The Health-Related Quality of Life of Patients with Type 2 Diabetes in Saudi Arabia

Latent class analysis for quality of life status, sleep quality and anxiety in patients with type 2 diabetes

INTRODUCTION

Type 2 diabetes (T2D) is a chronic metabolic disorder that is associated with reduced sleep quality and anxiety, and can cause a decrease in quality of life in these patients. Despite previous studies investigating these factors, few studies have examined their co-occurrence in these patients. To address this research gap, the present study aimed to determine the subgroups of patients with type 2 diabetes based on quality of life, sleep quality, and anxiety in the subgroups of using latent class analysis (LCA).

METHODS

This cross-sectional study was conducted using multistage random sampling. A total of 308 patients with type 2 diabetes were randomly selected from health centers in Ardabil. All participants completed four sets of checklists and questionnaires, (Demographic characteristics, 12-item Short Form survey, the Pittsburgh Sleep Quality Index and Generalized Anxiety Disorder 7-item). Data analysis was performed using Analysis of Variance (ANOVA), chi square and latent class analysis.

RESULTS

Three latent classes were identified: The first class (good status) included 56.4% of the participants. Also, the second (moderate status) and third (poor status) classes described 16.5% and 27.1% of the participants, respectively. In latent class 1, the probability of having good quality of life and good sleep quality was higher. In latent class 2, the probability of having moderate quality of life and poor sleep quality was higher. However, these patients revealed no anxiety. Those with third latent class membership were more likely to have moderate quality of life, poor sleep quality, and severe anxiety.

CONCLUSION

This study showed that sleep quality and anxiety is positively related to quality of life in patients with type 2 diabetes. In addition, this study indicated the co-occurrence of sleep quality and anxiety in these patients. Based on these findings, effective and targeted interventions can be designed to improve the health status and quality of life of these patients, taking into account sleep quality and anxiety.

The human cost of Type-2 diabetes mellitus: Uncovering the hidden burden on quality of life

Objectives

To evaluate the impact of Type 2 diabetes mellitus (T2DM) on quality of life (QOL) and compare it with healthy subjects.

Method

This case-control study was conducted at Aziz Fatimah Hospital and Aziz Fatimah Medical and Dental College, Faisalabad, Pakistan, from May 2023 to January 2024. A total of 170 subjects were included in the study through purposive sampling technique. Fasting and random blood glucose levels were measured using an enzymatic colorimetric test. HbA1c was determined with the Bioherms A1C EZ 2.0 Glyco-hemoglobin Test Kit. QOL was assessed using the Short Form-36 version 1 questionnaire. Statistical analysis was performed using SPSS version 26, with p ≤ 0.05 considered significant.

Results

The study included 86 T2DM patients and 84 controls, with a mean age of 49.23 ± 12.59 years. Among the participants, 44.7% were male and 55.3% were female. T2DM patients scored lower in physical functioning, limitations due to physical health, bodily pain and vitality subscale compared to controls (p = 0.003, 0.050, 0.030, 0.000 respectively). Both groups had physical component summary and mental component summary (MCS) scores below 50, indicating impaired QOL. MCS scores were significantly lower in T2DM patients than in controls (p = 0.002). Females scored lower in vitality (p = 0.0005) and bodily pain (p = 0.031). T2DM patients with less than five years of duration had lower SF-36 scores than those with longer duration.

Conclusion

T2DM impairs quality of life, especially in females and those with less than five years of disease duration, who face a greater negative impact.

The effect of telenursing follow-up on blood glycosylated hemoglobin and quality of life in the elderly with diabetes type 2

BACKGROUND

Diabetes mellitus is one of the most common and costly diseases. Telephone nursing plays an undeniable and effective role not only in reducing costs but also in providing nursing care and improving the quality of life of patients. This study was conducted with the aim of investigating the effect of telephone follow-up by a nurse on hemoglobin glycated control and the quality of life of elderly patients with diabetes type 2.

MATERIALS AND METHODS

In this clinical trial study, 90 patients with type 2 diabetes referred to the hospitals affiliated with Shahid Beheshti University of Medical Sciences in 1401-1402 were divided into two control and experimental groups (45 patients in each group) by the simple random sampling method. Data collection tools were a demographic-clinical information questionnaire and an elderly quality of life assessment questionnaire (CASP-19). Before the intervention, questionnaires were completed by the sample. The nursing follow-up test group intervention lasted for 12 weeks. In the first month, participants were contacted twice a week, and in the second and third months, they were contacted once a week by phone. Patients in the control group received only follow-up and center care. Finally, the statistical software SPSS version 21 (SPSS Inc, Chicago IL) was used for data analysis. In this study, an independent sample t-test or Mann-Whitney analysis, paired t-test or Wilcoxon test, and Analyze of Covariance (ANCOVA) test were used based on the type of variable distribution (normal or non-normal).

RESULTS

The results of this study showed that by adjusting the variables of weight, baseline level of the quality of life score (before the intervention), age, gender, and physical activity, the difference in the mean changes of the quality of life score in the control and intervention groups in the nurse telephone follow-up intervention was significant (P = 0.054). In addition, the difference in the mean changes of HbA1C in the control and intervention groups was significant due to the nurse's telephone follow-up intervention (P < 0.001).

CONCLUSION

The findings of this study showed that telenursing training and follow-up in the intervention group improved the quality of life and decreased hemoglobin glycosylate in the elderly with type 2 diabetes. Therefore, telenursing can be effective in improving the quality of life of the elderly with type 2 diabetes and managing its complications.

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.

Social/Emotional Health, Mental Health and Quality of Life among Adults with Comorbid Diabetes and Hypertension: A Population-based Cross-sectional Study

Introduction

West Virginia has a disproportionately large population of rural adults with diabetes and hypertension, two common chronic, comorbid conditions that represent a national economic, social, and public health burden. Anxiety, depression, and severe mental illness are associated with poor motivation to engage in coping/self-care behaviors and related increased morbidity/mortality.

Purpose

This study examines the relationship between self-reported mental health, selected social and emotional health factors, health-related quality of life (HRQoL), and clinical outcomes among adults with comorbid diabetes and hypertension.

Methods

This cross-sectional study consisted of 75 participants who participated in a diabetes and hypertension self-management program (DHSMP) in West Virginia. Baseline measures (2018-2019) were used to explore associations and included demographics, self-rated mental health, diabetes distress, HRQoL, HbA1c, and blood pressure. One-way ANOVA was performed to compare mentally healthy v. unhealthy participants by their demographics, diabetes distress and its domains, HRQoL and its domains, and clinical outcomes.

Results

The mean age and BMI were 60.8 ± 12.2 and 36.4 ± 8.1, respectively, indicating that the average participant was older and obese. Participants who self-reported fair or poor mental health had significantly higher BMI, higher diabetes distress, and lower HRQoL. Participants with good to excellent mental health had lower systolic blood pressure.

Implications

Findings indicate the potential role of social and emotional health on clinical outcomes and HRQoL among patients with comorbid chronic conditions, especially for older obese patients. Future studies with larger sample sizes should explore tailoring lifestyle and educational programs to address these factors for improved health outcomes.

Quality of life and psychosocial impact on patients with blood disorders: An empirical study from patients' perspectives in Saudi Arabia

STUDY PURPOSE

this study aims to analyze QOL and psychosocial impact on patients with blood disorders.

METHODS

A cross-sectional survey design is adopted in this study. The survey questionnaire included SF-36 form for measuring quality of life (QOL), along with psychosocial impact assessment scale. Adult patients with different types of blood disorders were recruited for the survey. Out of the 417 responses received, 389 were considered for data analysis and the remaining were avoided due to incomplete data.

RESULTS

In terms of psychosocial impact scales, the highest mean is observed for financial stress (4.09 ± 1.22), followed by social exclusion (3.76 ± 1.19) and relationship challenges (3.31 ± 1.18). Among the QOL scales, the highest mean was observed for pain (3.81 ± 1.17), followed by physical functioning (3.68 ± 1.12). Statistically significant differences (p < 0.05) were observed among the participants groups characterized by age and type of disorder. Strong positive correlations between social exclusion and general health (r = 0.513), as well as pain and relationship challenges (r = 0.735) were observed.

CONCLUSION

Given the existing challenges in social exclusion, poor awareness, and support there is a need to develop comprehensive and personalized treatment plans integrating physical and mental support, awareness creation, and financial support.

The relationship between the duration of diabetes and dimensions of general health and quality of life associated with the health of diabetic patients

Introduction

Diabetes is one of the most common chronic diseases in the world. Diabetes has a major impact on the quality of life of patients. The purpose of this study is the relationship between the duration of diabetes and dimensions of general health and quality of life associated with the health of diabetic patients.

Materials and Methods

In this cross-sectional-analytical study, diabetic patients with more than 1-year history who were not suffering from other chronic diseases were included in the study. Then, using 15 questions for diabetes quality of life, questionnaires and GHQ28 general health were investigated in terms of quality of life and general health. The data were statistically analyzed using SPSS version 24 software.

Results

The average age was equal to 42.8 ± 14.4 years (with a median of 40 years). The average duration of the disease in the patients was equal to 7.7 ± 7.2 years (with a median of 5 years). The average quality of life score of the patients was equal to 50.3 ± 7.8 (out of 75). A negative and significant correlation between age and quality of life of patients was observed (P < 0.001). The duration of the disease had a direct and significant relationship with the general health score. But a significant difference between the quality of life of married and single people was not observed (P = 0.613). A direct and significant relationship between duration of disease, age with physical symptoms (P < 0.001), anxiety and insomnia (P = 0.001), social activity failure (P = 0.013), and depression (P = 0.001) was observed and was also observed with the overall score of general health (P < 0.001).

Discussion and Conclusion

The duration of diabetes disease affects the quality of life and general health of diabetic patients, and discomfort, depression, and anxiety are the main problems that affect the quality of life of diabetic patients.

Factors associated with patient activation among patients with diabetes on hemodialysis: a multicenter cross-sectional study from a developing country

BACKGROUND

Diabetes mellitus (DM) is a major public health concern with considerable morbidity and mortality. DM affects patients' quality of life and can lead to multiple complications, including chronic kidney disease (CKD) and the need for dialysis. Higher patient activation can improve health outcomes in hemodialysis patients with DM. This study aimed to explore the factors associated with higher patient activation and health-related quality of life (HRQoL) among hemodialysis patients with DM.

METHODS

This was a cross-sectional, questionnaire-based study conducted on hemodialysis patients with DM in Palestine. The quota sampling method was utilized to draw samples from six dialysis centers. The questionnaire consists of three sections. The first section includes demographic, socioeconomic and clinical questions. The second section utilizes the patient activation measure-13 (PAM-13) to measure patient activation, while the third section assesses HRQoL using the EQ-5D-5 L tool and the visual analog scale (VAS). Mann‒Whitney and Kruskal‒Wallis tests were employed to examine the relationships between variables at the bivariate level, and multiple regression analysis was employed at the multivariate level.

RESULTS

Of the 200 patients who were approached, 158 were included. The median PAM, EQ-5D index, and VAS score were low at 51.0, 0.58, and 60.0, respectively. A higher PAM score was independently associated with a higher household income level and taking medications independently. A higher EQ-5D index was associated with taking more than eight medications, taking medications independently, living with fewer than three comorbid conditions, and having a higher PAM. A higher VAS score was associated with being married, and receiving less than 3.5 hours of hemodialysis.

CONCLUSIONS

A higher patient activation level was associated with a higher income level and independence in taking medications. Interventions designed to improve patient activation, such as medication management programs, should address these factors among the target population. Longitudinal studies are needed to assess the time effect and direction of causation between health status and patient activation.

Relationship between diabetes health literacy, distress, burnout, social support, complications, self-care behaviors, and quality of life among patients with type 2 diabetes: a path analysis study

INTRODUCTION

Improving the quality of life (QOL) is the most important goal of early diagnosis and treatment in patients with type 2 diabetes (T2D). Numerous studies have indicated the positive effects of health literacy, social support and self-care behaviors and the negative effects of diabetes distress and burnout on the QOL of patients with T2D. Understanding these factors is crucial for people with diabetes. However, no study has investigated the simultaneous effects of these variables on QOL. In this study, our goals were to find out how these variables are related to each other, in addition, which variables play the role of mediating variables, and finally, what is the cumulative effect of these variables in predicting the QOL of patients with T2D. So, this study aimed to examine the relationship between diabetes health literacy (DHL), distress, burnout, social support, complications of diabetes, self-care behaviors, and QOL among patients with T2D by application Path analysis method.

METHODS

In this study 929 participants were entered to study by cluster sampling method and finally, data were analyzed among 820 participants. Data were gathered by self-report and with seven tools of Demographic section, DHL Scale, Diabetes distress scale, Diabetes Burnout scale, Diabetes Self-Management Questionnaire (DSMQ), Perceived social support, Diabetes Quality of Life (DQOL) Questionnaire. The software's of SPSS version 24 and AMOS version 24 were used for analysis.

RESULTS

The variables of DHL, social support, diabetes distress, and complications of diabetes predicted 38% variance in diabetes burnout (R2 = 0.38). Greatest impact on diabetes burnout was related to diabetes distress (estimate total effect = 0.539). The variables of DHL, social support, diabetes distress, complications of diabetes, and diabetes burnout predicted 24% variance in self- care behaviors (R2 = 0.24). Greatest impact on self- care behaviors was related to DHL (estimate total effect = 0.354). The variables of DHL, social support, diabetes distress, diabetes burnout, complications of diabetes, and self- care behaviors predicted 49% variance in DQOL (R2 = 0.49). Greatest impact on DQOL was related to variables of diabetes distress (estimate total effect = -0.613), DHL (estimate total effect = 0.225), diabetes burnout (estimate total effect = -0.202), complications of diabetes (estimate total effect = - 0.173), social support (estimate total effect = 0.149), and self -care (estimate total effect = 0.149), respectively.

CONCLUSION

To improve QOL in patients with T2D, health care providers must develop interventions that increase DHL of diabetic. Because DHL can decrease distress and burnout, enhance self -care skills, create supportive networks, and ultimately improve QOL in patients with type 2 diabetes.

Health-related quality of life among people with diabetes: A cross-sectional study in Hail region, Saudi Arabia ​

BACKGROUND

Diabetes Mellitus is a serious and expanding health problem, together with the issues of health- related quality of life (HRQoL). This further puts pressure on the government to allocate more funds for public healthcare.

OBJECTIVES

This study was devised to evaluate the health-related quality of life of people living with diabetes in Hail region of Saudi Arabia.

METHODS

This cross-sectional research was carried out at eight locations in the Hail region of Saudi Arabia between 21st March-20th May 2022 using the adapted version of the Euro QoL-5 dimension (EQ-5D-3L) questionnaire. A multistage random sample approach was used to choose the diabetes clinics, and data collectors approached the participants in the waiting areas to collect the information. The data were analyzed using logistic regression analysis, Mann-Whitney test, and Kruskal-Wallis tests in IBM SPSS statistics 21.0.

RESULTS

The mean HRQoL score was 0.71±0.21 with a visual analog score of 68.4±16.2. Despite having much higher levels of quality of life in terms of self-care (85.8%), regular activity (73.8%) and anxiety (71.8%), nearly one half of the people reported moderate pain or discomfort, and more than one third reported having moderate mobility issues. In general, the quality of life for women was poorer than for men. Individuals with diabetes who were unmarried, young, educated, financially secure, and taking only oral medication had much improved HRQoL. The Euro QoL of people with diabetes patients were significantly influenced by gender, marital status, age, education, employment and treatment modality (p-values < 0.05), whereas only treatment modality had a significant impact on the patients' visual analogue measures (p-values < 0.05).

CONCLUSIONS

The HRQoL of people with diabetes in Hail region was moderate in general, with pain and mobility issues being particularly prevalent. Gender, marital status, age, education, employment and type of medication therapy are significant predictors of HRQoL of patients with diabetes. Hence, planning and programs to enhance the HRQoL of people with diabetes, especially women is recommended.

Metaphoric perceptions of individuals with diabetes in Turkey: A content analysis

Background

The diagnosis of diabetes mellitus adversely impacts the quality of life due to treatment, changes in daily life, functional disability, and emerging complications. Using metaphors to convey perceptions of diseases and life experiences is crucial for understanding healthcare behaviors.

Objective

This study aimed to explore the metaphorical perceptions of "diabetes" and "being a person with diabetes" within a sample group of individuals with diabetes in Turkey.

Methods

A qualitative design was employed to investigate the metaphoric perceptions of 72 people with diabetes. Data were collected face-to-face between 15 May and June 2023 using a semi-structured questionnaire. Data were analyzed using content analysis.

Results

From the statements of the individuals with diabetes in the sample, seven metaphoric themes related to diabetes - "pain and distress, helplessness and hopelessness, instability, attention and sensitivity, captivity, positive outlook and acceptance, deprivation" - and six metaphoric themes concerning being a person with diabetes - "suffocation and distress, helplessness, powerlessness and disappointment, captivity, attention and sensitivity, guilt, and being worn out" - were identified. Commonly recurring sub-themes with negative connotations included "darkness, well, convict, prison, captivity, microbe, infectious disease, a hot flush, guilt, clouding life, and being ruined." Some positively framed statements included "friend, traffic sign, and driving a car."

Conclusion

The majority of patients in the study used negative metaphors, with fewer expressing positive sentiments regarding the necessity of accepting and paying attention to the disease. Defining individuals' metaphorical perceptions of their disease may enable the provision of better quality and holistic care. Nurses, in particular, play a crucial role in facilitating behavioral changes for patients with diabetes to achieve self-management.

Assessment and Factors Contributing to the Quality of Life in Diabetes Mellitus Patients: A Cross-Sectional Single-Center Study

Introduction Diabetes mellitus (DM) is one of the most common chronic illnesses worldwide, with its prevalence rising rapidly every year. This condition adversely affects vasculature, leading to several potentially devastating complications like cerebrovascular mishaps, myocardial infarction, retinal damage, and renal compromise. These sequelae could lead to serious disabilities and negatively impact quality of life (QoL). Objectives This study aims to assess the QoL of adult diabetic patients in Saudi Arabia and determine influencing socio-demographic factors. Methods This is a cross-sectional study targeting adult diabetic patients visiting the Imam Medical Center in Riyadh, Saudi Arabia, from October 2022 to June 2023. The study encompasses diabetic patients of both genders aged 18 or more but excludes those diagnosed recently, i.e., within less than one year. A validated Arabic questionnaire, available online, was used to assess the QoL of the diabetic patients enrolled in this study. The sample size was 244 adult diabetic patients recruited from the Imam Medical Center through their official social media sites. Results The cohort of 244 patients recruited in this study were mostly aged between 18 and 30 (44.7%), females (52.5%), and married (47.5%). Furthermore, 58.6% of the participants were found to hold a bachelor's degree, 48.8% were employed, and 36.1% earned less than 5000 Saudi riyals each month. Of the total patients, 36.5% were diagnosed with diabetes 1-5 years ago, while 30.5% were diagnosed 5-10 years ago. Type 1 diabetes afflicted 48.4% of participants, whereas 47.1% were affected by type 2 diabetes. It was also determined that type 2 diabetic patients have higher overall QoL scores than type 1 diabetic patients. QoL had a high mean score of 22.05±4.4. The psychological/spiritual domain has the greatest mean score of 24.06±5.4, while the social and economic domain has the lowest (20.58±4.6). The majority of participants (71.3%) did not have other chronic conditions, whereas hypertension (18%) is the prevalent comorbidity, followed by respiratory ailments (7.4%) and cardiovascular disease (3.3%). Furthermore, people with hypertension had a higher total QoL and four life domain scores than those with cardiovascular and respiratory disorders. Conclusion The relevance of the findings is that it could aid health practitioners in developing techniques to encourage patients to undertake self-care to improve physiological management of the condition and reduce complications.

Cognitive and Emotional Perceptions of Illness in Patients Diagnosed with Type 2 Diabetes Mellitus

Type 2 diabetes mellitus (T2DM) affects a patient's physical, social, and mental well-being. Perceptions of the illness are linked to quality of life. The aim of this study was to assess illness perception in patients diagnosed with T2DM and to validate the Brief Illness Perception Questionnaire in the Slovenian language. A cross-sectional study involved 141 patients diagnosed with T2DM. We performed a content analysis of the questionnaire and estimated the S-CVI, I-CVI, kappa coefficient. We also used Cronbach's alpha to assess the reliability. Participants did not have a very threatening perception of T2DM, but being overweight and having cardiovascular disease were significant contributors to a more threatening perception. The most frequently indicated factors influencing the onset and development of T2DM were heredity and genetics, stress and other psychological distress, and poor and inadequate nutrition. I-CVI ranged from 0.833 to 1.00, while the kappa is greater than 0.74, confirming the excellent validity of the questions. The content validity assessment of the questionnaire further confirms that the questionnaire is suitable for use with the target population in Slovenia. The questionnaire proved to be a valid and reliable tool that can be used to assess the relationship between illness perception and self-management of T2DM.

Navigating the Frontier: Emerging Techniques for Detecting Microvascular Complications in Type 2 Diabetes Mellitus: A Comprehensive Review

This review comprehensively explores emerging techniques for detecting microvascular complications in Type 2 Diabetes Mellitus (T2DM), addressing the critical need for advancements in early detection and management. As T2DM continues to rise globally, microvascular complications, including retinopathy, nephropathy, and neuropathy, contribute significantly to the morbidity and mortality associated with the condition. The review synthesizes key findings, revealing various emerging technologies, from advanced imaging modalities to genomic and proteomic approaches. It underscores the potential for personalized medicine, emphasizing the importance of tailoring diagnostic strategies to individual patient profiles. Challenges, including the lack of standardized criteria and issues related to patient adherence, highlight the necessity for collaborative efforts. The conclusion issues a call to action, advocating for enhanced collaboration, increased research investment, patient empowerment through education, and seamless integration of emerging diagnostic techniques into routine clinical care. The review envisions a transformative shift in detecting and managing microvascular complications in T2DM, ultimately improving patient outcomes and contributing to a healthier future for individuals affected by this prevalent metabolic disorder.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand

Introduction

Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition.

Material and Methods

A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD).

Results

Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities.

Conclusion

Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus

BACKGROUND

At present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.

METHODS

In this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.

RESULTS

Decreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.

CONCLUSION

Medication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.

Quantifying health-related quality of life in Malaysian type 2 diabetes: focusing on complication types and severity

PURPOSE

There is a knowledge gap of health utility values for Type 2 Diabetes Mellitus (T2DM) complications in Malaysia. This study aimed to estimate EQ-5D-5L utility values and evaluate health-related quality of life (HRQoL) for Malaysian T2DM associated with complications and clinical characteristics.

METHODS

A cross-sectional study was conducted on T2DM patients at a tertiary hospital outpatient using the Malay and English version of the EQ-5D-5L questionnaire. Health utility values were derived using the Malaysian EQ-5D-5L value set. Ordinary least squares (OLS) multivariable regression model was used to estimate the health utility decrements associated with T2DM-related complications and clinical characteristics.

RESULTS

A total of 513 T2DM patients were recruited. Overall, pain was the most affected of all five EQ-5D-5L dimensions. Patients with foot ulcer, amputation, severe heart failure and frequent hypoglycemia reported more problems collectively in all EQ-5D-5L dimensions. Older age, lower education level, longer duration of T2DM, urine protein creatine index (UPCI) > 0.02 g/mmol, and injection therapy were significantly associated with lower EQ-5D-5L utility values (p < 0.004, Bonferroni adjusted). The lowest unadjusted utility values were reported for severe heart failure 0.65 (interquartile range, IQR 0.50), frequent hypoglycemia 0.74 (0.22) and being amputated 0.78 (0.47). In the multivariable regression model after controlling for sociodemographic and clinical characteristics, the largest utility value decrement was observed for amputation (- 0.158, SE 0.087, p = 0.05), frequent hypoglycemia (- 0.101, SE 0.030, p = 0.001), myocardial infarction (-0.050, SE 0.022, p = 0.022) and obesity (-0.034, SE 0.016, p = 0.029).

CONCLUSION

Larger utility value decrements were found for severe stages of complications. These findings suggest the value of defining severity of complications in utility elicitation studies. The utility decrement quantified for different T2DM complication severity will be useful for economic evaluations within diabetic-related fields.

Health-related quality of life of Kuwaiti adults living with diabetes

Diabetes is known to compromise patients' health-related quality of life (HRQoL). It is important to understand the HRQoL of Kuwaiti nationals living with diabetes and identify factors that negatively affect it. This study included 1,182 Kuwaiti nationals with diabetes, aged 18-80 years. Patients' demographic and HRQoL information was collected using the EuroQol EQ-5D-5L instrument. Mean values for each EQ-5D subscale were worst for mobility (1.9) and pain/discomfort (1.8). Most patients reported having no problems in self-care (84.4%). Older adults were most likely to report severe problems with mobility (p < 0.001). Females were more likely to report severe problems with anxiety and depression than males (p < 0.006). The EQ visual analog scale (EQ VAS), which reports perceived overall health on a 0-100 scale, showed a mean of 74.7 (±19.6). Patients with comorbidities and/or complications perceived their health to be worse, with VAS scores significantly lower (p < 0.001). Other factors that negatively affected VAS scores were being female, obesity, insulin usage, and lower levels of education. In conclusion, patients with diabetes who have comorbidities and/or complications perceived their health to be worse. Further research is required to evaluate if current diabetes management interventions help improve patients' HRQoL.

Quality of life in elderly people with type 2 diabetes using EQ-5D-5L tool: a case control study

Background

According to the World Health Organization (WHO), quality of life is “an individual’s perception of their position in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and concerns. Researchers have conceptualized quality of life on many levels, and there are multiple views on how it should be defined and measured. Chronic diseases like diabetes mellitus are known to compromise the HRQoL. Type 2 diabetes mellitus (DM) is a chronic metabolic disease known to affect HRQoL adversely. Two types of tools have been developed to measure HRQoL. Generic tools are general purpose measures used to assess HRQoL of communities and also for comparison between populations. The EQ-5D-5L consists of two pages—the EQ-5D-5L descriptive system and the EQ visual analog scale (EQ VAS). The descriptive system comprises the five dimensions (mobility, self-care, usual activities, pain/discomfort, anxiety/depression).

Objectives

Assess of quality of life in elderly patients of type 2 diabetes mellitus as well as determine effects of factors related to diabetes and diabetic control on the quality of life of type 2 diabetes.

Methods

- Population of study and disease condition:

◦ A total of 60 participants were enrolled in this study, and all of the participants were among the geriatric group of people (age ≥ 60 years old).

◦ Thirty of them self-reported to have diabetes mellitus type 2, while the other 30 subjects were a control group (self-reported no to have diabetes mellitus).

◦ All participants were subjected to careful history taking, full clinical examination, in addition to laboratory investigation in the form of HBA1C.

◦ All participants had to fill in self-reported questionnaire which is used as a tool for the assessment of HRQOL named EQ-5D-5L (some patients were illiterate so the questionnaire was interviewed to them).

◦ All participants underwent interview questionnaires of the following HRQOL scales: geriatrics depression scale, ADL (activities of daily living scale), and IADL (instrumental activities of daily living scale).

Results

EQ-5D-5L score is significantly higher in diabetic patients than non-diabetics (p value < 0.001).

EQ VAS score is significantly lower in diabetic patients than non-diabetics (p value < 0.001).

ADL (activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001). 

IADL (independence in activities of daily living) functional assessment impairment is higher in diabetics than non-diabetics (p value < 0.001).

Visual prop is impaired in diabetics more than non-diabetics (p value < 0.001).

Pain severity is mainly affected in diabetics more than non-diabetics.

Conclusion

Type 2 diabetes mellitus in elderly patients affects their health-related quality of life and their daily activities.

In our study, the HRQOL of uncontrolled diabetic patients were more negatively affected than that of the controlled diabetic patients.

Moreover, some of our diabetic patients were found to suffer from cognitive disorders (insomnia and depression) as a complication of diabetes.

We also found that the EQ-5D-5L of diabetic patients with comorbidities was higher than those without comorbidities and EQ-VAS was lower in comorbid diabetic patients.

Quality of Life and Metabolic Indicators of Patients with Type 2 Diabetes: A Cross-Sectional Study in Iran

BACKGROUND

The World Health Organization (WHO) has considered type 2 diabetes mellitus (T2DM) a major global health challenge because of its high prevalence worldwide. T2DM can affect patients' personal, social, and economic statuses. On the other hand, due to the increasing prevalence of T2DM, Quality of Life (QOL) has received more attention in recent years.

OBJECTIVE

The present study was conducted to investigate the relationships between QOL and physical activity level, body mass index, fasting blood sugar, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, total cholesterol, HbA1c, and systolic and diastolic blood pressure among Iranian patients with uncomplicated T2DM.

METHODS

This cross-sectional study was conducted on 135 participants selected through consecutive sampling. The study data were collected using International Physical Activity Questionnaire and Short-Form Health Survey Questionnaire. Then, the data were entered into the SPSS ver. 28 software, and Pearson's correlation was used to measure the correlation between the variables. Linear regression was also employed. The significance level was set at 0.05.

RESULTS

The significant association was observed between gender (p = 0.007), HDL level (p = 0.02), and gender-adjusted physical activity (p = 0.002) with QOL.

CONCLUSIONS

Due to the association between physical activity and HDL level with QOL in patients with uncomplicated T2DM, they should be given the necessary training to improve their physical activity and regulate HDL level. Also, empowering them in this matter improves their QOL.