Health-Related Quality-of-Life and Diabetes Self-Care Activity in Elderly Patients with Diabetes in Korea

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

Introduction

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

Methods

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

Results

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

Conclusion

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

Correlation of health-related quality of life for older adults with diabetes mellitus in South Korea: theoretical approach

BACKGROUND

While some studies have explored the health-related quality of life (HRQOL) of older adults with diabetes mellitus (DM) in South Korea using a theoretical framework, these studies suffer sample-related limitations, as they focus only on a specific subgroup of older adults. To address this gap, this study aimed to investigate the predictors of HRQOL of older adults with DM in South Korea, using extensive national data and based on the theory of Health-Related Quality of Life in South Korean Older Adults with Type 2 Diabetes (The HIKOD theory).

METHODS

A secondary data analysis was conducted using data from 1,593 participants aged 65 years and older with DM sourced from the 2015-2019 Korea National Health and Nutrition Examination Survey (KNHANES). The variables included in this study are as follows: demographic factors (gender, age, household income, and education level), disease-specific factors (duration of DM, treatment of DM, and control of HbA1c), barriers (number of comorbidities), resources (living alone status), psychosocial factors (perceived stress), and health-promoting behaviors (physical activity and fundus examination). Considering the complex sampling design employed in this study, statistical analyses including Rao-Scott chi-square tests, correlation analysis, and hierarchical multiple regression analysis were conducted.

RESULTS

Mobility (45.0%) was the HRQOL dimension with which participants experienced the highest number of problems. Number of comorbidities (r = -0.36, p < 0.001), living alone status (rpb = 0.16, p < 0.001), perceived stress (rpb = 0.14, p < 0.001), and physical activity (rpb = 0.12, p < 0.001) were correlated with HRQOL. While adjusting for background factors, HRQOL was negatively predicted by higher number of comorbidities (estimate B = -0.03, p < 0.001), living alone (estimate B = -0.03, p = 0.043), higher perceived stress (estimate B = -0.09, p < 0.001), and lower physical activity (estimate B = -0.03, p < 0.001).

CONCLUSION

Complex and diverse factors influence HRQOL among older adults with DM in South Korea. To improve their HRQOL, intervention programs that integrally regard HRQOL, along with various predictors, are necessary.

Effects of Metabolic Medicine and Metabolic Surgery on Patient-Reported Outcomes Among Patients with Type 2 Diabetes

The assessment and management of patient-reported outcomes (PROs) is considered secondary to that of cardiometabolic outcomes. When assessed, health-related quality of life (HRQOL), a PRO, can yield pertinent information that cannot be obtained from cardiometabolic assessments. For instance, physical and mental distress can be quantified and treated. Moreover, treatment convenience and satisfaction can be gaged. Behavioral modification, bariatric surgery, and pharmacotherapy can improve PROs. Typically, HRQOL is responsive to changes in weight. Specifically, weight loss and weight gain are associated with positive and negative changes in quality of life, respectively. In addition, patient satisfaction can be influenced by glycemic control. Therefore, hypoglycemia and hyperglycemic episodes can negatively affect patient satisfaction. When managing type 2 diabetes (T2D), it is important to consider how therapies impact PROs. Generally, changes in clinical outcomes mirror changes in PROs. To best manage T2D, integrating the assessment of PROs with clinical outcomes is needed.

Evaluation of the effectiveness of Persian diabetes self-management education in older adults with type 2 diabetes at a diabetes outpatient clinic in Tehran: a pilot randomized control trial

Purpose

The effectiveness of diabetes self-management interventions has been more generally demonstrated in adults, but there is little evidence of diabetes self-management specific to older adults situated in Iran. The purpose of this study was to evaluate the effectiveness of Persian Diabetes Self-Management Education on self-efficacy, quality of life, self-care activity, depression and loneliness in older adults with type 2 diabetes.

Methods

In pilot randomized controlled trial, a total of 34 participants ≥60 years with type 2 diabetes were randomly assigned into intervention (n = 17) and control (n = 17) group in an outpatient diabetes clinic in Tehran. To assess the primary outcome of participant experiences, the Diabetes Management Self-efficacy Scale (DMSES) was the method of measurement. The Diabetes Quality of Life-Basic Clinical Inventory (DQoL-BCI), Patient Health Questionnaire-9 (PHQ-9), Diabetes Self-Management Education Scale (DSMES), and adult Social-Emotional Loneliness Scale Short form (SELSA-S) were used as secondary outcomes. Participants' evaluations were completed at baseline, while measurements were conducted two and four weeks after allocation, using repeated measurements of Univariate and multivariate ANOVA (adjusted for baseline values) to analyze the data.

Results

In the multivariate model, there was a significant difference between the control and intervention groups regarding reported quality of life (p = 0.04) and the medical-domain's reported self-efficacy (p = 0.02). However, there were no significant differences in the reported self-management, depression, loneliness, as well as the other domain of self-efficacy; as compared between the two groups before and after intervention.

Conclusion

The study depicts a promising impact on older adults, imparted by the pertinent program. The finding showed PDSME has a positive effect on quality of life and medical control domain of self-efficacy. This pilot study showed that the program is feasible and duly beneficial if delivered to older adults. This pilot proves appealing to begin further testing within a larger sample population.

Predictors of Health-Related Quality of Life in Korean Adults with Diabetes Mellitus

Diabetes mellitus (DM) as a chronic disease is a major public health problem worldwide. It is important to improve the quality of life of people with DM, especially health-related aspects, which should be monitored and managed as part of diabetes management. Accordingly, this study investigated health-related quality of life (HRQoL) and identified predictors of HRQoL in Korean adults with DM using the Seventh Korea National Health and Nutrition Examination Survey (KNHANES VII) 2016–2018. This was a cross-sectional study with a stratified multistage probability sampling design that collected data from 1228 participants aged 30–80 years diagnosed with DM. HRQoL was measured using the Euro Quality of Life Five Dimension (EQ-5D) questionnaire. Analyses consisted of one-way analysis of variance, t-tests, chi-squared tests, and general linear regression analyses with complex sampling designs. Results demonstrated that low HRQoL was associated with older age (β = −0.002, 95% CI: −0.003 to −0.001), having elementary school education or less (β = −0.037, 95% CI: −0.061 to −0.014), being unmarried (β = −0.060, 95% CI: −0.078 to −0.040), poor subjective health status (β = −0.074, 95% CI: −0.094 to −0.055), perceived high stress (β = −0.047, 95% CI: −0.066 to −0.028), limited activity (β = −0.105, 95% CI: −0.131 to −0.079), being overweight (β = −0.021, 95% CI: −0.038 to −0.002), or obese (β = −0.016, 95% CI: −0.032 to −0.001), and three or more comorbidities (β = −0.044, 95% CI: −0.085 to −0.001). Comprehensive health care programs to manage these predictors should be provided to improve health-related quality of life of patients with DM.