology of many diseases. The ageing process of the body absolutely contributes to the degeneration of body tissues and the loss of function and the associated health-related quality of life (HR-QoL). Purpose Effect of age on HR-QoL among patients of 13 disease units. Matherial and methods The study was conducted among 7620 patients. The following age groups were included in the analysis: <30 years old, 30-39 years old, 40-49 years old, 50-59 years, 60-69 years, 70-79 years, and ≥ 80 years. The criterion for inclusion in the group was: age ≥ 18 years, written consent to participate in the study, treatment for chronic disease (at least 2 years), absence of other diseases and/or coexisting chronic symptoms. The SF-36 (Physical Component Summary (PCS); Mental Component Summary (MCS); Index of Life Quality (ILQ)) questionnaire was used to assess HR-QoL. Results The chance of having a better HR-QoL at 60-69 years of age decreases 3-fold (OR = 0.33) in MCS compared to the youngest group of patients. As far as PCS is concerned, there is a 5-fold lower chance of better HR-QoL (OR = 0.20). However, in the oldest group of patients, the chance of better HR-QoL in the MCS dimension is more than 12 times lower, and in PCS the chance of better HR-QoL is 33 times lower. A significant correlation between quality of life and age was confirmed. The level of PCS (R=-0.60), MCS (R=-0.50) and ILQ (R=-0.58) decreases with age. Cancer diseases (CD), regardless of the patient's age, showed the strongest association with HRQoL among the 13 analyzed disease entities. The average level of HRQoL was the lowest. A decreased level of HRQoL was noted in patients with cardiovascular disease (CVD) aged 30-39 years. The highest HR-QoL was noted in the group of patients aged 40-49 years for both CD and CVD, in later years HR-QoL decreased in patients with CD and CVD. The chance of better HR-QoL decreases with age. After the age of 60, the highest decrease in HR-QoL is observed in both MCS and PCS. In all age groups, there is more often a chance of better HR-QoL in the MCS dimension than in PCS.

Psychiatric Safety of Semaglutide for Weight Management in People Without Known Major Psychopathology: Post Hoc Analysis of the STEP 1, 2, 3, and 5 Trials

Importance

Obesity is associated with numerous psychosocial complications, making psychiatric safety a consideration for treating people with obesity. Few studies have investigated the psychiatric safety of newly available antiobesity medications.

Objective

To evaluate the psychiatric safety of subcutaneous semaglutide, 2.4 mg, once weekly in people without known major psychopathology.

Design, Setting, and Participants

This post hoc analysis of pooled data from the randomized, double-blind, placebo-controlled, multicenter phase 3a STEP 1, 2, and 3 trials (68 weeks; 2018-2020) and phase 3b STEP 5 trial (104 weeks; 2018-2021) included adults with overweight or obesity; STEP 2 participants also had type 2 diabetes. Trial designs have been published previously.

Interventions

Semaglutide, 2.4 mg, vs placebo.

Main Outcomes and Measures

Depressive symptoms and suicidal ideation/behavior were assessed using the Patient Health Questionnaire (PHQ-9) and Columbia-Suicide Severity Rating Scale, respectively. Psychiatric and nervous system disorder adverse events were investigated.

Results

This analysis included 3377 participants in the STEP 1, 2, and 3 trials (2360 women [69.6%]; mean [SD] age, 49 [13] years) and 304 participants in STEP 5 (236 women [77.6%]; mean [SD] age, 47 [11] years). In the STEP 1, 2, and 3 trials, mean (SD) baseline PHQ-9 scores for the semaglutide, 2.4 mg, and placebo groups were 2.0 (2.3) and 1.8 (2.3), respectively, indicating no/minimal symptoms of depression. PHQ-9 scores at week 68 were 2.0 (2.9) and 2.4 (3.3), respectively; the estimated treatment difference (95% CI) between groups was -0.56 (-0.81 to -0.32) (P < .001). Participants treated with semaglutide vs placebo were less likely to shift (from baseline to week 68) to a more severe category of PHQ-9 depression (odds ratio, 0.63; 95% CI, 0.50-0.79; P < .001). Based on the Columbia-Suicide Severity Rating Scale, 1% or fewer of participants reported suicidal ideation/behavior during treatment, with no differences between semaglutide, 2.4 mg, and placebo. Psychiatric disorder adverse events were generally balanced between groups. Similar results were observed in STEP 5.

Conclusions and Relevance

The results of this post hoc analysis suggest that treatment with semaglutide, 2.4 mg, did not increase the risk of developing symptoms of depression or suicidal ideation/behavior vs placebo and was associated with a small but statistically significant reduction in depressive symptoms (not considered clinically meaningful). People with obesity should be monitored for mental health concerns so they can receive appropriate support and care.

Trial Registration

ClinicalTrials.gov Identifiers: STEP 1 (NCT03548935), 2 (NCT03552757), 3 (NCT03611582), and 5 (NCT03693430).

Serious digital games for diabetes Mellitus: A scoping review of its current State, Accessibility, and functionality for patients and healthcare providers

The global rise in diabetes prevalence poses a significant challenge to healthcare providers, stimulating interest in digital interventions such as educational games. However, the impact and availability of research-developed diabetes games remain uncertain. This scoping review aimed to provide a comprehensive overview of serious games for diabetes, encompassing their availability, characteristics and health effects. Through an electronic search in multiple databases, a total of 21 articles addressing 23 games were included in the literature review. The majority of these games were inaccessible outside of research settings, despite demonstrating positive effects on various aspects of diabetes management, including knowledge, physical activity, self-management, mental well-being, and HbA1c levels. Most games were designed for mobile phones, targeting both children and adults. A subsequent app store search revealed 13 additional diabetes games, however nearly none (7.7%) of these underwent research scrutiny, leaving their expected effects uncertain. The disparity between evidence-based games and those available in app stores underscores the need for bridging this gap to ensure the availability of effective digital games for diabetes management worldwide.

Depression scores and its relationship with sexual quality of life in women with type 1 and type 2 diabetes: A cross-sectional study

Diabetes is an important public health problem with increasing prevalence worldwide. However, the prevalence of diabetes in women is increasing. Women with diabetes have many physical and psychological complications. It has been reported that complications experienced by women with diabetes negatively affect both their sexual and mental health. This study aimed to determine the sexual quality of life (SQoL) and depression scores in women with type 1 diabetes (T1D) and type 2 diabetes (T2D), the relationship between them, and to examine the factors predicting the SQoL. This study was analytical and cross-sectional. This study was conducted with 440 women with diabetes (206 women with type 1 and 234 women with type 2 diabetes) who came to the endocrine policlinic of a university hospital in Izmir, western Türkiye, between April and October 2023. Data were collected using the "Individual Description Form," "Sexual Quality of Life Questionnaire" and "Beck Depression Inventory." Correlation and multiple regression analyses were conducted to investigate the relationship between SQoL and depression scores. When women with T1D and T2D were compared, it was determined that women with T2D had worse SQoL and higher depression scores (P < .05). Both T1D and T2D women were found to have a strong negative correlation between SQoL and depression scores (r = -0.753; -0.837; P < .05). Age (B = -0.291), body mass index (BMI; B = -2.747), type 2 diabetes (B = -3.074), and depression scores (B = -1.898) were predictive factors of SQoL in women with diabetes (R2 = 0.670; P < .05). In our study, it was determined that depression scores were increased in women with diabetes mellitus with decreased SQoL. When T1D and T2D were compared, T2D had worse SQoL and higher depression scores. It also revealed that age, BMI, T2D, and depression scores affected SQoL. Healthcare professionals especially nurses should provide education and counseling to women with T1D and T2D about sexual life and mental health.

Chronic moderate hyperglycemia does not alter sexual motivation in the female rat

The relationship between diabetes mellitus type 2 (DM2) and sexual desire in women has not been systematically studied, therefore, animal models have been used for this purpose. When streptozotocin (STZ) is administered in the neonatal stage, the rat shows moderate chronic hyperglycemia and glucose intolerance in adulthood, resembling a DM2 model. These females show less alterations of sexual behavior (a slight decreased proceptivity and loss of paced mating) than their counterpart with severe hyperglycemia. However, the motivational components of copulation in female rats in this DM2 model have not been examined. The aim of this study was to evaluate female sexual motivation in a model of DM2 in three behavioral paradigms: the partner preference (PP), the sexual incentive motivation (SIM) and the odor preference test (OPT) tests. Neonatal females (3-4 days) were administered with streptozotocin (STZ, 70 mg/kg, intraperitoneally) or citrate buffer. At week 8, a glucose tolerance test was performed, females with blood glucose levels ≥ 250 mg/dl 60 min after a sucrose load (2 g/kg) were considered for the study. Behavioral tests were conducted at week 12, when the females were in natural proestrus. For PP we registered the time in each compartment and the sexual behavior, while in the SIM test, we calculated the time the females remained in each incentive zone. In these tests a castrated male and a sexually experienced male were used as stimuli. In OPT we evaluated the time the females spent sniffing the sawdust coming from cages housing these stimuli. In the PP and OPT hyperglycemic females behave similarly than controls, i.e., they retain a preference for sexually active males. In the SIM test there was a decrease in the time the hyperglycemic females remain in the vicinity of the sexually expert male. Data are discussed on the bases of the accessibility of the females to the stimuli.

Nearly one in five older adults in Danish nursing homes live with type 2 diabetes

AIM

This study aimed to investigate the prevalence of type 2 diabetes (T2D) among Danish nursing home residents (aged ⩾65 years).

METHODS

Individuals with T2D in the Danish population of older adults in 2018 were identified using a Danish diabetes register based on administrative and clinical register data. Data on age, sex, type of housing, educational level and place of origin were obtained from various high-quality administrative registers. We calculated frequencies of T2D among older adults living in nursing homes and in other types of housing. We performed a multiple logistic regression analysis to estimate the odds ratio (OR) of T2D among people living in nursing homes and adjusted for sex, age, educational level and place of origin.

RESULTS

All Danish older adults aged ⩾65 years, alive and living in Denmark on 31 December 2018 were included (N=1,170,517). Nursing home residents accounted for 37,891 older adults, and of these, 19% had T2D, whereas 14% of older adults living in other types of housing had T2D. According to the multiple logistic regression analysis, nursing home residents had a higher OR of having T2D compared to older adults living in other types of housing (OR=1.47; confidence interval 1.43-1.51) when adjusting for socio-demographic factors.

CONCLUSIONS

The prevalence of T2D in nursing home residents exceeds the prevalence in the background population at ⩾65 years of age. This indicates a need for increased focus on individualised interdisciplinary care plans aimed at maintaining physical function and maximising quality of life for this group of vulnerable older adults.

Diabetes quality of life, Chemical Intolerance, and generational status in a Latino sample: an RRNeT study

Objectives

The impact of diabetes on quality of life (QoL) includes deficits in physical functioning and emotional and mental health. Individuals with diabetes can experience significant distress related to diabetes management and burden. Comorbid conditions can contribute to QoL among individuals with diabetes. Chemical Intolerance (CI) has received minimal attention in the context of diabetes. CI is characterized by multi-systemic symptoms initiated by a one-time high dose or persistent low-dose exposure to environmental toxins. Latinos experience diabetes distress and are exposed to environmental factors at disproportionate rates. This study sought to investigate generational differences in diabetes QoL and CI in a Latino sample across generational status.

Methods

To assess the modifying effect of CI between QoL and generations, the analysis was stratified by those with and without CI.

Results

Compared to 2nd generation Latinos, Latino immigrants were more likely to indicate that without diabetes, their life would be better across several QoL domains. Latino immigrants had a lower A1C and BMI than2nd generation Latinos. Additionally, they were less likely to have scores indicative of CI than U.S.-born Latinos. QoL varied by generational status and suggested a greater emphasis on family and social relationships among immigrants than U.S.-born Latinos. There were no differences in health services measures across generations.

Conclusions

This study highlights generational differences in the impact of diabetes on QoL. It is one of the few studies to seek to understand the impact of CI on QoL in the context of a chronic condition such as type 2 diabetes.

Automated Personalized Self-care Program for Patients With Type 2 Diabetes Mellitus: A Pilot Trial

PURPOSE

Providing continuous self-care support to the growing diabetes population is challenging. Strategies are needed to enhance engagement in self-care, utilizing innovative technologies for personalized feedback. This study aimed to assess the feasibility of the Automated Personalized Self-Care program among type 2 diabetes patients and evaluate its preliminary effectiveness.

METHODS

A parallel randomized pilot trial with qualitative interviews occurred from May 3, 2022, to September 27, 2022. Participants aged 40-69 years with type 2 diabetes and HbA1c ≥ 7.0% were recruited. The three-month program involved automated personalized goal setting, education, monitoring, and feedback. Feasibility was measured by participants' engagement and intervention usability. Preliminary effectiveness was examined through self-care self-efficacy, self-care behaviors, and health outcomes. Qualitative interviews were conducted with the intervention group.

RESULTS

A total of 404 patients were screened. Out of the 61 eligible patients, 32 were enrolled, resulting in a recruitment rate of 52.5%. Retention rates at three months were 84.2% and 84.6% in the intervention and control groups, respectively. Among the intervention group, 81.3% satisfied adherence criteria. Mobile application's usability scored 66.25, and participants' satisfaction was 8.06. Intention-to-treat analysis showed improvements in self-measured blood glucose testing, grain intake, and HbA1c in the intervention group. Qualitative content analysis identified nine themes.

CONCLUSION

Feasibility of the program was verified. A larger randomized controlled trial is needed to determine its effectiveness in self-care self-efficacy, self-care behaviors, and health outcomes among type 2 diabetes patients. This study offers insights for optimizing future trials assessing clinical effectiveness.

TRIAL REGISTRATION

Clinical Research Information Service, KCT0008202 (registration date: 17 February 2023).

Beyond diagnosis: Investigating factors influencing health-related quality of life in older people with type 2 diabetes in Slovenia

AIMS

To examine the present state of health-related quality of life (HRQOL) among elderly individuals with type 2 diabetes (T2D) receiving integrated care and identify risk factors associated with low HRQOL.

METHODS

A multi-centre cross-sectional survey among elderly individuals with T2D, treated in Slovenian urban and rural primary care settings was performed. HRQOL was investigated using EuroQol 5-dimension (EQ-5D) questionnaire and Appraisal of Diabetes Scale (ADS). Furthermore, socio-demographic, clinical, and laboratory data were collected. Low HRQOL was defined as EQ-5D utility score <10%. Statistical analysis was performed using univariate and multivariate binary logistic regression statistics.

RESULTS

Examining 358 people with median age of 72 (range 65-98) years and with a mean EQ-5D utility score of 0.80, the study found that lower HRQOL correlated with older age, higher body mass index (BMI), lower education, elevated depressive symptoms, increased challenges across all EQ-5D dimensions, and less favourable appraisal of diabetes. When considering age, gender, education, and HbA1c, the main predictors of low HRQOL were BMI (OR 1.35, 95% CI 1.04-1.76, p = 0.025) and ADS score (OR 1.63, 95% CI 1.13-2.35, p = 0.009).

CONCLUSIONS

To improve HRQOL, integrated care models should consider interventions that target mental health, obesity prevention, chronic pain management, diabetes education, self-management, and treatment plan personalisation.

Diabetes-related distress and quality of life among people with type 2 diabetes at primary care level in Brazil

PURPOSE

Living with diabetes can be challenging, particularly when it comes to dealing with psychological distress and requiring self-care directives. Patients may feel frustrated, angry, overwhelmed, and discouraged. This study aimed to investigate the diabetes-related distress and quality of life among people with type 2 diabetes mellitus (T2DM).

METHODS

A cross-sectional study carried out at the Clinical Research Centre at the University of Campinas, Brazil, between September 2020 and April 2021. Patients answered data regarding demographic and clinical variables, the Brazilian version of the Diabetes Distress Scale and the Diabetes Quality of Life (QOL) Measure by telephone contact. The data were managed using the RedCap System. For statistical analysis of the data, the Mann-Whitney and Kruskal-Wallis tests were applied for comparisons, and the Chi-square test for associations. The correlations were evaluated using the Spearman correlation coefficient.

RESULTS

Out of the 302 participants we recruited, 50.33% exhibited significant diabetes-related distress. Those with elevated diabetes-related distress scores had shorter education levels (p < 0.05), lower HbA1c levels (p < 0.05), and lower total scores in Diabetes QOL Measure (p < 0.0001), particularly in the QOL impact (p < 0.0001), social/vocational worry (p < 0.05), and diabetes worry (p < 0.0001) subscales compared to the group with the lowest diabetes-related distress.

CONCLUSION

Elevated diabetes-related stress scores significantly affect patients' QOL. Therefore, early screening of individuals at risk for this condition, using well-coordinated protocols, could mitigate adverse QOL effects and enhance their overall experience during disease management.

Impact of pain and adverse health outcomes on long-term US testicular cancer survivors

BACKGROUND

No study has quantified the impact of pain and other adverse health outcomes on global physical and mental health in long-term US testicular cancer survivors or evaluated patient-reported functional impairment due to pain.

METHODS

Testicular cancer survivors given cisplatin-based chemotherapy completed validated surveys, including Patient-Reported Outcomes Measurement Information System v1.2 global physical and mental health, Patient-Reported Outcomes Measurement Information System pain questionnaires, and others. Multivariable linear regression examined relationships between 25 adverse health outcomes with global physical and mental health and pain-interference scores. Adverse health outcomes with a β^  of more than 2 are clinically important and reported below.

RESULTS

Among 358 testicular cancer survivors (median age = 46 years, interquartile range [IQR] = 38-53 years; median time since chemotherapy = 10.7 years, IQR = 7.2-16.0 years), median adverse health outcomes number was 5 (IQR = 3-7). A total of 12% testicular cancer survivors had 10 or more adverse health outcomes, and 19% reported chemotherapy-induced neuropathic pain. Increasing adverse health outcome numbers were associated with decreases in physical and mental health (P < .0001 each). In multivariable analyses, chemotherapy-induced neuropathic pain (β^ = -3.72; P = .001), diabetes (β^ = -4.41; P = .037), obesity (β^ = -2.01; P = .036), and fatigue (β^ = -8.58; P < .0001) were associated with worse global mental health, while being married or living as married benefited global mental health (β^ = 3.63; P = .0006). Risk factors for pain-related functional impairment included lower extremity location (β^ = 2.15; P = .04) and concomitant peripheral artery disease (β^ = 4.68; P < .001). Global physical health score reductions were associated with diabetes (β^ = -3.81; P = .012), balance or equilibrium problems (β^ = -3.82; P = .003), cognitive dysfunction (β^ = -4.43; P < .0001), obesity (β^ = -3.09; P < .0001), peripheral neuropathy score (β^ = -2.12; P < .0001), and depression (β^ = -3.17; P < .0001).

CONCLUSIONS

Testicular cancer survivors suffer adverse health outcomes that negatively impact long-term global mental health, global physical health, and pain-related functional status. Clinically important factors associated with worse physical and mental health identify testicular cancer survivors requiring closer monitoring, counseling, and interventions. Chemotherapy-induced neuropathic pain must be addressed, given its detrimental impact on patient-reported functional status and mental health 10 or more years after treatment.

Health-Related Quality of Life Among Type 2 Diabetes Mellitus Patients Using the 36-Item Short Form Health Survey (SF-36) in Central Ethiopia: A Multicenter Study

Introduction

Diabetes, one of the major global health emergencies of the 21st century, can affect a patient's quality of life. A compromised quality of life has adverse effects on self-care practices, resulting in inadequate glycemic control and an increased susceptibility to complications. In Ethiopia, there is a paucity of information regarding the quality of life of patients with type 2 diabetes mellitus. Therefore, this study aimed to assess health-related quality of life in type 2 diabetes mellitus patients.

Methods

A cross-sectional study was conducted among type 2 diabetes mellitus patients attending diabetes follow-up clinics in selected public hospitals in Addis Ababa using short form- 36 (SF-36) health survey measures. Descriptive statistics were used to summarize the characteristics of the study participants. Simple and multiple linear regressions were done to identify significantly associated factors with health-related quality of life.

Result

A total of 309 patients participated in this study. The mean scores of the physical and mental component summaries were 40.15 (SD = 7.27) and 48.11 (SD = 8.87), respectively. Being old, being overweight or obese, living with type 2 diabetes mellitus for more than fifteen years, taking combined medication, having diabetes-related complications, and having comorbidities were factors that reduced the mean score of the physical component summary (p-value<0.05). Being obese and diabetes related complication were factors that negatively affect mental component summary (p-value <0.05). On the other hand, being married was factors that positively affect mental component summary (p-value <0.05).

Conclusion

Older age, being married, obesity, overweight, longer duration of diabetes, using combined medications, diabetic-related complications, and co-morbidities were factors associated with health-related quality of life. Healthcare providers should strengthen counseling patients on lifestyle modifications such as diet modifications, and weight reduction.

Factors associated with quality of life among elderly patients with type 2 diabetes mellitus: the role of family caregivers

BACKGROUND

As a long-term chronic disease, Type 2 diabetes mellitus (T2DM) patients' quality of life is affected by both themselves and his/ her close relatives, requiring comprehensive support from family members to ensure that patients are able to manage disease. The objective of this study is to investigate the relationship between caregivers' sense of coherence, caregiver competence, and T2DM patients' quality of life, as well as to explore the factors affecting patients with T2DM patients.

METHODS

This investigation was a cross-sectional study. Between October 2022 and July 2023, 392 participant-caregiver dyads from two hospitals in Jinzhou City, Liaoning Province, were researched. Participants were investigated by General Characteristics Questionnaire, Modified Barthel Index (MBI), Diabetes Specific Quality of Life Scale (DSQLS), Sense of Coherence scale-13 (SOC-13), and Family Caregiver Task Inventory (FCTI). Data were statistically analyzed using SPSS 25. Univariate and multivariate linear regression analyses were used to identify the independent factors associated with the quality of life of elderly patients with T2DM.

RESULTS

The average score of T2DM quality of life was 61.14 (SD = 7.37), quality of life was negatively correlated with sense of coherence (r=-0.344, P<0.01) and positively correlated with caregiver competence (r = 0.522, P<0.01). Furthermore, we found that age, disease duration, activities of daily living scores, sense of coherence, and caregiver competence scores were the main predictors of quality of life (R2 = 0.375, P < 0.001).

CONCLUSIONS

This study found that high levels of sense of coherence and caregiver competence in family caregivers were associated with better quality of life for patients. Furthermore, we also found that good quality of life was also related to younger age, shorter disease duration, and less dependence. This study offers a feasible example for policymakers to improve the quality of life from the perspective of T2DM patients' family caregivers.

Can pharmaceutical care decrease the oxidative stress in type 2 diabetes mellitus?

Type 2 diabetes mellitus (T2D) is a chronic metabolic disorder characterized by an increase in oxidative stress, which is itself related to development of T2D's main chronic complications. Oxidative stress caused by elevated production of reactive species of oxygen and decrease of antioxidant defense system level, leads to activation of lipid peroxidation (LPO) and oxidative lipoprotein modification with increasing atherogenicity. Therefore, the aim of this study was to evaluate whether pharmacotherapeutic follow-up in patients with T2D, users and non-users of insulin, interferes with the levels of oxidative stress, measuring lipid peroxidation and protein oxidation, nitric oxide and superoxide dismutase levels. After the follow-up, there was a decrease in nitric oxide levels and an increase in superoxide dismutase concentration for the group with insulin therapy. Accordingly, these results show that the proposed pharmaceutical care program reduced the oxidative stress levels, mainly in patients in insulin therapy, as a consequence, can impact in the surging of the main chronic complications in T2D.

Trajectories of quality of life in people with diabetes mellitus: results from the survey of health, ageing and retirement in Europe

Introduction

Previous longitudinal studies identified various factors predicting changes in Quality of Life (QoL) in people with diabetes mellitus (PwDM). However, in these studies, the stability of QoL has not been assessed with respect to individual differences.

Methods

We studied the predictive influence of variables on the development of QoL in PwDM across three waves (2013-2017) from the cross-national panel dataset Survey of Health, Ageing, and Retirement in Europe (SHARE). To determine clinically meaningful changes in QoL, we identified minimal clinically important difference (MCID). Linear regressions and Linear Mixed Models (LMM) were conducted to determine factors associated with changes in QoL.

Results

On average, QoL remained stable across three waves in 2989 PwDM, with a marginal difference only present between the first and last wave. However, when looking at individual trajectories, 19 different longitudinal patterns of QoL were identified across the three time-points, with 38.8% of participants showing stable QoL. Linear regression linked lower QoL to female gender, less education, loneliness, reduced memory function, physical inactivity, reduced health, depression, and mobility limitations. LMM showed that the random effect of ID had the strongest impact on QoL across the three waves, suggesting highly individual QoL patterns.

Conclusion

This study enhances the understanding of the stability of QoL measures, which are often used as primary endpoints in clinical research. We demonstrated that using traditional averaging methods, QoL appears stable on group level. However, our analysis indicated that QoL should be measured on an individual level.

Improving Type 2 Diabetes Care with Extended-Release Metformin: Real-Life Insights from a Physician Educational Program

BACKGROUND

Compared to Immediate-Release (IR) metformin, Extended-Release (ER) metformin reduces side effects and pill burden while improving adherence; however, there is little real-life data on patient satisfaction with this innovative formulation to guide physicians toward a more holistic approach.

OBJECTIVE

Our goal is to train general practitioners on holistic patient management, with the aim of increasing patient satisfaction and treatment adherence, reducing side effects, and improving quality of life in patients with poor tolerance to metformin-IR.

MATERIALS AND METHODS

We designed an educational program for physicians called SlowDiab, aimed at establishing a holistic patient approach. In this context, adult patients with T2DM who experienced gastrointestinal discomfort with metformin-IR were enrolled and switched to metformin- ER. Data on glycemic control were collected at baseline and 2 months after switching. A survey was carried out on patients to assess their level of satisfaction.

RESULTS

In 69 enrolled patients (mean (min-max) age, 68.2 (41-90)), side effects decreased after switching from 61.8% to 16.2% (p < 0.01), and the mean perceived burden of adverse events on a scale of 1 to 10 also decreased (6.17 vs. 3.82; p < 0.05). Among patients previously intolerant to metformin-IR, 74.3% reported no longer experiencing any side effects after the switch. The mean number of tablets taken daily (2.28 vs. 1.66; p < 0.01) and mean plasma glycated hemoglobin (HbA1c) values (7.0% vs. 6.7%; p < 0.05) decreased, while 93.8% of patients were satisfied with the treatment change. Moreover, 84.2% reported an improvement in glycemic control after the switch.

CONCLUSION

In a real-life setting, an educational program for general practitioners confirmed that metformin ER reduces side effects and improves pill burden, therapeutic adherence, and patient satisfaction compared to metformin IR.

Moderating Effect of Grip Strength in the Association between Diabetes Mellitus and Depressive Symptomatology

Diabetes mellitus and depression rank among the leading causes of disease burden and are present in the top ten causes of disability-adjusted life years worldwide. Numerous studies have shown that both depression and diabetes have a detrimental effect on the quality of life, and when they coexist, the effect is considerably worse. This study aimed to analyse how grip strength moderates the relationship between diabetes and depressive symptoms among middle-aged and older adults. In total, 41,701 participants (18,003 men) in wave 8 of the cross-sectional population-based Survey of Health, Ageing, and Retirement in Europe (2019/2020) data were studied. A dynamometer was used to test grip strength twice on each hand. Depressive symptoms were measured using the 12-item EURO-D scale. The relationship between diabetes and depressive symptoms is negatively moderated by grip strength (male: B = -0.03, 95% CI = -0.04, -0.03; female: B = -0.06, 95% CI = -0.07, -0.06). Furthermore, the significant zone grip strength moderation values for males and females were less than 48.7 kg and 38.9 kg, respectively. Muscular strength was a moderator of depressive symptoms, attenuating its association with diabetes. This supports the premise that physical activity, namely muscle-strengthening exercises, should be included in diabetes treatment programs.

The relationship between loneliness, psychological resilience, quality of life and taste change in cancer patients receiving chemotherapy

PURPOSE

This study aimed to determine the correlation between taste change, nutritional intake and quality of life in cancer patients receiving chemotherapy. A total of 610 (F = 314, M = 296) volunteers aged 19 and 65 who received outpatient chemotherapy treatment participated in the study.

METHODS

Individuals' general information was obtained, anthropometric measurements were carried out, malnutrition status (Patient-Generated Subjective Global Assessment PG-SGA), loneliness (Cancer Loneliness Scale), psychological resilience (Psychological Resilience Scale), quality of life (Quality of Life Scale (EORT QLQ-C30) and taste changes were scrutinized [Chemotherapy-Induced Taste Alteration Scale (CiTAS)].

RESULTS

There was a negative correlation between the Cancer Loneliness Scale and PG-SGA and General Health Status (r = -0.494, p = 0.000; r = -0.406, p = 0.000) and a positive correlation with Symptom Scales (r = 0.484, p = 0.000; r = 0.506, p = 0.000) (p < 0.05). There was a positive correlation between the Psychological Resilience Scale and General Health Status (r = 0.393, P = 0.000), Functional Scales (r = 0.349, P = 0.000), and a negative correlation between Symptom Scales (r = -0.302, p = 0.000) (p < 0.05). 70.9% of men and 70.7% of women had severe malnutrition. General Taste Changes, General Health and Symptom Scale values were significant predictors of severe malnutrition status (p < 0.05).

CONCLUSION

The symptoms that develop during the treatment process cause many psychological problems. Before starting treatment, patients should be evaluated comprehensively, depression anxiety levels and quality of life levels should be determined, and precautions should be taken accordingly.

Impact of Treviamet® & Treviamet XR® on quality of life besides glycemic control in type 2 DM patients

BACKGROUND

Maintaining the quality of life is the main objective of managing type 2 diabetes (T2DM) (QoL). Since it is a key factor in patient motivation and adherence, treatment-related QoL has always been considered when choosing glucose-lowering medicines. The objective of the study was to evaluate the quality of life besides glycemic control among type 2 diabetes mellitus patients receiving Treviamet® & Treviamet XR® (Sitagliptin with Metformin) in routine care.

METHODS

It was a prospective, open-label, non-randomized clinical trial including T2DM patients uncontrolled on Metformin therapy. All patients received Treviamet® & Treviamet XR® for six months. Sequential changes in QoL, fasting plasma glucose, HbA1c, body weight, and blood pressure were monitored from baseline to 3 consecutive follow-up visits. The frequency of adverse events (AEs) was also noted throughout the study.

RESULTS

A total of 504 patients were screened; 188 completed all three follow-ups. The mean QoL score significantly declined from 57.09% at baseline to 33.64% at the 3rd follow-up visit (p < 0.01). Moreover, a significant decline in mean HbA1c and FPG levels was observed from baseline to 3rd follow-up visit (p < 0.01). Minor adverse events were observed, including abdominal discomfort, nausea, flatulence, and indigestion. Gender, HbA1c, diarrhea, and abdominal discomfort were significant predictors of a patient's QoL, as revealed by the Linear Regression Model (R2 = 0.265, F(16, 99) = 2.231).

CONCLUSION

Treviamet® & Treviamet XR® significantly improved glycemic control (HbA1c levels) and QoL in T2DM patients without serious adverse events.

TRIAL REGISTRATION

ClinicalTrials.gov identifier (NCT05167513), Date of registration: December 22, 2021.

Factors affecting the willingness of patients with type 2 diabetes to use digital disease management applications: a cross-sectional study

Background

The global burden of type 2 diabetes has significantly increased, leading to a considerable impact on healthcare systems worldwide. While the advent of mobile healthcare has provided some relief by addressing the shortage of certain medical resources, its adoption among the Chinese population remains relatively low. To extend the benefits of mHealth to a greater number of Chinese diabetic patients, it is essential to investigate the factors that influence their willingness to utilize it and implement targeted interventions based on these influencing factors. The Technology Acceptance Model (TAM) is widely employed to examine users' ultimate usage behaviors, and previous studies have indicated the potential relevance of the Perceived Risk (PR) theory and the eHealth Literacy Theory to users' usage behaviors.

Objective

Our objective was to investigate the determinants that affect the willingness of Chinese patients diagnosed with type 2 diabetes patients to utilize digital disease management applications (DDMAs).

Methods

We conducted a cross-sectional study of patients with type 2 diabetes in three tertiary general hospitals in Chengdu using questionnaires designed by the investigators. Participants were sampled using a convenience sampling method. The questionnaire comprised three sections: socio-demographic profile and medical history; current awareness and willingness to use digital disease management applications; and the current level of e-health literacy. Structural equation modeling was employed to assess the impact of patient awareness of DDMAs and e-health literacy on the willingness to use such DDMAs.

Results

(1) Patients' attitudes toward using DDMAs were significantly influenced by perceived ease of use (β = 0.380, P < 0.001) and perceived usefulness (β = 0.546, P < 0.001); (2) Electronic health literacy exerted a significant impact on patients' perceived usefulness (β = 0.115, P = 0.018) and perceived ease of use (β = 0.659, P < 0.001); (3) Patients' willingness to use was significantly influenced by perceived usefulness (β = 0.137, P < 0.001) and use attitude (β = 0.825, P < 0.001).

Conclusions

The present research findings hold both theoretical and practical significance, and can serve as a guide for healthcare practitioners and researchers to gain a deeper comprehension of the acceptance of digital disease management applications (DDMAs) among type 2 diabetes patients.

Quality of life and psychosocial outcomes among children with metabolically healthy and unhealthy obesity

BACKGROUND

Obesity and obesity-related morbidities are associated with poor psychosocial adjustment and health-related quality of life (HRQoL). This study aims to examine HRQoL and psychosocial outcomes in children with metabolically healthy obesity (MHO) and metabolically unhealthy obesity (MUO), and the effects of familial health on these outcomes.

METHODS

Four hundred and six children with BMI for age ≥ 97th percentile were classified as having MHO and MUO based on the absence or presence of metabolic abnormalities. HRQoL and psychosocial outcomes were assessed using validated questionnaires such as PedsQL and DASS-21.

RESULTS

There were no significant differences in HRQoL and psychosocial outcomes between children with MHO and children with MUO. Children with MUO and prior knowledge of existing metabolic conditions reported significantly lower total HRQoL (71.18 ± 17.42 vs. 75.34 ± 15.33), and higher depression (12.16 ± 11.80 vs. 8.95 ± 8.52) and stress (12.11 ± 8.21 vs. 10.04 ± 7.92) compared to children with MHO. Children with MUO who had fathers with metabolically unhealthy phenotype reported significantly lower total HRQoL (72.41 ± 15.67 vs. 76.82 ± 14.91) compared to children with MUO who had fathers with metabolically healthy phenotype.

CONCLUSION

Prior knowledge of existing metabolic abnormalities was associated with poorer HRQoL and mental health in children with obesity. Paternal metabolic health status influenced HRQoL in children with MUO.

IMPACT

First study that compared health-related quality of life (HRQoL) and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). No significant differences in HRQoL and psychosocial outcomes between children with metabolically healthy obesity (MHO) and children with metabolically unhealthy obesity (MUO). Children with MUO who had prior knowledge of existing metabolic conditions reported lower HRQoL, higher depression and stress compared to children with MHO. Paternal metabolic health status was found to influence HRQoL in children with MUO. Mental health support intervention with paternal involvement should be provided for children with MUO.

The Impact of Diabetes Mellitus Duration and Complications on Health-Related Quality of Life Among Type 2 Diabetic Patients in Khamis Mushit City, Saudi Arabia

BACKGROUND AND OBJECTIVES

 Diabetes mellitus is one of the most significant public health problems in Saudi Arabia. Therefore, this study aims to investigate the impact of disease duration and disease complications on health-related quality of life among type 2 diabetic patients.

MATERIALS AND METHODS

A cross-sectional study was conducted on 380 adult diabetic type 2 patients at a tertiary hospital in the city of Khamis Mushit in Saudi Arabia. The participants were asked to complete a pre-validated health status questionnaire (SF-36) consisting of 36 questions measuring eight domains of health, with each domain providing a score from 0 to 100. Demographic and clinical variables were collected using a diabetes type 2 specification form designed to be used in conjunction with the health status questionnaire. The clinical data included variables such as duration of diabetes, co-morbidities, and treatment modality. Statistical analysis was conducted using SPSS version 22 (IBM Corp., Armonk, NY, USA), with differences tested using various statistical tests. Spearman correlation was done between the score and continuous variables, such as age and BMI. A p-value less than 0.05 was considered statistically significant.

RESULTS

Most of the participants (40%) were recently diagnosed with diabetes mellitus (less than one year ago) and 29.5% of the participants were diagnosed with diabetes mellitus within one to five years. The percentage of those with complications was 39.2%, which was mainly diabetic foot (43.4%) followed by nephropathy (29.5%). 46.8% of the participants were admitted due to conditions related to diabetes mellitus. Dietary modifications were prescribed in 38.4% of the participants, 19.5% used non-insulin medications only, 22.6% were on insulin, and 19.5% were using oral medications and insulin. The relationship between diabetes mellitus complications and quality of life domains revealed no significant difference in most of the domains except physical function and general health, which were lower with complicated diabetes melitus. Similarly, the relation between diabetes mellitus duration and quality of life domains was also not significant in all domains except physical function, which was low with a duration of more than 10 years.

CONCLUSIONS

Understandably, the complications associated with diabetes melitus resulted in low quality of life - in terms of physical function and general health - due to the organ-dysfunction associated with poor glycaemic control. Similarly, disease duration greater than 10 years resulted in impaired physical functioning.

Digital Emergency Management for a Complex One Health Landscape: the Need for Standardization, Integration, and Interoperability

OBJECTIVE

Planning reliable long-term planning actions to handle disruptive events requires a timely development of technological infrastructures, as well as the set-up of focused strategies for emergency management. The paper aims to highlight the needs for standardization, integration, and interoperability between Accident & Emergency Informatics (A&EI) and One Digital Health (ODH), as fields capable of dealing with peculiar dynamics for a technology-boosted management of emergencies under an overarching One Health panorama.

METHODS

An integrative analysis of the literature was conducted to draw attention to specific foci on the correlation between ODH and A&EI, in particular: (i) the management of disruptive events from private smart spaces to diseases spreading, and (ii) the concepts of (health-related) quality of life and well-being.

RESULTS

A digitally-focused management of emergency events that tackles the inextricable interconnectedness between humans, animals, and surrounding environment, demands standardization, integration, and systems interoperability. A consistent and finalized process of adoption and implementation of methods and tools from the International Standard Accident Number (ISAN), via findability, accessibility, interoperability, and reusability (FAIR) data principles, to Medical Informatics and Digital Health Multilingual Ontology (MIMO) - capable of looking at different approaches to encourage the integration between the ODH framework and the A&EI vision, provides a first answer to these needs.

CONCLUSIONS

ODH and A&EI look at different scales but with similar goals for converging health and environmental-related data management standards to enable multi-sources, interdisciplinary, and real-time data integration and interoperability. This allows holistic digital health both in routine and emergency events.

Life Satisfaction and Dental Visits in Adults Aged ≥50 Years and Living with Diabetes Mellitus: A Comparison between Urban and Rural Mexican

Objective

To examine the association between low life satisfaction with past-year dental visits in a rural-urban national sample of 50-year-old Mexican adults with diabetes mellitus (DM).

Methods

Data are drawn from the Mexican Health and Aging Study (MHAS), a cross-sectional study conducted in 2018 involving 3,592 older adults aged 50 years and older and living in urban and rural areas in Mexico. Life satisfaction was measured using the Satisfaction with Life Scale (SWLS) and past-year dental visits dichotomized as none and ≥1 dental visits. The Poisson regression analyses were used to assess the association, adjusting for confounders.

Results

62.9% were women, mean age was 65.5 (±9.6), and 16.5% lived in a rural area, while the female subjects continue to present a higher probability of visiting a dentist (PR = 1.28 (95% CI 1.08-1.51)). In terms of age, the ≥70-year group presented 28% lower possibility of visiting a dentist (PR = 0.72 (95% CI 0.60-0.86)). The interaction showed that adults ≥50 years who reside in a rural area and have low life satisfaction were 40% less likely to have visited a dentist in the last year (PR = 0.60 (95% CI 0.37-0.98)) than adults ≥50 years who reside in an urban area and have high life satisfaction.

Conclusions

The present study highlights the association between low life satisfaction and past-year dental visits in rural populations. Therefore, rurality should be considered a possible confounder in analysis of life satisfaction in the older adult population.

The Prevalence of Diabetes Mellitus Type II (DMII) in the Multiple Sclerosis Population: A Systematic Review and Meta-Analysis

Introduction: The interactions between Diabetes Mellitus type II (DMII) and Multiple Sclerosis (MS) lead to higher levels of fatigue, higher risk of physical disability, faster cognitive decline, and in general a lower quality of life and a higher frequency of depression compared to the general population. All of the above accelerate the disability progression of patients with MS, reduce the patients' functional capacity, and further increase their psychological and economic burden. Methods: This systematic review and meta-analysis aims to calculate the prevalence of DMII in the MS population. Following PRISMA guidelines, a thorough search of the Medline Pubmed, Cochrane Library, and Scopus databases was performed, focusing on the frequency of DMII in the MS population. Results: A total of 19 studies were included in the synthesis. The results of the main meta-analysis of random effects using R studio 3.3.0 for Windows and the Meta r package showed that the prevalence of DMII in the MS population is 5% (95% CI [0.03, 0.07], 19 studies, I2 = 95%, pQ < 0.001). Additional subgroup analysis based on region showed a difference of 4.4% (I2 = 95.2%, pQ < 0.001), psubgroupdifference = 0.003) between European and non-European participants, while demographic- and MS-specific characteristic (EDSS, Disease Duration) did not seem to affect the prevalence of DMII in the MS population (p = 0.30, p = 0.539, p = 0.19, p = 0.838). No publication bias was discovered (Egger's p test value: 0.896). Conclusions: Even though the prevalence of DMII in the MS population is lower than 10% (the reported prevalence of DMII in the general population) the interactions between the two conditions create significant challenges for MS patients, their caregivers, and physicians. DΜΙΙ should be systematically recorded in the case of MS patients to clearly delineate any potential relationship between the two conditions. Additionally, more structured studies investigating the interactions of MS and DMΙΙ as well as the direction of the causation between those two conditions are necessary in order to gain a deeper insight into the nature of the interaction between MS and DMII.

Stratification of diabetes in the context of comorbidities, using representation learning and topological data analysis

Diabetes is a heterogenous, multimorbid disorder with a large variation in manifestations, trajectories, and outcomes. The aim of this study is to validate a novel machine learning method for the phenotyping of diabetes in the context of comorbidities. Data from 9967 multimorbid patients with a new diagnosis of diabetes were extracted from Clinical Practice Research Datalink. First, using BEHRT (a transformer-based deep learning architecture), the embeddings corresponding to diabetes were learned. Next, topological data analysis (TDA) was carried out to test how different areas in high-dimensional manifold correspond to different risk profiles. The following endpoints were considered when profiling risk trajectories: major adverse cardiovascular events (MACE), coronary artery disease (CAD), stroke (CVA), heart failure (HF), renal failure (RF), diabetic neuropathy, peripheral arterial disease, reduced visual acuity and all-cause mortality. Kaplan Meier curves were plotted for each derived phenotype. Finally, we tested the performance of an established risk prediction model (QRISK) by adding TDA-derived features. We identified four subgroups of patients with diabetes and divergent comorbidity patterns differing in their risk of future cardiovascular, renal, and other microvascular outcomes. Phenotype 1 (young with chronic inflammatory conditions) and phenotype 2 (young with CAD) included relatively younger patients with diabetes compared to phenotypes 3 (older with hypertension and renal disease) and 4 (older with previous CVA), and those subgroups had a higher frequency of pre-existing cardio-renal diseases. Within ten years of follow-up, 2592 patients (26%) experienced MACE, 2515 patients (25%) died, and 2020 patients (20%) suffered RF. QRISK3 model's AUC was augmented from 67.26% (CI 67.25-67.28%) to 67.67% (CI 67.66-67.69%) by adding specific TDA-derived phenotype and the distances to both extremities of the TDA graph improving its performance in the prediction of CV outcomes. We confirmed the importance of accounting for multimorbidity when risk stratifying heterogenous cohort of patients with new diagnosis of diabetes. Our unsupervised machine learning method improved the prediction of clinical outcomes.

The Effect of Culturally Appropriate Self-Care Intervention on Health Literacy, Health-Related Quality of Life and Glycemic Control in Iranian Patients with Type 2 Diabetes: A Controlled Randomized Clinical Trial

Background

Cultural and language differences are necessary factors for diabetes management and self-care education programs in patients suffering from diabetes. This study aims to investigate the effectiveness of culture-based self-care intervention on health literacy, quality of life, and glycemic parameters in patients with type 2 diabetes.

Materials and Methods

This randomized clinical trial has been carried out in selected centers in Darreh Shahr, Iran; 80 participants were randomly assigned into intervention and control groups. The intervention group received an educational program for 6 sessions twice a week, but the control group only received routine services. Data were collected using health literacy and life quality scales for diabetic patients, which were completed by both groups before, immediately after, and 3 months after the intervention; hemoglobin A1C (HbA1c) was checked before and 3 months after the intervention. SPSS software was also analyzed data using χ2, Fisher's exact, independent t, and repeated measures analysis of variance tests.

Results

There were no significant differences between the 2 groups before the study (p >0.05) goes forward. But, mean scores of health literacy (F2,40 = 5.61, p =0.007), quality of life (F2, 40 = 4.09, p =0.01), and HbA1c levels (t, 39 = 6. 91, p <0.001) have shown significant differences between the 2 groups immediately and 3 months after the intervention have been applied.

Conclusions

Culturally appropriate intervention should be offered as a part of the nurse' care program for diabetic to control HbA1c, and improve their life quality and health literacy.

The Association between the Atherogenic Index of Plasma and Cardiometabolic Risk Factors: A Review

Background: Metabolic syndrome (MetS) is a condition caused by a combination of cardiometabolic risk factors (CMR). MetS leads to type 2 diabetes mellitus (T2DM) and cardiovascular disease (CVD), both of which place a burden on not only the patients but also the healthcare system. Diagnostic criteria for MetS vary, and there is no universal tool to detect it. Recently, many studies have found positive associations between the atherogenic index of plasma (AIP) and some CMR factors. Therefore, a comprehensive review was needed to recapitulate these studies and qualitatively estimate the likelihood of AIP being associated with CMR. We aimed to review and summarise observational data on AIP and CMR factors and verify their association. Materials and Methods: A review of observational studies was conducted by searching “atherogenic index of plasma” in PubMed, One Search, and the Cochrane library. A total of 2068 articles were screened, and 32 were included after excluding paediatric, non-human and interventional studies, and those carried out on cohorts with conditions unrelated to MetS or on lipid-lowering medication. The Newcastle-Ottawa scale was used to assess their quality. Results: Most studies that reported high waist circumference (WC), triglycerides (TG), insulin resistance (IR) and low high-density lipoprotein cholesterol (HDL-C) concentration, also reported high AIP. Few studies investigated blood pressure (BP) and some discrepancies existed between their results. Conclusion: AIP may be associated with WC, TG, IR, and HDL-C. It is unclear if AIP is associated with BP. The current study’s results should be used to inform futureward a meta-analysis to be seen quantitatively. It is also recommended that more cohort studies stratified by gender and ethnicity be performed to ascertain if AIP can predict MetS before it manifests.

Quality of life and mental health measurements among patients with type 2 diabetes mellitus: a systematic review

BACKGROUND

Over the past few decades the benefits of assessing Quality of Life (QoL) and mental health in patients with Type 2 Diabetes Mellitus (T2DM) have steadily increased with limited studies relating to the most useful method to assess these patients. This study aims to identify, review, summarise, and evaluate the methodological quality for the most validated commonly used health-related QoL and mental health assessment measurements in diabetic patients.

METHODS

All original articles published on PubMed, MedLine, OVID, The Cochrane Register, Web of Science Conference Proceedings and Scopus databases were systematically reviewed between 2011 and 2022. A search strategy was developed for each database using all possible combinations of the following keywords: "type 2 diabetes mellitus", "quality of life", mental health", and "questionnaires". Studies conducted on patients with T2DM of ≥ 18 years with or without other clinical illnesses were included. Articles designed as a literature or systematic review conducted on either children or adolescents, healthy adults and/or with a small sample size were excluded.

RESULTS

A total of 489 articles were identified in all of the electronic medical databases. Of these articles, 40 were shown to meet our eligibility criteria to be included in this systematic review. Approximately, 60% of these studies were cross-sectional, 22.5% were clinical trials, and 17.5% of cohort studies. The top commonly used QoL measurements are the SF-12 identified in 19 studies, the SF-36, included in 16 studies, and the EuroQoL EQ-5D, found in 8 studies. Fifteen (37.5%) studies used only one questionnaire, while the remaining reviewed (62.5%) used more than one questionnaire. Finally, the majority (90%) of studies reported using self-administered questionnaires and only 4 used interviewer mode of administration.

CONCLUSION

Our evidence highlights that the commonly used questionnaire to evaluate the QoL and mental health is the SF-12 followed by SF-36. Both of these questionnaires are validated, reliable and supported in different languages. Moreover, using single or combined questionnaires as well as the mode of administration depends on the clinical research question and aim of the study.

Empowerment and Knowledge as Determinants for Quality of Life: A Contribution to a Better Type 2 Diabetes Self-Management

The purpose of this study was to assess how knowledge and empowerment impact the quality of life (QoL) of a person with type 2 diabetes, leading to better communication and disease management. We conducted a descriptive and observational study of individuals with type 2 diabetes. The Diabetes Empowerment Scale-Short Form (DES-SF), Diabetes Knowledge Test (DKT), and EQ-5D-5L were used, in addition to sociodemographic and clinical characteristics. Evaluating the variability in the DES-SF and DKT in relation to the EQ-5D-5L and identifying possible sociodemographic and clinical determinants were conducted using univariate analyses followed by a multiple linear regression model to test whether the factors significantly predicted QoL. A total of 763 individuals were included in the final sample. Patients aged 65 years or older had lower QoL scores, as well as patients who lived alone, had less than 12 years of education, and experienced complications. The insulin-treated group showed higher scores in DKT than the non-insulin-treated group. It was also found that being male, being under 65 years of age, having no complications present, and having higher levels of knowledge and empowerment predicted higher QoL. Our results show that DKT and DES are still determinants of QoL, even after adjusting for sociodemographic and clinical characteristics. Therefore, literacy and empowerment are important for the improvement of the QoL of people with diabetes, by enabling them to manage their health conditions. New clinical practices focused on education, increasing patients' knowledge, and empowerment may contribute to better health outcomes.

Relationship between social determinants of health and quality of life in low income adults with diabetes in Lebanon

BACKGROUND & OBJECTIVE

Global rates of type 2 diabetes (T2DM) are increasing, with the Middle East and North Africa (MENA) region having the second highest prevalence in the world. Populations from the MENA region, including Lebanon, are also witnessing massive waves of immigration to the western hemisphere. Limited data exist about how social determinants of health (SDOH) impact outcomes for T2DM in this population. Thus, the aim of this study was to assess the relationship between SDOH and quality of life (QoL) in Lebanese adults with T2DM.

METHODS

Adults with T2DM (n = 300) were recruited from primary healthcare centers in Lebanon. Demographic characteristics and WHO QoL domains (physical health, psychological wellbeing, social relationships, and environment) were assessed. SDOH included socioeconomic, neighborhood/built environment, and psychosocial variables. Partially and fully adjusted regression models were used to test for associations between SDOH and QoL domains.

RESULTS

Mean age of the participants was 60.3 years, 48% were women, 73% were married, and 64% had less than high-school education. Results from the fully adjusted regression models showed that psychosocial (i.e. adverse childhood experiences and depression), socioeconomic (i.e. employment, income, family size, insurance, financial status, and financial independence), and neighborhood/built environment (i.e. transportation, number of rooms in the household, and certain household items) variables were independent correlates of different QoL domains.

CONCLUSIONS

This study shows that psychosocial, socioeconomic, and neighborhood/built environment variables are differentially associated with different QoL domains, suggesting that SDOH factors are strongly associated with quality of life in low-income adults with T2DM in Lebanon.

Factors predicted quality of life of people with type 2 diabetes in western Ethiopia

BACKGROUND

Multiple factors predict the quality of life of adults with diabetes. However, the relationships of demographics, self-management practice, and support status with the quality of life of people with diabetes are unknown. Therefore, the study aimed to assess factors related with the quality of life of adults with type 2 diabetes in western Ethiopia.

METHODS

A hospital-based cross-sectional study involving adults with type 2 diabetes was conducted in western Ethiopia from June 02, 2020, to August 31, 2020. Convenience sampling technique was used in selecting subjects. The translated and psychometrically tested summary of diabetes self-management activities (expanded), diabetes quality of life, and diabetes care profile support scales were used in measuring self-management practice, quality of life, and support status, respectively. Data were collected via face-to-face interviews. Factors related with quality of life were examined through bivariate analysis and multivariable linear regression. In all statistical tests, P value <0.05 and confidence level that excluded zero were considered statistically significant.

RESULTS

A total of 417 adults with type 2 diabetes participated in the study. In a multivariable linear regression, seven factors including age, male, homemakers, those separated/divorced, number of years since diabetes diagnosis, self-management practice and support needed were related with quality of life. Male patients (β = 2.786, 95% CI = 1.285 to 4.287, p < 0.001), homemakers (β = 0.366, 95% CI = 0.056; 0.677, p = 0.021), self-management practice (β = 4.528, 95% CI = 3.851 to 5.205, p < 0.001) and those who needed support from their families or peers (β = 1.623, 95% CI = 0.458; 2.788, p = 0.006) were related positively with quality of life whereas those who separated or divorced (β = -1.698, 95% CI = -3.371 to -0.025, p = 0.047), older age (β = -0.195, 95% CI = -0.269 to -0.121, p < 0.001) and those who lived with diabetes for a longer duration (β = -2.206, 95% CI = -4.151 to -0.261, p = 0.026) were related negatively with quality of life.

CONCLUSION

Quality of life of people with type 2 diabetes living in western Ethiopia was predicted positively by being male, homemakers, having self-management practice, and support needed, whereas negatively influenced by old age, separation or divorce, and long diabetes life. Thus, encouraging self-management practice, and continuous family or friend support are necessary to enhance quality of life of people with type 2 diabetes. Further study should employ random sampling techniques and involve participants from multiple study settings to increase representativeness of the samples.

Exploring Strategies for Developing Enabling Environments for People with Chronic Heart Disease: An Ethnographic Study Protocol

The impact of chronic diseases on people's daily lives and the exponential number of people affected is a major public health issue. The consequences on individuals and their families is significant, particularly in terms of quality of life. In the literature, this phenomenon is well described in terms of care policy and cost. Although there is a link between a supportive environment and empowerment, there is little literature describing a supportive environment and the daily lives of people living with cardiovascular disease. The objectives of this study are to identify the strategies people use to develop an enabling environment. It will be a qualitative ethnographic study that will address both human behavior and the notion of culture in a broad sense. In the context of this study, an orientation towards critical ethnography will be considered for its particular interest in vulnerable people and in the power relations that may exist in the socio-cultural system. Data will be collected directly in people's homes through observations and interviews with 10 people with cardiovascular disease. For each person, the data collection will take place over three days and will represent approximately 210 h of observation. This protocol was registered in the Research Register on 30 June 2021 and its number is 6933. This study will explore strategies for developing an enabling environment for people living with heart disease and eventually provide recommendations for nursing practices in terms of support.

Stress Estimation Using Biometric and Activity Indicators to Improve QoL of the Elderly

It is essential to estimate the stress state of the elderly to improve their QoL. Stress states change every day and hour, depending on the activities performed and the duration/intensity. However, most existing studies estimate stress states using only biometric information or specific activities (e.g., sleep duration, exercise duration/amount, etc.) as explanatory variables and do not consider all daily living activities. It is necessary to link various daily living activities and biometric information in order to estimate the stress state more accurately. Specifically, we construct a stress estimation model using machine learning with the answers to a stress status questionnaire obtained every morning and evening as the ground truth and the biometric data during each of the performed activities and the new proposed indicator including biological and activity perspectives as the features. We used the following methods: Baseline Method 1, in which the RRI variance and Lorenz plot area for 4 h after waking and 24 h before the questionnaire were used as features; Baseline Method 2, in which sleep time was added as a feature to Baseline Method 1; the proposed method, in which the Lorenz plot area per activity and total time per activity were added. We compared the results with the proposed method, which added the new indicators as the features. The results of the evaluation experiments using the one-month data collected from five elderly households showed that the proposed method had an average estimation accuracy of 59%, 7% better than Baseline Method 1 (52%) and 4% better than Baseline Method 2 (55%).

Predicting Factors of Health-Related Quality of Life Among Adults With Type 2 Diabetes: A Systematic Review

Introduction

One of the most important outcomes of diabetes care and treatment is an improvement in patients' health-related quality of life (HRQoL).

Objective

This study aimed to review the empirical evidence regarding the predictors of HRQoL among adults with type 2 diabetes mellitus (T2DM).

Methods

To find all English-language articles published between 2012 and 2022, a comprehensive literature search was conducted using ProQuest, Scopus, PubMed, Science Direct, and CORE. Cross-sectional studies were the focus of this analysis. Search terms included "type 2 diabetes" OR "T2DM" AND "health-related quality of life" OR "HRQoL" AND ("predicting factors" OR "influencing factors" OR "associated factors"). The original search yielded a total of 1,089 studies, from which 35 met the review's inclusion criteria. The systematic review protocol was registered with PROSPERO CRD42023431229.

Results

The final analysis comprised 24,346 people with type 2 diabetes and used data from 35 cross-sectional studies conducted during the preceding decade. Socio-demographic factors (age, marital status, gender, monthly income, education, area of residence, and religiosity), patient-centered factors (diabetes knowledge and self-efficacy), disease characteristics (comorbidities, duration of diabetes, and insulin treatment), self-management behaviors (physical activity, medication adherence, and frequent glucose checks), and family support were found to be predictors of HRQoL.

Conclusion

A diabetes program to enhance the HRQoL among people with T2DM is highly encouraged to address these factors, which can be focused on promoting self-management behaviors, diabetes distress management, and encourage family support.

Interaction of sleep duration and depression on cardiovascular disease: a retrospective cohort study

Background

To assess the interaction of sleep duration and depression on the risk of cardiovascular disease (CVD).

Methods

A total of 13,488 eligible participants were enrolled in this retrospective cohort study eventually. Baseline characteristics were extracted from the China Health and Retirement Longitudinal Study (CHARLS) database, including age, sex, diabetes, high-density lipoprotein (HDL), blood glucose (GLU), glycosylated hemoglobin (GHB) etc. Univariate and multivariate negative binomial regression models were carried out to assess the statistical correlation of sleep duration and depression on CVD separately. Additionally, multivariate negative binomial regression model was used to estimate the interaction of sleep duration and depression on CVD risk.

Results

After adjusting for age, sex, educational background, hypertension, diabetes, dyslipidemia, the use of hypnotics, disability, nap, drinking, deposit, sleep disturbance, HDL, triglyceride, total cholesterol, GLU and GHB, the risk of CVD in participants with the short sleep duration was increased in comparison with the normal sleep duration [relative risk (RR)=1.02, 95% confidence interval (CI):1.01-1.03]; compared to the participants with non-depression, participants suffered from depression had an increased risk of CVD (RR=1.05, 95%CI:1.04-1.06). Additionally, the result also suggested that the interaction between short sleep duration and depression on the risk of CVD was statistically significant in these patients with diabetes and was a multiplicative interaction.

Conclusion

An interaction between short sleep duration and depression in relation to an increased risk of CVD among Chinese middle-aged and elderly individuals was noticed, which may provide a reference that people with diabetes should focus on their sleep duration and the occurrence of depression, and coexisting short sleep duration and depression may expose them to a higher risk of CVD.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-14143-3.

Medication-related burden and associated factors among diabetes mellitus patients at Felege Hiwot Comprehensive Specialized Hospital in northwest Ethiopia

Background

Evaluating the medicine burden from the patients' perspective is essential for getting good health outcomes of diabetes mellitus (DM) management. However, data are limited regarding this sensitive area. Thus, the study was aimed to determine the medication-related burden (MRB) and associated factors among DM patients at Felege Hiwot Comprehensive Specialized Hospital (FHCSH) in northwest Ethiopia.

Methods

A cross-sectional study was conducted on 423 systematically selected DM patients attending the DM clinic of FHCSH from June to August 2020. The medication-related burden was measured by using the Living with Medicines Questionnaire version 3 (LMQ-3). Multiple linear regression was used to identify factors associated with medication-related burden and reported with 95% confidence interval (CI). p-value <0.05 was considered as statistically significant to declare an association.

Results

The mean LMQ-3 score was 126.52 ( ± 17.39). The majority of the participants experienced moderate (58.9%, 95% CI: 53.9-63.7) to high (26.2%, 95% CI: 22.5-30.0) degrees of medication burden. Nearly half (44.9%, 95% CI: 39.9-49.7) of the participants were non-adherent to their prescribed medications. VAS score (B = 12.773, p = 0.001), ARMS score (B = 8.505, p = 0.001), and fasting blood glucose (FBS) on visit (B = 5.858, p = 0.003) were significantly associated with high medication-related burden.

Conclusion

A significant number of patients suffered from high medication-related burden and non-adherence to long-term medicine. Therefore, multidimensional intervention to decrease MRB and to upgrade adherence is required to increase patients' quality of life.

Distress and Living with Diabetes: Defining Characteristics Through an Online Survey

INTRODUCTION

There is considerable evidence for diabetes reducing quality of life. The impact of such a diagnosis on mental health is less well understood and was subsequently explored here.

METHODS

Online PHQ-9 scores (which calculate the severity of depression), Diabetes Distress Screening Scale (DDSS) and EQ-5D-5L (quality-of-life) questionnaires were completed by patients with diabetes, followed by the extraction of data where possible from responders' clinical records.

RESULTS

A total of 133 people submitted questionnaires. However, not all data items could be completed by each patient; 35% (45/130) had type I diabetes mellitus (T1DM); 55% (64/117) were women. The overall median age of 117 responders was 60 (IQR 50-68 years). The median aggregated response scores were: EQ-5D-5L 0.74 (IQR 0.64-0.85) (lower quality of life than UK population median of 0.83), DDSS 1.9 (IQR1.3-2.7) (≥ 2 indicates moderate distress) and PHQ-9 5 (IQR2-11) (≥ 5 indicates depression). Higher diabetes distress (DDSS)/lower quality of life EQ-5D-5L/higher depressive symptoms (PHQ-9) linked to female sex (DDSS 0.5/25% above median), younger age (< 50 years DDSS 0.7/35% above median), fewer years after diagnosis (< 10 years DDSS 0.8/40% above median), and obesity (BMI > 35 DDSS 0.6/30% above median). Additionally, a HbA1c reading of ≤ 48 mmol/mol was associated with higher DDSS scores, as did a reduction of more than 5 mmol/mol in HbA1c over the last three HbA1c measurements. The 30 individuals with a history of prescribed antidepressant medication also showed higher diabetes distress scores (DDSS 0.9, equating to 45% above the median). The DDSS score elevation came from an increase in emotional burden and regimen-related distress. DDSS scores were not significantly linked to diabetes type, insulin use, absolute level/change in blood glucose HbA1c. Physician-related distress showed a similar pattern.

CONCLUSIONS

A low level of stress in relation to diabetes management may be associated with lower HbA1c. The larger impact of diabetes on mental health in younger women/people with shorter diabetes duration should be noted when considering psychosocial intervention/behavior change messaging. Physician-related distress is a potentially remediable factor. However, this sample was self-selecting, limiting generalization to other samples.

Assessment of health-related quality of life in patients with heart failure: a cross-sectional study in Saudi Arabia

Background

As a precarious clinical condition and a public health problem, heart failure (HF) is associated with a significant burden of morbidity, mortality, and health care costs. As almost all of the published research has been conducted in Western countries, there is a need for culturally relevant studies in Saudi Arabia. This is the first study to investigate health-related quality of life (HRQoL) and its associated factors among Saudi patients with HF in the Qassim region.

Methods

A cross-sectional study was conducted at the only tertiary care hospital in the Qassim region of Saudi Arabia during the period from November 2020 to July 2021. The participants were interviewed face-to-face by trained interviewers using the standard validated 36-item Short-Form Health Survey (SF-36) questionnaire for HRQoL assessment. The data were analyzed using STATA version 16.

Results

The participants included 246 HF patients whose mean (SD) age was 56.7 (10.9) years. A majority of the respondents (80%, n = 197) were male, and 49% (n = 121) had an education level of less than secondary school. The median scores were high for the domains of social functioning (100 points) and bodily pain (75 points) and low for role-physical functioning (25 points). In general, the median scores for the physical and mental component summaries were 58.1 and 63.7, respectively. Patients with an education level less than secondary school were more likely to have a low physical component summary score (aOR 3.00, 95% CI 1.46–6.17), while female patients were more likely to have a low mental component summary score (aOR 2.67, 95% CI 1.38–5.16).

Conclusions

Health-related quality of life was found to be moderate among these HF patients. Periodic HRQoL assessment is recommended for HF patients to minimize their physical and psychological concerns, particularly for patients with low education levels and female patients.

Serum vitamin B12 levels and glycemic fluctuation in patients with type 2 diabetes mellitus

PURPOSE

The aim of the study was to explore the correlation between serum vitamin B12 levels and glycemic fluctuation in patients with type 2 diabetes mellitus (T2DM).

METHODS

This study included 202 T2DM patients in whom blood glucose levels were recorded using a continuous glucose monitoring system retrospectively. Glycemic fluctuation was determined using the average daily risk range (ADRR), a diabetes-specific measure of the risk for hyper- and hypoglycemia.

RESULTS

Serum vitamin B12 levels were higher in T2DM patients with wider glycemic fluctuations than in those with minor glycemic fluctuations (p < 0.001). We observed a positive correlation between serum vitamin B12 levels and ADRR in both T2DM patients who received and did not receive metformin therapy (r = 0.388, p < 0.001 and r = 0.280, p = 0.004, respectively). Multiple linear regression analysis showed that serum vitamin B12 levels were independently correlated with ADRR in T2DM patients who received and did not receive metformin therapy (beta = 0.367, p < 0.001 and beta = 0.410, p < 0.001, respectively).

CONCLUSIONS

Serum vitamin B12 levels are correlated with glycemic fluctuation in patients with T2DM and may serve as an underlying useful biomarker of glycemic fluctuation in T2DM patients, treated with or without metformin therapy.

Quality of life and factors associated with a good quality of life among diabetes mellitus patients in northern Thailand

Background

Quality of life (QOL) is a good indicator of lifespan, especially for individuals who are suffering from a particular illness. QOL among patients with diabetes mellitus (DM) could be used for further implementations in addition to improving patient care and disease management, especially during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess QOL and identify factors associated with a good QOL among DM patients in northern Thailand.

Methods

A cross-sectional study was conducted to gather information from DM patients attending six randomly selected hospitals in the Chiang Rai province, northern Thailand. A validated questionnaire and the 26-item quality of life brief version (WHOQOL-BREF) were used to collect socioeconomic factors and assess QOL, respectively. Chi-square tests and logistic regression were used to detect the associations between variables at a significance level of α = 0.05.

Results

A total of 967 participants were enrolled in the study: 58.8% were female, 52.3% were aged ≥ 60 years, 79.7% graduated primary school and had no additional education, 68.7% had an annual income ≤ 50,000 baht, and 29.3% were unemployed. The majority of patients had a poor-to-moderate overall QOL (49.4%); 90.1% reported a moderate QOL in the physical domain, 54.7% reported a moderate QOL in the mental domain, 63.4% reported a good QOL in the social relationship domain, and 50.6% reported a good QOL in the environmental domain. In multivariate analysis, seven variables were found to be associated with good QOL among the participants. Those aged ≤ 59 years had 1.90 times (95% CI 1.32–2.73) greater odds of having good QOL than those aged ≥ 60. Those who had annual income ≥ 100,001 baht had 2.16 times (95% CI 1.17–3.96) greater odds of having good QOL than those who had annual income ≤ 50,000 baht. Those who lived alone and with spouses had 3.38 times (95% CI 1.42–8.02) and 2.20 times (95% CI 1.20–4.02) greater odds of having good QOL, respectively, than those who lived with relatives. Those who exercised regularly had 4.72 times (95% CI 2.71–8.19) greater odds of having good QOL than those who never exercised. Those who had a high level of knowledge regarding prevention and care had 3.26 times (95% CI 1.22–5.55) greater odds of having good QOL than those who had low knowledge. Those who did not have diabetic nephropathy had 7.41 times (95% CI 4.99–11.01) greater odds of having good QOL than those who were diagnosed with diabetic nephropathy, and those whose medical fees were supported by the government under the universal scheme had 4.31 times (95% CI 1.15–16.7) greater odds of having good QOL than those who had to support themselves.

Conclusions

Almost a half of DM patients in northern Thailand reported having a low-to-moderate QOL, which can be improved by focusing on socioeconomic factors, family support as well as improving knowledge regarding DM prevention and care, including the support of medical fees.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12955-022-01986-y.