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

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.

The Bidirectional and Temporal Associations of Depression With Allergic Rhinitis and Chronic Rhinosinusitis: A Nationwide Cross-Sectional Study

PURPOSE

This study aimed to delve into the bidirectional and temporal relationship between depression, allergic rhinitis (AR) and chronic rhinosinusitis (CRS).

METHODS

A total of 17,028 participants from the Korean National Health and Nutritional Examination Survey, surveyed in 2016, 2018, and 2020, were included in this study. Participants' medical histories were used to determine their depression, AR and CRS status, as well as the age at diagnosis. Logistic regression analyses were conducted to reveal the associations between AR/CRS and depression. Subgroup analysis was performed considering various clinical characteristics.

RESULTS

Regardless of occurring independently or coexisting, AR and CRS consistently preceded the diagnosis of depression. The prevalence of depression was higher among patients with AR and CRS, and similarly, the prevalence of AR and CRS was elevated among patients with depression (all P < 0.001). Depression was associated with increased odds of AR (odds ratio [OR], 1.646; 95% confidence interval [CI], 1.309-2.071; P < 0.001) and CRS (OR, 1.882; 95% CI, 1.427-2.416; P < 0.001). Similarly, AR (OR, 1.613; 95% CI, 1.278-2.036; P < 0.001) and CRS (OR, 1.869; 95% CI, 1.415-2.467; P < 0.001) were both associated with heightened odds of depression.

CONCLUSIONS

The study findings indicated a bidirectional and complex association between depression and AR/CRS, emphasizing the importance of early detection and intervention.

Self-care and health-related quality of life in Mexican older adults with type 2 diabetes

BACKGROUND

Type 2 diabetes (T2D) is one of the most prevalent chronic diseases in the world and represents one of the main risk factors for cardiovascular diseases. The evidence suggests that inadequate self-care behavior among patients with chronic diseases might negatively affect their health-related quality of life (HRQoL); however, the evidence in older adults with diabetes is inconclusive, and the information is scarce in the Mexican context. Therefore, this study aimed to determine self-care behavior and HRQoL in Mexican older adults with T2D and evaluate the association between both variables.

MATERIALS AND METHODS

An analytical cross-sectional design was used. Participants (n = 300) were recruited at six senior centers in Hidalgo, Mexico. The Self-Care Capacity and Perception Test for Older Adults and the brief version of the World Health Organization Quality of Life Scale (WHOQOL-BREF) were used to assess self-care behavior and HRQoL, respectively. The associations between the variables of interest were evaluated by logistic regression models adjusted for confounders.

RESULTS

Older adults with inadequate self-care behavior were more likely to have poor HRQoL in all domains of the WHOQOL-BREF: physical health [adjusted odds ratio (aOR) = 4.10; 95% CI = 1.59, 10.57], psychological health (aOR = 6.98; 95% CI = 2.41, 20.19), social relationships (aOR = 7.02; 95% CI = 2.64, 18.67), and environmental health (aOR = 4.25; 95%CI = 1.43, 11.50). Partially adequate self-care behavior also showed a significant association with poor HRQoL.

CONCLUSION

Self-care behavior was independently associated with HRQoL in Mexican older adults with T2D. Thus, it is important to plan awareness-raising interventions to improve self-care behaviors in older adults with chronic conditions.

Effects of Personalized DiaBetes TEXT Messaging Combined with Peer Support Education on Patients With Type 2 Diabetes: A Randomized Controlled Trial

BACKGROUND

To investigate the effects of personalized DiaBetes TEXT messaging combined with Peer Support Education (DB-TEXT+ PSE) on clinical outcomes in patients with type 2 diabetes.

METHODS

An assessor-blinded, three-arm randomized controlled trial recruited 84 participants between December 2022 and July 2023. Participants were randomly assigned to a DB-TEXT + PSE group, a DB-TEXT group, or a professional education program (PEP) group. Primary outcomes included glycated hemoglobin (HbA1c), fasting blood glucose (FBG) levels, and clinical remission rates, whereas secondary outcomes measured lipid profiles, fatigue, sleep quality, depression, and quality of life (QoL). Outcomes were assessed at baseline (T0), three months (T1), and six months (T2) postintervention.

RESULTS

Relative to PEP, personalized DB-TEXT + PSE and DB-TEXT alone led to significantly reduced HbA1c levels at T1 and decreased FBG levels at T1 and T2. Type 2 diabetes remission was achieved by 35.7% and 50% of the participants in the DB-TEXT + PSE group, by 17.9% and 25% in the DB-TEXT group, and by 3.7% and 3.7% in the PEP group at T1 and T2, respectively. Relative to the PEP, DB-TEXT + PSE led to significantly reduced TC levels, diastolic blood pressure (DBP), and systolic blood pressure (SBP) and improved sleep quality and QoL over time.

CONCLUSIONS

Personalized DB-TEXT + PSE is more effective at enhancing clinical outcomes, reducing fatigue, improving sleep quality, and improving quality of life in patients with type 2 diabetes than DB-TEXT alone and PEPs are. Educators can incorporate personalized DB-TEXT + PSE as a component of diabetes education programs and thereby integrate digital interventions and supplementary programs.

Anxiety, Depression, and Quality of Life in Women with Breast Cancer and Type 2 Diabetes: A Pilot Study in North Greece

Introduction: The incidence of breast cancer, as well as diabetes mellitus (DM), has continuously increased in recent years. The concurrent study of these diseases is particularly important, as there is a strong correlation between them due to hormonal, biochemical, and environmental factors. Moreover, the underlying metabolic dysfunction in this case could affect the treatment of breast cancer, as well as overall survival. In addition, the relationship of these two diseases with depression is not well studied. Patients with DM and cancer patients both experience depressive symptoms that have an impact on their mental health, as well as their quality of life. Personalized medicine offers a potential solution to these challenges by tailoring treatments to individual patient profiles. The present study will attempt to fill a gap in the existing literature regarding the relationship of patients with concurrent breast cancer and DM experiencing depression. More specifically, it will attempt to answer the question of whether there is a strong correlation between breast cancer, DM, and mental health in patients from a large geographical division of the country. Methodology: This was a cross-sectional study. A total of 120 female patients participated in the research, 60 with type 2 diabetes mellitus (T2DM) (group B) and 60 with T2DM and breast cancer (group A). The DASS-21 questionnaire was used to determine their levels of anxiety and depression, and ADDQoL-19 was used to measure the patients' quality of life. Results: Regarding quality of life, women with T2DM and breast cancer showed a better quality of life (QoL) than women with T2DM. Women who were retired (p = 0.025) and consequently postmenopausal (p = 0.035) demonstrated the highest levels of QoL, while stage III cancer patients had lower ADDQoL-19 scores. Regarding mental health, in the women from group A, a positive correlation of treatment with the occurrence of anxiety and depression (p = 0.034) and a negative correlation of cancer stage with mental health was observed. The women in group B (those with T2DM only) showed better mental health outcomes related to their treatment (p = 0.009). However, both married and unmarried women in this study experienced mental health burdens, with no significant difference between the two groups in terms of mental health impact. These findings suggest that marital status did not significantly influence the mental health of the participants in this study. Conclusions: Women with T2DM and breast cancer generally presented a better clinical picture than women with T2DM alone. Therefore, the comorbidity of these two diseases did not seem to negatively affect the quality of life and mental health of these women.

The association between health literacy and quality of life of patients with type 2 diabetes mellitus: A cross-sectional study

BACKGROUND

Health literacy-driven interventions in patients with type 2 diabetes have been found to play an important role in achieving glycemic control and enhancing diabetic self-management outcomes. The present study aimed to examine the role of health literacy as a predictor of quality of life among diabetic patients in Jordan.

METHODS

This cross-sectional study enrolled 400 Type 2 diabetic patients visiting the endocrinology department at the outpatient clinic at Al Basheer Hospital in Amman, Jordan. The data were collected between 1st of August and 28th of December 2023, using the validated Jordanian Diabetic Health Literacy Questionnaire and the EuroQol-5D tool. A quantile regression analysis was conducted to explore the factors associated with health-related quality of life among the study participants.

RESULT

This study included 68.8% females, with a median age of 58 (50-64) years. The median EQ5-D index score was 0.66 (0.41-0.78). Findings from regression analysis indicated as patients' age increased, their quality of life scores significantly decreased (-0.004, 95%CI (-0.006, -0.001), p = 0.002). Additionally, higher JDHLQ scores were significantly associated with higher EQ5-D scores (0.012, 95% CI (0.006-0.018), p<0.001). Moreover, patients with only an elementary education had significantly lower EQ5-D scores compared to those with a postgraduate education (-0.106, 95%CI (-0.190, -0.023), p = 0.013).

CONCLUSION

The findings of the present study emphasize the importance of including health literacy assessments and interventions in the diabetes care plans of patients in Jordan.

Association Between Quality of Life and Drug Adherence Among Patients With Diabetes in India

INTRODUCTION

Diabetes represents a significant global health concern. Effective diabetes management necessitates substantial behavioral and psychological modifications, including regular glucose monitoring, dietary adjustments, and medication adherence. However, treatment adherence remains suboptimal, particularly in developing countries, leading to poor glycaemic control, increased healthcare costs, and diminished quality of life (QoL). Common factors influencing medication nonadherence include lack of medication knowledge, age, education of patients, polypharmacy, duration of disease, cost of therapy, complexity of dosing regime, and the presence of comorbidities. So, the study aims to assess the adherence status to antidiabetic medication and its association with QoL among diabetes patients in the Anand district of Gujarat state.

METHODOLOGY

A study was carried out in Anand district, Gujarat, from 2023 to 2024, focusing on community-based cross-sectional research. In the eight blocks of Anand district, a two-stage cluster sampling method was utilized, with one village or town randomly chosen from each taluka, and 25 diabetes patients interviewed per area. Data collection involved visiting 200 participants' houses, starting with a randomly selected house and continuing until the target was met. The interviews, conducted in the local language, lasted around 45 minutes and utilized a pre-validated and pretested questionnaire. The questionnaire covered demographic details, disease characteristics, and medication adherence using the semi-structured scale from Adherence to Refills and Medications Scale (ARMS-D), as well as the assessment of QoL using the WHOQoL-BREF questionnaire. Descriptive and inferential statistics were used for data analysis. Sociodemographic attributes were presented in terms of percentages (%) and frequencies (N). The means and standard deviation (SD) of health-related QoL and adherence to anti-diabetic medication were reported. Multiple linear regression analysis was used to assess the impact of adherence to antidiabetic medication within each QoL area after adjusting for a few sociodemographic variables. P values below 0.05 were considered statistically significant.

RESULTS

The study included predominantly older participants (58.1 years) with 53.5% being male. Most participants (65.5%) had diabetes for more than 5 years, 60.0% had comorbidities, and 29.0% experienced complications. Nonadherence to treatment was observed in 37.0% of patients. The study found that factors like age, education, occupation, family history of diabetes, smoking, alcohol consumption, exercise habits, and medication adherence significantly influenced the QoL in diabetic patients, with medication adherence showing the strongest positive association with all QoL domains.

CONCLUSION

This study shows a high percentage of nonadherence to antidiabetic medications. Poor adherence had significantly lower mean scores across all domains of QoL. Community-based educational programs targeting older and less-educated individuals should promote regular physical activity. Developing strategies to improve medication adherence and ensuring affordable access to essential medications, along with prioritizing enhancements in the QoL through psychosocial support and lifestyle counseling are imperative for diabetic patients.

Quality of Life and Its Determinants Among Individuals With Diabetes in Saudi Arabia: A Cross-Sectional Online Survey

Background Diabetes mellitus is a significant public health issue globally, with increasing prevalence rates. In Saudi Arabia, a substantial proportion of the adult population is affected. While the impact of diabetes on physical health is well-documented, less is known about its effects on emotional and social well-being in this region. Methods From January to March 2024, we conducted a cross-sectional online survey of 207 individuals with diabetes in Saudi Arabia. The survey, available in Arabic and English, assessed physical symptoms, emotional health, social interactions, and overall quality of life. Descriptive statistics were used for analysis. Results The majority of participants were aged 31-45 years (n=63, 30.4%) and female (n=118, 56.9%). Type 2 diabetes was the most common (n=122, 59.1%). Regarding physical health, 34.6% (n=72) rated their health as good while 37.2% (n=77) experienced physical symptoms sometimes and 17.9% (n=37) often. Emotional health challenges were reported by 39.2% (n=81) experiencing anxiety and 33.9% (n=70) experiencing depression. Social interactions were impacted, with 28.6% (n=59) reporting challenges in relationships and 14.3% (n=30) facing significant impacts on recreational activities. Overall quality of life was rated as good by 40.4% (n=83), fair by 29.9% (n=62), and very poor by 4.8% (n=10). Conclusions The study highlights the significant effects of diabetes on the physical, emotional, and social aspects of life in Saudi Arabia. The findings underscore the need for comprehensive care strategies that incorporate medical treatment, emotional support, and social integration to improve the overall quality of life for individuals with diabetes.

The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study

BACKGROUND

Women with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress.

METHODS

This analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman's correlation, t-test, analysis of variance, and multiple linear regression.

RESULTS

The mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life.

CONCLUSION

GDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

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.

Quality of life, stress, anxiety and depression and associated factors among people with type 2 diabetes mellitus in Western region Saudi Arabia

Introduction

The objective of this study is to evaluate the quality of life (QoL), depression, anxiety, and stress, along with associated factors among individuals with diabetes in Saudi Arabia.

Methods

This survey was conducted at King Abdulaziz University (KAU), Jeddah, Kingdom of Saudi Arabia (KSA). The assessment of depression, anxiety, and stress related to Type 2 Diabetes Mellitus (T2DM) was conducted using the DASS-21 questionnaire, while diabetes-related QoL was evaluated using the revised version of the diabetes QoL questionnaire (RV-DQoL13). Data were analyzed using SPSS-26.

Results

A total of 251 subjects were included in the study (165 [65.7%] males and 86 [34.3%] females, mean age 50.1 ± 14.5 years). The individuals with DM had a mean value of QoL of 29.16 ± 9.23, with 46.9% having poor QoL. Furthermore, in dimensions of QoL, almost half of the individuals reported high worry about the disease (49.6%), followed by a high diabetes impact (46.6%) and low life satisfaction (42.9%). The prevalence of depression, anxiety, and stress was 49.4, 71.7, and 49.8%, respectively. A significant correlation was found between depression, anxiety, and stress and DASS-21 scores with QoL (p < 0.001). The regression analysis indicated an association of distinct factors with QoL like age above 41 years (p = 0.004), being married (p < 0.001), being divorced (p = 0.04), higher education (p = 0.007), regular medicine intake (p = 0.01), regular exercise (p = 0.03), lipid profile (p = 0.01), HbA1c (p < 0.001), and DASS-21 scores (p < 0.001). Poor QoL score (TQoL score > 27) was significantly associated with depression, anxiety, and stress (p < 0.001). The participants with higher monthly income, shorter disease duration, regular medicine use, and altered lipid profile, and older subjects had a lower chance of depression, anxiety, and stress.

Conclusion

Approximately half of individuals with T2DM experienced poor QoL, while the prevalence rates for depression, anxiety, and stress were 49.4, 71.7, and 49.8%, respectively. Scores in the domains of impact, worry, and satisfaction were below optimal levels. Several factors were linked to QoL and depression, anxiety, and stress, and an association was observed between DASS-21 scores and QoL.

Health Care Access and Quality of Life of Community-Dwelling Senior Citizens in Pampanga, Philippines

This study examined the association between healthcare access and quality of life (QOL) among senior citizens in Pampanga, Philippines. We conducted a cross-sectional study among 410 community-dwelling senior citizens aged 60 and above. Using validated scales, we assessed both healthcare access and QOL. Descriptive statistics were employed to characterize the senior citizens, and multiple linear regression was used to examine the association between healthcare access and QOL. Senior citizens, averaging 69 years old, were predominantly women, single/widowed, and with comorbidities. They reported high healthcare access (mean = 120.13) and moderate QOL (mean = 70.79). Environmental health scored highest in QOL domains, while social relationships scored lowest. Overall healthcare access was positively associated with overall QOL (B [unstandardized beta] = .22, 95% CI [confidence interval] 0.10, 0.33) and its domains. Significant associations with overall QOL were observed for accessibility (B = 1.95, 95% CI 0.98, 2.91) and affordability (B = -1.60, 95% CI -2.46, -0.74). Filipino senior citizens in Pampanga demonstrated high healthcare access and moderate QOL. The study highlights the importance of healthcare access in enhancing senior citizens' QOL, particularly regarding accessibility and affordability. Further research is needed to explore the nuanced relationships between healthcare access subscales and specific QOL domains.

"Failure to control blood sugar" experiences of persons with type 2 diabetes mellitus

Objectives

This study aimed to explore the experiences of persons with type 2 diabetes mellitus having poor glycemic control.

Methods

A narrative qualitative study was conducted. Eight participants were recruited at a hospital's primary care unit (PCU) in northeastern Thailand from October to December 2021. The data was collected using in-depth interviews, field notes, and non-participatory observation. It was then analyzed based on the thematic analysis guide of Braun & Clarke (2006).

Results

The results revealed four main themes and eight sub-themes: lifestyle practice (inappropriate eating behaviors, taking diabetes drugs irregularly, exercising irregularly); perception of self-care (misperceptions about self-care practices, diabetes was a genetic disease and therefore had to be accepted); awareness regarding complications (not being aware of glycemic control, issues with social gatherings); stress from socioeconomic issues (feeling stressed in daily life).

Conclusions

It is the role of healthcare professionals to stress the importance of healthy behaviors to improve glycemic control in terms of diet, exercise, medication use, perception, awareness, culture, and beliefs. The study results could aid healthcare providers in developing innovations in nursing care or interventions to change unhealthy behaviors.

The mediating role of quality of life on depression and medication adherence among patients with type 2 diabetes mellitus: A cross-sectional study

Background and Aim

Patients living with diabetes mellitus have a high burden of psychological distress such as depression and anxiety as well as impaired quality of life, which may negatively impact their adherence to medications, glucose control, and health-related costs.This study assessed the impact of quality of life and depression on medication adherence among patients with type 2 diabetes (type 2 diabetes mellitus [T2DM]) in a tertiary care setting in Ghana.

Methods

The study was a cross-sectional study involving 238 patients with diabetes aged 18 years and above. Validated tools were used to assess medication adherence, depressive symptoms, and quality of life. Structural Equation Modeling was adopted to examine the mediation effect of quality of life on the relationship between depression and medication adherence among participants.

Results

The mean age of the participants was 58.82 ± 13.49, and 169 (71.0%) out of a total of 238 respondents were females. Depression had a significant direct relationship with the quality of life of respondents [aβ (95% confidence interval, CI) = -0.20 (-0.03, -0.00), p < 0.05; -0.21 (-0.41, -0.01) p < 0.05, respectively] and indirect relationship with quality of life [aβ (95% CI) = -0.01 (-0.02, -0.004) p < 0.001]. Educational status and religion both showed a significant indirect relationship with quality of life [aβ (95% CI) = 0.06 (0.07, 0.12), p < 0.05; 0.18 (0.01, 0.35) p < 0.05, respectively]. The mediating effect of quality of life on the relationship between depression and medication adherence was significant (Sobel = -3.19, p < 0.001).

Conclusion

Depression, medication adherence, and quality of life were higher among older adults with T2DM. Depression was also found to have a strong negative association with both medication adherence and quality of life. Interventions to screen for depression and to improve the quality of life in patients living with diabetes are also recommended and this should go beyond the provision of standard treatments to explore further the mechanisms of this relationships.

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.

Identifying and prioritizing resilient health system units to tackle the COVID-19 pandemic

Since human health greatly depends on a healthy and risk-free social environment, it is very important to have a concept to focus on improving epidemiology capacity and potential along with economic perspectives as a very influential factor in the future of societies. Through responsible behavior during an epidemic crisis, the health system units can be utilized as a suitable platform for sustainable development. This study employs the Best-Worst Method (BWM) in order to develop a system for identifying and ranking health system units with understanding the nature of the epidemic to help the World Health Organization (WHO) in recognizing the capabilities of resilient health system units. The purpose of this study is to identify and prioritize the resilient health system units for dealing with Coronavirus. The statistical population includes 215 health system units in the world and the opinions of twenty medical experts are also utilized as an informative sample to localize the conceptual model of the study and answer the research questionnaires. The resilient health system units of the world are identified and prioritized based on the statistics of "Total Cases", "Total Recovered", "Total Deaths", "Active Cases", "Serious", "Total Tests" and "Day of Infection". The present descriptive cross-sectional study is conducted on Worldometer data of COVID-19 during the period of 17 July 2020 at 8:33 GMT. According to the results, the factors of "Total Cases", "Total Deaths", "Serious", "Active Cases", "Total Recovered", "Total Tests" and "Day of Infection" are among the most effective ones, respectively, in order to have a successful and optimal performance during a crisis. The attention of health system units to the identified important factors can improve the performance of epidemiology system. The WHO should pay more attention to low-resilience health system units in terms of promoting the health culture in crisis management of common viruses. Considering the importance of providing health services as well as their significant effect on the efficiency of the world health system, especially in critical situations, resilience analysis with the possibility of comparison and ranking can be an important step to continuously improve the performance of health system units.

Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes

Globally, almost 9.3% of the population aged 20-80 years have been diagnosed with diabetes making diabetes management a global health problem beyond specific regions or races. This study aimed to determine the effect of diabetes knowledge, self-stigma, and self-care behavior on the quality of life of patients with diabetes. This descriptive research study evaluated 180 patients receiving diabetes treatment at the outpatient Department of Endocrinology at C University Hospital. Data were collected between 30 July 2019, and 30 August 2019. The study variables were general patient characteristics, disease-related characteristics, quality of life, diabetes knowledge, self-stigma, and self-care behavior. Factors affecting the quality of life were analyzed by hierarchical regression. Self-stigma (β = -0.298), monthly income (β = 0.270), and self-care behavior (β = 0.140) significantly affected the quality of life, in that order. The higher the self-stigma, the lower the quality of life, and the higher the monthly income and the level of self-care behavior, the higher the quality of life. A psychosocial support program to positively change the attitude toward diabetes is needed to improve the quality of life among patients with diabetes.

The Influence of Family Caregiver Knowledge and Behavior on Elderly Diabetic Patients' Quality of Life in Northern Thailand

The quality of life (QoL) of elderly diabetic patients may be affected by caregiver factors, but this has received little empirical support. The objective of this cross-sectional study is to determine the influence of family caregivers’ diabetes knowledge and behavior on the QoL among elderly patients with diabetes mellitus (DM). The participants included 354 elderly patients with Type 2 DM and their family caregivers, who were recruited through multistage sampling from five districts in Chiang Mai, Thailand. Face-to-face interviews with DM patients were conducted using the Thai Simplified Diabetes Knowledge Scale (T-SDKS), the Thai version of the Diabetes Self-Management Questionnaire (DSMQ) for self-care behaviors, and the Thai version of the World Health Organization Quality of Life for Older People (WHOQOL-OLD) scale. For caregivers, their diabetes knowledge was measured by T-SDKS and patient-care or supportive behaviors were developed based on DSMQ. The results showed a moderate level of QoL among elderly diabetic patients. According to simple linear regression analysis, the QoL score among elderly DM patients was positively associated with their diabetes knowledge (B = 1.25), self-care behaviors (B = 3.00), caregivers’ knowledge (B = 0.97), and supportive behavior from caregivers (B = 2.92) at a significance level of p < 0.01. In the multivariable model, patients’ self-care behaviors (B = 1.58, p = 0.001), caregivers’ knowledge (B = 0.58, p = 0.001), and patient-care behaviors (B = 1.38, p = 0.004) were significantly associated with QoL among DM patients when controlling for patient factors, including age, body mass index (BMI), education, and living arrangements, which accounted for 27.0% of the variance. This indicates that caregivers’ adequate diabetes knowledge and appropriate supportive behaviors may impact the QoL of elderly diabetic patients. Health care providers should prioritize motivating and empowering family caregivers to pay more attention to the patient for the success goal.

Knowledge, Attitudes, and Practices Regarding “New Normal” Guidelines and Quality of Life Among Thai People During the COVID-19 Outbreak: An Online Cross-Sectional Survey

In Thailand, strict prevention and control strategies have been implemented to mitigate the rapid spread of coronavirus disease 2019 (COVID-19). “New normal” guidelines and a series of mobile health applications have been introduced by the healthcare sector and implemented to aid the disease control monitoring and prevention of widespread outbreaks. This study aimed to assess the knowledge, attitudes, and practices (KAP) regarding “new normal” guidelines and quality of life (QOL) among Thai people during the COVID-19 outbreak, and to determine the association between KA, QOL, and practices. An online cross-sectional survey was conducted from 7 June to 12 September 2021 among Thai people in Public Health Region 6 aged ≥ 18 years old. Of the 506 survey participants, 80.3% were female, and 65.0% were 25–59 years old. The survey revealed that 52.2% of participants were classified as having more accurate knowledge, 58.9% were classified as having more positive attitudes, and 80.8% were classified as having more frequent practices regarding “new normal” guidelines, and 54.7% had high QOL. Of the participants, 93.7% agreed that “people who have been fully vaccinated should wear a mask while outside,” and 95.5% wore a face mask outdoors in crowded places. However, 60.9% of participants misunderstood some details regarding online applications for contact tracing and vaccination services, 44.2% felt that these applications were difficult to use, and 33.4% rarely or never downloaded or used these applications. In logistic regression analyses, accurate knowledge of COVID-19 was associated with higher education, being a government employee, monthly family income &gt; 30,000 Thai Baht, and regular use of social media. More positive attitudes regarding “new normal” guidelines and high QOL were associated with positive practices. High QOL was associated with older age, and higher education. Enhancement of attitudes and QOL is also important for improving practices in the general population during the COVID-19 pandemic. Significant factors identified in KAP will be crucial for developing effective prevention and control programs to mitigate the spread of COVID-19. To implement mobile health applications effectively, more work is required to improve the ease of use and promotion strategies.