Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey

An Audit of Diabetes-Dependent Quality of Life (ADDQOL) in Older Patients with Diabetes Mellitus Type 2 in Slovenia

OBJECTIVE

This article reports a study to measure diabetes-dependent quality of life (QOL) in older Slovenian patients with diabetes mellitus type 2 (DMT2).

METHODS

A cross-sectional study of older (age ≥ 65 years) patients with DMT2 at outpatient diabetic centers was conducted in all regions in Slovenia. The Audit of Diabetes-Dependent Quality of Life questionnaire was carried out between January and May 2012. Statistical analysis was performed by using IBM SPSS Statistics software, version 18.0.

RESULTS

After exclusion of noneligible respondents, a total of 285 respondents were included in the analysis, which represented a 57% response rate. Lower QOL was significantly connected to a heart attack episode (odds ratio 2.42; 95% confidence interval 1.06-5.20) and to the perception of not having diabetes under control (odds ratio 0.36; 95% confidence interval 0.18-0.69). Eleven (3.9%) patients reported no impact of DMT2 on their QOL at all, while in the remaining respondents, particular reference was put to the effects on freedom to eat, dependency on others, and family life. There was no significant difference between the older people living in urban and rural areas.

CONCLUSIONS

The findings of the present study highlight the impact of DMT2 on QOL. DMT2 imposes a personal burden on individuals. Information on the QOL of older patients with diabetes is important to Slovenian policymakers and family physicians to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QOL of patients with diabetes.

Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15-34 years - a Swedish population-based study using EQ-5D

Background

Diabetes with onset in younger ages affects both length of life and health status due to debilitating and life-threatening long-term complications. In addition, episodes and fear of hypoglycaemia and of long-term consequences may have a substantial impact on health status. This study aims to describe and analyse health-related quality of life (HRQoL) in individuals with onset of diabetes at the age of 15—34 years and with a disease duration of 1, 8, 15 and 24 years compared with control individuals matched for age, sex and county of residence.

Methods

Cross-sectional study of 839 individuals with diabetes and 1564 control individuals. Data on socioeconomic status and HRQoL using EQ-5D were collected by a postal questionnaire. Insulin treatment was self-reported by 94% of the patients, the majority most likely being type 1.

Results

Individuals with diabetes reported lower HRQoL, with a significantly lower mean EQ VAS score in all cohorts of disease duration compared with control individuals for both men and women, and with a significantly lower EQ-5D_index for women, but not for men, 15 years (0.76, p = 0.022) and 24 years (0.77, p = 0.016) after diagnosis compared with corresponding control individuals. Newly diagnosed individuals with diabetes reported significantly more problems compared with the control individuals in the dimension usual activities (women: 13.2% vs. 4.0%, p = 0.048; men: 11.4% vs. 4.1%, p = 0.033). In the other dimensions, differences between individuals with diabetes and control individuals were found 15 and 24 years after diagnosis: for women in the dimensions mobility, self-care, usual activities and pain/discomfort and for men in the dimension mobility. Multivariable regression analysis showed that diabetes duration, being a woman, having a lower education and not being married or cohabiting had a negative impact on HRQoL.

Conclusions

Our study confirms the negative impact of diabetes on HRQoL and that the difference to control individuals increased by disease duration for women with diabetes. The small difference one year after diagnosis could imply a good management of diabetes care and a relatively quick adaptation. Our results also indicate that gender differences still exist in Sweden, despite modern diabetes treatment and management in Sweden.

Health related quality of life in patients with type 2 diabetes mellitus in Iran: a national survey

INTRODUCTION

The aim of this study was to measure health-related quality of life (HRQoL) in Iranian people with Type 2 Diabetes Mellitus using two different measures and examines which socio-demographic and diabetes-related characteristics are associated with better quality of life based on a nationally distributed sample.

METHODS

A multi-stage cluster sampling method was used to select 3472 subjects as a part of Iranian surveillance of risk factors of non-communicable disease (ISRFNCD). EuroQol-5 Dimensions questionnaire (EQ-5D) and Visual Analog Scale (VAS) were employed to measure HRQoL. Binary logistic and Tobit regression models were used to investigate factors associated with EQ-5D results.

RESULTS

The mean age of subjects was 59.4 years (SD = 11.7), 61.3% were female and had 8.08 years (SD = 6.7) known duration of diabetes. The patients reported "some or extreme problems" most frequently in Pain/Discomfort (69.3%) and Anxiety/Depression (56.6%) dimensions of EQ-5D. The mean EQ-5D and VAS score were 0.70 (95% CI 0.69-0.71) and 56.8 (95% CI 56.15-57.5) respectively. Female gender, lower education, unemployment, long duration of diabetes, diabetes-related hospitalization in past years and having nephropathy and lower extremity lesions were associated with higher probabilities of reporting "some or extreme problems" in most dimensions of EQ-5D in binary logistic regression models. The same factors in addition to retinopathy were significantly associated with lower levels of HRQoL in Tobit regression analysis too.

CONCLUSIONS

The study findings indicate that patients with diabetes in Iran suffer from relatively poor HRQoL. Therefore much more attention should be paid to main determinants of HRQoL to identify and implement appropriate policies for achieving better management of diabetes and ultimately improving the quality of life of diabetic patients in this region.

Health-related quality of life and glycaemic control in patients with Type 2 diabetes mellitus in Singapore

AIMS

To investigate the health-related quality of life of patients with diabetes mellitus in Singapore and its associations with diabetes-related characteristics and glycaemic control.

METHODS

An interviewer-administered, cross-sectional survey was conducted in a sample of 301 adult diabetes patients under primary care. The survey questionnaire included both a generic health-related quality of life measure, the Euroqol 5-D and a diabetes-specific instrument, the Audit of Diabetes-dependent Quality of Life. Patients' most recent HbA(1c) values were extracted from their medical records.

RESULTS

After excluding patients who lacked the 90-day HbA(1c) test result, the final number of responses analysed was 282. Pain/discomfort was the most common complaint among the five Euroqol 5-D domains (by 28.0% of the respondents). Lack of freedom to eat was the Audit of Diabetes-dependent Quality of Life domain with the greatest negative average weighted impact (= -3.8, on a scale of -9 to 3). A significant association was observed between Audit of Diabetes-dependent Quality of Life average weighted impact and both duration of diabetes and use of insulin. A negative correlation was found between health-related quality of life and HbA(1c) values in both health-related quality of life measures (both r=-0.2, P=0.001).

CONCLUSIONS

Patients with diabetes in primary-care settings frequently reported problems with pain/discomfort and restrictions in diet. Poorer health-related quality of life was found to be associated with higher HbA(1c) values. The chronicity of diabetes and insulin therapy may have a negative impact on patients' diabetes-related health-related quality of life. This study indicates the importance of achieving better disease management to improve the health-related quality of life of patients with diabetes.

Type 2 diabetes quality of life patients treated with insulin and oral hypoglycemic medication

The aim of the study is to assess QoL depending on the choice of therapeutic regimen. From a total of 200 patients, half (n = 100) were treated with insulin (66% were females, age 52.1 ± 7.4-group A), the remaining 100 received oral treatment (74% females, age 63.3 ± 8.3-group B). For self-assessment of QoL, the WHOQOL-BREF questionnaire was used. In group A, we found a negative influence of increased level of glycemia and occurrence of coexisting diseases in the somatic domain . In the psychological domain, frequent checkups showed a positive influence while circulatory failure produced negative results. For social domain, disobeying of recommended diet was strongly negative as well as increased levels of glycemia and coexisting disease for environmental domain. In group B, for somatic domain, correct values of glycemia and place of residence had positive influence. Incorrect values of BMI, WHR, and co-existing disease influenced the same domain negatively. In the psychological domain, a positive influence had place of residence but a negative BMI, ischemic heart disease, clinical complications. For environmental domain, a positive influence had correct values of glycemia but a negative BMI, ischemic heart disease and clinical complications. Finally, the social domain for group B was negatively influenced by BMI, ischemic heart disease, clinical complications, and lack of regular supervisions of glycemia level. A higher assessment of quality of life was found in the group of patients treated with oral hypoglycemic medicines in somatic and environmental domains, and in the group of patients treated with insulin in psychological domain.

Relationship between diabetes mellitus, hypertension and obesity, and health-related quality of life in Gaziantep, a central south-eastern city in Turkey

AIMS AND OBJECTIVES

The main goal of nursing care should be to increase health-related quality of life as well as improve the medical status of patients with chronic disease. For this reason, this study aims to evaluate and compare the health-related quality of life of patients with diabetes mellitus, hypertension and obesity in Gaziantep, a south-eastern city in Turkey.

BACKGROUND

Diabetes mellitus, hypertension and obesity are the most decisive factors in terms of adversely affecting health-related quality of life.

DESIGN

A cross-sectional, descriptive design was used.

METHOD

In this study, the research population included a total of 1601 diabetes mellitus, hypertension and obesity patients. To evaluate health-related quality of life of patients, Short Form-36 (SF-36) was used. Student's t-test, one-way anova and chi-square analyses were used for comparisons between groups.

RESULTS

In total, 18·1% of patients had combined obesity, hypertension and diabetes mellitus; 16·1% had hypertension and diabetes mellitus. Approximately 16·1% had only hypertension; 15·4% had obesity and hypertension; 13·3% had diabetes mellitus; 12·7% had obesity and diabetes mellitus; and 8·4% had obesity. The health-related quality of life physical component mean scores of patients with combined obesity and hypertension were lower than that of the other groups (p < 0·05). Health-related quality of life physical component mean scores were determined as 34·5 (SD 0·4), and mental component mean scores were determined as 43·9 (SD 4·4). Health-related quality of life physical component mean scores of moderately active patients were higher, while older age and lower educational and income levels had a negative effect on health-related quality of life (p < 0·05).

CONCLUSION

Diabetes, hypertension and obesity decrease patient health-related quality of life while physical activity increases it. The coexistence of obesity and hypertension, in particular, has a more negative effect on health-related quality of life.

RELEVANCE TO CLINICAL PRACTICE

Patients with hypertension, obesity and diabetes mellitus need professional support from nurse. Frequent health-related quality of life evaluation and support is required for chronic patients, especially for those who are older, have lower educational and income levels and those with more than one chronic disease.

Comparison of demographic and clinical characteristics influencing health-related quality of life in patients with diabetic foot ulcers and those without foot ulcers

BACKGROUND

A number of studies have demonstrated that health-related quality of life (HRQoL) is negatively affected by diabetic foot ulcers. The aim of this study was to compare HRQoL in diabetic patients with and without foot ulcers and to determine demographic and clinical factors influencing HRQoL.

METHODS

There were no variables affecting HRQoL except for gender in diabetic patients without foot ulcers. Demographic and clinical variables were recorded and HRQoL was evaluated using the Short Form 36 (SF-36) survey for all participants. The summary physical component score (PCS) and mental component score (MCS) and eight domains of HRQoL were compared in the two groups. Linear regression analysis was also used to investigate sociodemographic and clinical characteristics as predictors of quality of life as measured by SF-36.

RESULTS

The overall score, PCS, and MCS, were significantly higher in patients without diabetic foot ulcers. Except for gender, none of the variables affected HRQoL in diabetic patients without foot ulcers. Male gender had a higher score in all domains of quality of life than female gender in diabetic patients without foot ulcers. Living alone, a low educational level, and having at least one complication were all associated with a lower HRQoL score in patients with foot ulcers. High-grade ulcers determined by Wagner's classification and poor glycemic control as measured by HbA(1C) predicted HRQoL impairment in patients with diabetic foot ulcers.

CONCLUSION

Because Wagner's grade was one of the strongest variables associated with HRQoL, this scale is recommended for monitoring of patients with diabetic foot ulcers in order to prevent continuing deterioration of HRQoL by treatment of foot ulcers at an earlier stage.

Psychometric properties and responsiveness of the Turkish version of the Diabetes Treatment Satisfaction Questionnaire (s) on a sample of diabetics of three consecutive monitoring periods

The aim of this study is to test the psychometric properties and the responsiveness of the original (status) version of Turkish DTSQ. The study sample included 88 patients with diabetes mellitus who were evaluated in three consecutive time points. The first data collection time point was during their initial contact to the clinic, and the two following (3rd month and 6th month) were during the monitoring visits to the Celal Bayar University Endocrinology Department in 2007. After the adaptation of the DTSQ to Turkish language by following standard procedures, this instrument was applied to the patients along with WBQ-12 and World Health Organization Quality of Life Measure (WHOQOL-Bref). The reliability of the DTSQ was evaluated by running internal consistency analysis (Cronbach Alpha) and item analysis. Construct validity of the instrument was evaluated by various tests such as Principal Components analysis, Confirmatory Factor Analysis, Concurrent validity and "Known Groups" comparisons. Finally the sensitivity (responsiveness to change) of the DTSQ scores to the changes of the metabolic conditions were assessed. 50.0% of the participants were male with a mean age of 51.1 ± 11.4 (min 22, max 78). Majority of them had type 2 diabetes (86.4%) and 72.7% of these patients had at least one co-morbid chronic conditions. While 53.4% of the patients had been treated by insulin the remaining 46.6% had been taking oral anti-diabetic agents. The results revealed satisfactory alpha values for DTSQ (α > 0.70). All of the three metabolic measures (i.e., FBG, PBG, and HbA1c) had significant correlations with the DTSQ scores. The criterion and construct validity of the scale were found to be very satisfactory. The Turkish version of the DTSQ showed acceptable fit indices (RMSEA = 0.03, CFI > 0.90) with the original (hypothetic) construct. Almost all of the sub-dimensions of the WBQ and WHOQOL were correlated with the DTSQ as expected, indicating a good concurrent validity. DTSQ status version was found to be a reliable and valid instrument for the assessment of treatment satisfaction in Turkish diabetes mellitus patients.

The well-being and treatment satisfaction of diabetic patients in primary care

Background

The quality of life in patients with diabetes is reduced and emotional coping with the disease has great impact on patient well-being.

Objectives

The aim of this study was to assess the psychological well-being and treatment satisfaction in patients with type 2 diabetes mellitus in primary care.

Study Design and Setting

Patients (n = 112) with type 2 diabetes mellitus diagnosis for at least six months were enrolled. The Well-Being Questionnaire-22 and the Diabetes Treatment Satisfaction Questionnaire were used. Physical examination and laboratory investigations were performed.

Results

The rates of the achieved targets were 32.1% for hemoglobin A_1c, 62.5% for cholesterol and 20.5% for blood pressure. The mean scores for the general well-being, depression, anxiety, positive well-being and energy were 44.40 ± 13.23 (range = 16-62), 12.65 ± 3.80 (range = 5-18), 10.57 ± 4.47 (range = 1-18), 12.00 ± 4.01 (range = 2-18), and 9.16 ± 2.47 (range = 2-12), respectively. The mean scores for the treatment satisfaction, perception for hyperglycemia and perception for hypoglycemia were 22.37 ± 9.53 (range = 0.00-36.00), 1.71 ± 1.59 (range = 0-6), and 0.51 ± 0.98 (range = 0-6), respectively. There were significant associations between the depression score and the educational status, compliance to diet and physical exercise, and diabetic complications; between the anxiety score and the educational status, glycemic control, compliance to diet and physical exercise; between the energy score and the educational status, compliance to physical exercise, and diabetic complications; between the positive well-being score and the educational status, compliance to diet and physical exercise, complications and type of treatment; between the general well-being score and the educational status, compliance for diet and physical exercise, and complications. Treatment satisfaction was significantly associated to the educational status, glycemic control and compliance to diet and physical exercise. A significant correlation was found between the treatment satisfaction and the well-being.

Conclusions

Individualized care of patients with diabetes should consider improving the quality of life. Psychosocial support should be provided to the patients with type 2 diabetes and the negative effects of psychopathological conditions on the metabolic control should be lessened.

Nitric oxide synthase in gingival tissues of patients with chronic periodontitis and with and without diabetes

BACKGROUND

The purpose of this study was to evaluate the expression of inducible nitric oxide synthase (iNOS) in the gingival tissues of periodontitis patients with and without type 2 diabetes to assess whether NO plays a role in the severity of periodontitis in patients with diabetes. Patients with diabetes and healthy patients were used as controls.

METHODS

A total of 80 patients were evaluated in four groups (with 20 subjects each): patients with chronic periodontitis and diabetes (12 males and eight females; mean age, 52.1 +/- 6.9 years), patients with chronic periodontitis who were otherwise healthy (12 males and eight females; mean age, 43.1 +/- 8.9 years), periodontally healthy patients with diabetes (12 males and eight females; mean age 50.9 +/- 6.3 years), and systemically and periodontally healthy control subjects (12 males and eight females; mean age 29.8 +/- 9.2 years). Periodontal parameters were recorded. Immunohistochemistry was used to detect inflammation and iNOS expression in gingival tissues.

RESULTS

Although periodontal parameters were slightly higher in periodontitis compared to diabetic periodontitis, immunohistochemical parameters were higher in diabetic periodontitis compared to periodontitis. All periodontal parameters were higher in patients with periodontitis and with/without diabetes compared to controls and patients with diabetes. All immunohistochemical parameters were higher in patients with diabetes and periodontitis compared to patients with only diabetes or periodontitis, but there was no difference between the latter two groups. There was a correlation between the expression of iNOS and inflammatory cells in controls, patients with diabetes, and patients with periodontitis but not in patients with diabetes and periodontitis.

CONCLUSIONS

Inflammation and iNOS expression were more prominent in the gingiva of the patients with both diabetes and periodontitis. However, iNOS expression did not seem to have an additional detrimental effect on the course of periodontitis in patients with diabetes compared to those with periodontitis alone.