Predictors of Health-Related Quality of Life Among Patients with Type II Diabetes Mellitus Who Are Insulin Users: A Multidimensional Model

Diabetes knowledge among Malaysian adults: A scoping review and meta-analysis

Introduction

Optimal self-care promotes glycaemic control and prevents diabetes complications. Its performance is facilitated by an adequate level of diabetes knowledge. This review aimed to evaluate diabetes knowledge among Malaysians by assessing diabetes knowledge scores and their associated factors.

Methods

A comprehensive bibliographic search for Malaysian studies on diabetes knowledge was conducted in PubMed, Scopus and Google Scholar. Relevant literature was systematically selected and described; pertinent data were extracted; and data on diabetes knowledge levels and their associated factors were synthesised. The quality of the identified studies was assessed using a Joanna Briggs Institute critical appraisal tool.

Results

Thirty Malaysian cross-sectional studies that measured diabetes knowledge levels were retrieved. Nineteen of them used a named diabetes knowledge measurement tool, with 14 using the 14-item Michigan Diabetes Knowledge Test. A low knowledge level was prevalent among patients with diabetes mellitus (pooled mean knowledge score=6.92, proportion of patients with a low knowledge level=47.97%). The knowledge score was associated with some sociodemographic variables, health literacy, self-care and glycaemic control.

Conclusion

The association of diabetes knowledge with diabetes outcomes (e.g. self-care and glycaemic control) reflects the potential of the former as a target of intervention. Periodic measurement of diabetes knowledge in healthcare settings and among populations can help in assessing the effectiveness of diabetes educational interventions. Concerted efforts to improve diabetes knowledge among Malaysians have the potential to fill knowledge-practice gaps.

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study

Background

There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia.

Methods

The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into 'good', 'average', and 'poor'. Data were analysed by SPSS v.26.

Results

The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%).

Conclusion

Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.

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.

Medication Adherence of Persons with Type 2 Diabetes in Malaysia: A Scoping Review and Meta-Analysis

Objective

This is a scoping review of Malaysian scientific studies on medication adherence among persons with type 2 diabetes mellitus (T2DM).

Methodology

We conducted a bibliographic search of PubMed, Scopus and Google Scholar using the following keywords: "medication adherence," "drug compliance," "DMTAC" and "Malaysia." The search covered all publications up to 31 December 2021. Eligible articles were original studies conducted in Malaysia that measured or quantified medication adherence among persons with T2DM.

Results

We identified 64 eligible studies published between 2008 to 2021. Most studies included patients with T2DM in ambulatory facilities. Five studies were qualitative research. The quantitative research publications included clinical trials, and cross-sectional, validation, retrospective and prospective cohort studies. Thirty-eight studies used medication adherence scales. The Morisky Medication Adherence Scale (MMAS-8, used in 20 studies) and Malaysian Medication Adherence Scale (MALMAS, used in 6 studies) were the most commonly used tools. There were 6 validation studies with 4 medication adherence scales. A meta-analysis of 10 studies using MMAS-8 or MALMAS revealed that the pooled prevalence of low medication adherence is 34.2% (95% CI: 27.4 to 41.2, random effects model). Eighteen publications evaluated various aspects of the Diabetes Medication Therapy Adherence Clinics (DMTAC).

Conclusion

This scoping review documented extensive research on medication adherence among persons with diabetes in Malaysia. The quantitative meta-analysis showed a pooled low medication adherence rate.

Influences of Demographic, Social Determinants, Clinical, Knowledge, and Self-Care Factors on Quality of Life in Adults With Type 2 Diabetes: Black-White Differences

BACKGROUND

This study evaluated racial differences in the contribution of demographic, social determinants, clinical, and self-care factors on quality of life (QOL) in adults with type 2 diabetes mellitus (T2DM).

METHODS

A total of 615 adults with T2DM in Southeastern United States were recruited. Linear regression models were used to assess the contribution of demographic, social determinants, clinical, and self-care factors on the mental (MCS) and physical components (PCS) of QOL, after stratifying by race.

RESULTS

For the entire sample, there were significant relationships between PCS and psychological distress (β = 0.02, p < 0.01), neighborhood aesthetics (β = 0.05, p < 0.01), neighborhood walking environment (β = -0.02, p < 0.05), access to healthy food (β = 0.01, p < 0.05), neighborhood crime (β = -0.15, p < 0.05), and neighborhood comparison (β = 0.13, p < 0.05); and MCS and depression (β = -0.06, p < 0.05), psychological distress (β = -0.09, p < 0.001), perceived stress (β = -0.12, p < 0.01), and perceived health status (β = -0.33, p < 0.01). In the regression models stratified by race, notable differences existed in the association between PCS, MCS, and demographic, psychosocial, built environment, and clinical factors among Whites and Blacks, respectively.

CONCLUSION

In this sample, there were racial differences in demographic, social determinants, built environment, and clinical factors associated with PCS and MCS components of QOL. Interventions may need to be tailored by race or ethnicity to improve quality of life in adults with T2DM.

Health-related quality of life and associated factors among patients with type II diabetes mellitus: A study in the family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam

The current study aimed to examine the health-related quality of life (HRQoL) and to identify its related factors amongst adult patients with type 2 diabetes mellitus (T2DM). This cross-sectional study recruited randomly 519 patients diagnosed with T2DM for at least 6 months in the Family medicine center (FMC) of Agricultural General Hospital in Hanoi, Vietnam. The Short Form 36 (SF-36) health survey was used to measure their HRQoL. The female patients had lower physical and mental scores than the male patients. Patients with older age, comorbidity, and insulin treatment were more likely to have lower HRQoL. Meanwhile, educational attainment and having frequent exercise were positively associated with HRQoL.

A systematic review on clinical implication of continuous glucose monitoring in diabetes management

Objective

The aim of this systematic review was to evaluate the clinical implications of continuous glucose monitoring (CGM) among patients with diabetes mellitus using variables that include glycated hemoglobin (HbA1c), estimated A1c, glucose variability, and users' perspectives.

Materials and Methods

This study analyzed 17 articles that were identified and studied according to the research question criteria. PRISMA guidelines were used for identification and screening of the literature. The required data were searched using Medscape, PubMed, PROSPERO, Wiley Library, Scopus, Clinical Trial Registry, and Trip.

Results

The articles reviewed were on the use of CGM in type 1 and type 2 diabetes mellitus, which showed significant improvement in the levels of HbA1c as compared to non-CGM. The application of CGM on acute sudden onset type of adverse drug reactions (i.e., hypoglycemia) is better than fasting blood sugar or self-monitoring of blood glucose or capillary blood glucose (random blood glucose monitoring). CGM is beneficial for use in patients with type 2 diabetes mellitus including elderly patients as it gives information regarding glucose variability as well as HbA1c levels. The health-care providers require full spectrum of patients' CGM data to design a better therapeutic plan. However, the patients experienced inconvenience on wearing the device on the body for longer periods. The findings also stated the fact that more education and training is required for the patients to interpret their own glycemic data using CGM and modify their lifestyle accordingly. Use of CGM along with HbA1c has also been used to achieve better glycemic results and it allows the health care professional to guide patients in terms of their glucose level; whether they are hypoglycemic or hyperglycemic, however its use has some controversies that minimize its application.

Conclusion

The study concluded that CGM has significant potential in the management of not only patients with type 1 diabetes mellitus but also patients with type 2 diabetes mellitus in spite of the few limitations that are being improvised in the upcoming years. However, limited literature of CGM among patients with type 2 diabetes mellitus and pregnant women reduces the practice scope.