Health related quality of life in type-2 diabetic patients in Western India using World Health Organization Quality of Life – BREF and appraisal of diabetes scale

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.

Health-related Quality of Life and Domain-specific Associated Factors among Patients with Type2 Diabetes Mellitus in South India

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that has a major impact on health-related quality of life (HRQOL). The economic burden of the disease, along with its complications, negatively impact the individual, family, and society of Indian diabetic patients. This study explored the perception of the diabetic HRQOL of South Indian type2diabetic patients.

METHODS

This study was a cross-sectional descriptive quantitative study conducted in a tertiary care hospital in Chennai, Tamil Nadu, South India. Using the simple random sampling technique, we collected data from 352 T2DM patients aged ≥ 30 years of age who were diagnosed for a minimum of one year. Data collection occurred from June to August 2017. Data were analysed using IBM SPSS, Version 22.

RESULTS

Overall, 90% of patients with T2DM perceived poor HRQOL. The total and the domain- specific mean scores of HRQOL were high indicating poor HRQOL in energy mobility, diabetes control, anxiety and worry, social burden, and sexual functioning domains. Being female, increasing age, lower education levels, lower family income, and uncontrolled fasting blood glucose levels predicted poor HRQOL of patients with T2DM.

CONCLUSIONS

T2DM impacted the HRQOL in all measured domains of participants. A patient-centred approach to diabetes management can be incorporated to improve or enhance the health-related quality of patients’ lives. Improved HRQOL also may lead to fewer hospitalizations, and hence, reduce healthcare costs.

Assessment of quality of life in type 2 diabetes mellitus patients using World Health Organization quality of life-BREF questionnaire and appraisal of diabetes scale - a cross-sectional study

Diabetes is a chronic metabolic disorder that disturbs the quality of life (QOL) of patients. Therefore, evaluation of diabetes- related QOL could be a key outcome measure for its management. This study assessed the QOL in type 2 diabetes mellitus (T2DM) patients using the World Health Organization (WHO) quality of life (QOL)˗BREF questionnaire and disease-specific appraisal of diabetes scale (ADS). In this cross-sectional study, 520 T2DM patients were included. Patients’ demographic data, clinical information was collected through interviews, and the WHOQOL-BREF instrument and ADS were used for the QOL of patients. Statistical analysis was performed by using R software (Version 3.6.0). The mean ADS scores were lower in controlled diabetic subjects (18.50±3.08) and higher in uncontrolled diabetic subjects (19.29±2.73) (P<0.05). For WHOQOL-BREF, the mean scores for all the domains (overall general health, physical, psychological, social, and environmental) were significantly higher in controlled diabetic subjects (P<0.001). In addition, the age, duration of diabetes, associated comorbidities, treatment, and HbA1c level of patients showed a highly significant correlation with WHOQOL-BREF (P<0.001). Diabetic patients had poor-to-average QOL. Therefore, public health measures and education of diabetic patients are essential to create more awareness for improving the QOL of T2DM.

Quality of Life and Diabetes in India: A Scoping Review

In recent years, numerous studies have explored the quality of life (QoL) in those with diabetes mellitus. The aim of this scoping review was to explore the current state of knowledge on QoL and its various associated factors among people with diabetes in India. Three databases were searched (PubMed, Scopus, and Medline) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 41 articles were included in the review. The included studies were largely conducted in the Southern states and mainly investigated individuals with type 2 diabetes. The World Health Organization Quality of Life (WHOQOL-BREF) and Short Form Health Survey (SF-36) were the instruments used most often. In general, the studies showed that people with diabetes had poorer QoL than those without diabetes, and women with diabetes reported poorer QoL than men, consistent with findings across the world. However, the studies had significant methodological flaws which limit the validity and generalizability of the findings. Therefore, there is an urgent need to conduct high-quality QoL studies which are representative of all states of India as well as different types of diabetes in India in order to address this gap in the evidence.

Quality of Life and its Determinants in Patients with Diabetes Mellitus from Two Health Institutions of Sub-himalayan Region of India

BACKGROUND

Diabetes mellitus (DM) causes serious deterioration in general quality of life (QoL) mainly affecting the health-related quality of life (HRQOL). Routine assessment of QoL improves communication with the patient, helps to predict treatment response, and supports clinical decision-making. QoL can predict an individual's capacity to manage the disease and maintain long-term health and wellbeing.

AIMS

To find out the QoL and its socio-demographic, anthropometric, and clinical determinants among DM patients attending health institutions from sub-Himalayan region, catering rural population.

SETTINGS AND DESIGN

This cross-sectional study was conducted in two hospitals mostly catering rural population from 2014 to 2018. Purposive sampling technique was used.

MATERIALS AND METHODS

Socio-demographic, anthropometric, and clinical data of DM patients (N = 300) were collected. They were administeredHindi translation of QoL Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA).

RESULTS

About 10% had very poor, 13% poor, 11% average, 16% good, and 50% very good QoL on QOLID. General health (GH) and treatment satisfaction (TS) were the most affected domains. Fatigue was the most common symptom (79%) reported in QOLID. Age more than 55 years, rural background, and PHQ-9 score of more than 7 were predictors of poorer QoL.

CONCLUSION

There is a need for a holistic and collaborative care of DM patients, to maintain a good HRQoL. Screening of depression, fatigue, and regular assessment of QoL should be emphasized.

Quality of life and depression among diabetic patients attending the lifestyle clinic of a teaching hospital, West Bengal

CONTEXT

The coexistence of diabetes and depression has resulted in poor quality of life. Reported literature suggested the need for research for assessing the correlates of both quality of life along with depression in diabetic persons.

AIMS

To assess the quality of life (QOL), the prevalence of depression and associated factors in diabetic patients attending the lifestyle clinic of a tertiary healthcare facility in Eastern India.

SETTINGS AND DESIGN

This hospital-based descriptive, cross-sectional research recruited 219 patients with diabetes to assess the QOL and depression in the lifestyle clinic of a tertiary healthcare facility.

METHODS AND MATERIALS

The quality of life was assessed with the help of the World Health Organization (WHO) QOL BREF instrument. Depression was determined by a standardized Patient Health Questionnaire - 9(PHQ-9). The sociodemographic and diabetes-related information were collected by a semistructured questionnaire. Clinical and anthropometric examinations were conducted.

STATISTICAL ANALYSIS USED

All the available data were initially coded and then analyzed using the SPSS 22.0 licensed software.

RESULTS

The participants had a median age of 54 years. Illiteracy was significantly more among females. Hypertension was the most common comorbidity. Gender-wise difference in mean of weight, height, hip circumference, and QOL score in the psychosocial domain was significant. The mean QOL score was least in the social domain and highest in the environmental domain. Literate patients had a statistically significantly better QOL. Depression was observed significantly more in females, illiterates, and unemployed respondents.

CONCLUSIONS

Diabetic women with lesser literacy have an increased risk of poor QOL. Women, illiterates, and the unemployed suffered more from depression. Therefore, a target-specific, routine, and well-planned clinic approach is needed to improve the QOL and mental health of respondents.

Self-care activities, glycaemic control and health-related quality of life of patients with type 2 diabetes in a tertiary hospital in Nigeria

BACKGROUND AND AIMS

Diabetes is one of the global health emergencies of the 21st century. This study sought to assess self-care behaviours, glycaemic control and health-related quality of life (HRQoL) of type 2 diabetes patients at a Nigerian hospital, determine factors associated with HRQoL, and assess the inter-relationship among these outcomes.

METHODS

The Summary of Diabetes Self-Care Activities (SDSCA) measure was used to assess self-care behaviours; HRQoL was assessed with the Appraisal of Diabetes Scale (ADS) and SF-12v2 Health Survey. Glycaemic control was assessed with fasting blood sugar (FBS). The questionnaires were distributed to 250 eligible patients attending Endocrinology clinic at the University of Uyo Teaching Hospital, Akwa Ibom State, Nigeria.

RESULTS

Mean scores (±SD) of self-care behaviours were 4.0 ± 1.3, 3.9 ± 1.0, 2.4 ± 1.2, 1.0 ± 1.1, and 2.5 ± 2.1 for general diet, specific diet, exercise, blood glucose monitoring, and foot care respectively. Mean FBS was 7.1 ± 2.1 mmol/L. Mean ADS score was 18.1 ± 4.2. The physical and mental component summary scores were 47.84 ± 8.21 and 45.66 ± 8.74 respectively. HRQoL was significantly associated with patient socio-demographic (except gender) and clinical variables (p < 0.05). Self-care activities, FBS and HRQoL were significantly inter-correlated (r_s -0.31 to 0.68; p < 0.01, p < 0.001).

CONCLUSIONS

Patients were more adherent to diet recommendations than to other aspects of self-care. Though most patients had adequate glucose control, the presence of diabetes had a negative impact on the mental component of health. HRQoL was affected by most of the patient-related variables. Interventions to improve adherence to self-care are recommended to achieve good glycaemic control and improve HRQoL.

Impact of comorbidity on health-related quality of life among type 2 diabetic patients in primary care

BACKGROUND

Health-related quality of life (HRQL) is an important outcome for chronic diseases such as diabetes mellitus that is associated with complications, comorbidities, and lifelong care.

OBJECTIVES

The present study aims to explore the impact of comorbidities on the different dimensions of HRQL among type 2 diabetic patients attending primary care.

METHODS

A total of 912 type 2 diabetic patients attending primary care centers in India were assessed using a predesigned and pretested questionnaire - Diabetes Comorbidity Evaluation Tool in Primary Care. The HRQL was measured by physical and mental health summary scores [physical component summary (PCS) and mental component summary (MCS)] of the Short Form Health Survey 12. The associations of sociodemographic variables and clinical variables with PCS and MCS were assessed, and a minimal difference of 5 in the scores (on a scale of 0-100) was kept as clinically relevant difference for this study. Mean differences in mental (MCS) and physical (PCS) scores of quality of life by number and type of comorbid conditions in type 2 diabetic patients were calculated.

RESULT

The presence of comorbid conditions was associated with lower scores of PCS and MCS (P < 0.001). Significant reduction in HRQL was found with increase in number of comorbid conditions, and negative association was established between the number of comorbidities and the PCS (r = -0.25, P < 0.0001) and MCS scores (r = -0.21, P < 0.0001). Among comorbidities, acid peptic disease, chronic lung disease, visual impairment, depression, and stroke had significantly and clinically relevant reduced scores. Duration of diabetes, use of insulin, and obesity were also associated with poor HRQL.

CONCLUSION

Comorbidities considerably impair the HRQL among type 2 diabetic patients. National programs designed for diabetes management should also take into account the challenges of coexisting chronic conditions and its substantial effect on HRQL.

Health-related Quality of Life of Patients with Type 2 Diabetes Mellitus at A Tertiary Care Hospital in India Using EQ 5D 5L

OBJECTIVE

To assess the health-related quality of life of Type 2 Diabetes mellitus patients attending outpatient departments of a tertiary hospital using EQ-5D-5L.

METHODS

The study was conducted at a tertiary care hospital in India. The quality of life of patients with type 2 Diabetes mellitus, age 18 years and older, attending outpatient departments of Medicine and Endocrinology was assessed with the help of EQ-5D-5L, a measure of self-reported health related quality of life. Data was analyzed to obtain EQ-5D-5L scores for the five dimensions and EQ VAS score. Correlation of EQ VAS score with different variables was analyzed.

RESULTS

Out of total 358 participants, 208 had comorbidities, hypertension being the most common. Mean age was 60.71 ± 11.41 years and 216 (58.9%) were female participants. Out of five dimensions, Mobility, Self-care, Usual activities, and Pain/discomfort were most affected in age group 71 years and above while anxiety/depression affected age group 18-30 years the most. Mean EQ VAS score was 78.83 ± 15.02. Female participants had significantly higher EQ VAS score (P = 0.00) than male participants. EQ VAS score showed significant negative correlation with uncontrolled state of diabetes (P = 0.000). There was significant difference in EQ VAS score between patients with and without comorbidities. (P =0.004) Cronbach alpha for EQ-5D-5L was 0.76.

CONCLUSION

The results suggest that EQ-5D-5L is a reliable measure for assessing health related quality of life of patients with Type 2 Diabetes mellitus. Type 2 Diabetes adversely affects the quality of life of patients. Uncontrolled disease and comorbidities can further compromise the quality of life.

Clinico-epidemiological factors of health related quality of life among people with type 2 diabetes

AIM

To investigate the quality of life (QOL) and its clinical and epidemiological correlates among people with type 2 diabetes.

METHODS

This cross-sectional study was conducted in Tabriz, Northwest of Iran, including a total of 394 people with type 2 diabetes using convenient sampling method from November 2014 to March 2015. General information including demographic, socioeconomic status and lifestyle factors were collected by trained interviewers. Clinical information was retrieved from clinic’s record and QOL was assessed using the 26-item WHOQOL-BRIFE questionnaire. Univariate and multivariate linear regression were performed to assess the related factors and QOL dimensions.

RESULTS

The mean of overall health related QOL was 52.11 ± 11.53 and the maximum and minimum dimensions were respectively seen in psychological (60.38 ± 14.54) and social (38.32 ± 16.94) dimensions. The results of multiple linear regression showed a significant overall relationship between HRQOL and age (b = -1.48%, 95%CI: -0.03 and -2.93) level of education (b = 4.12%, 95%CI: 2.73 and 5.5), number of comorbidities (b = -2.41%, 95%CI: -3.89 and -9.41), and level of income (b = 1.98, 95%CI: 0.05 and 3.9), functional limitation (b = -3.59, 95%CI: -2.26 and -4.92) and psychological distress (b = -2.02%, 95%CI: -2.83 and -1.21). Level of education, functional limitation, psychological distress were associated with the score of physical, mental and environmental dimensions, and number of comorbidities was associated with the score of physical and mental dimensions.

CONCLUSION

Based on our findings, lifestyle modification and increasing facilities of clinics providing service can be effective steps to improve the QOL among people with type 2 diabetes.

Predictors of health-related quality of life among people with type II diabetes Mellitus in Ardabil, Northwest of Iran, 2014

AIMS

The present study aims at investigating different dimensions of the Health-Related Quality of Life (HRQOL) and its determinants among type II diabetes Mellitus (T2DM) referred to diabetes clinic in Ardabil.

METHODS

The present study was conducted through a cross-sectional method in which 300 people with T2DM were selected using a convenience sampling method between January and May 2014. Data were collected through 26-item structured and WHOQOL-BREF questionnaires. Data analysis was performed using descriptive and analytical statistical methods, independent t-test, Mann Whitney test, ANOVA, Kruskal Wallis, Welch test, and multivariable linear regression model using SPSS (V.20).

RESULTS

The mean age of the participants was 54.13±9.13, and about 72% of the patients were women. The mean score of the total HRQOL was 53.07±17.09; the highest score of HRQOL was related to the environmental domain (57.10±10.52) and the lowest to the dimension of social health (45.68±17.25). Based on multivariable linear regression, total QOL was influenced by gender, marital status, MHI, and comorbid renal disease. PH Dimension was associated with MHI and neuropathy; PSH with education level, comorbid depression, comorbid renal, and other disease; SR with marital, comorbid renal, and other disease; EH with marital status, Monthly household income (MHI), and education level.

CONCLUSION

According to the results of this study, Predictors of the HRQOL in T2DM are associated with demographic and socioeconomic factors, comorbidities, and with less impact, diabetes complications, respectively. Moreover, diabetic patients had moderate HRQOL, and compared with men, scores of all domains were lower in women.