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

Examining the Relationship Between Social Support, Self-Efficacy, Diabetes Self-Management, and Quality of Life Among Rural Individuals With Type 2 Diabetes in Eastern China: Path Analytical Approach

BACKGROUND

Patients with type 2 diabetes (T2D) in rural China frequently exhibit inadequate diabetes self-management (DSM) and a reduced quality of life (QoL). Social support and self-efficacy are known to influence DSM and QoL. However, the pathways through which social support and self-efficacy impact DSM and QoL among patients with T2D in rural China has yet to be fully elucidated.

OBJECTIVE

This study offers a foundation for developing policies in rural chronic disease management, thereby, contributing to the improvement of T2D prevention and control in China and other transitional countries.

METHODS

This study used a cross-sectional design, collecting data from a survey conducted between May and July 2021 on DSM and QoL among rural patients diagnosed with T2D in 2 townships in East China. All patients with T2D were enrolled through cluster sampling from the township health center database, and a questionnaire survey was administered by investigators. Structural equation modeling and multiple regression analyses were used to explore the pathways through which social support influences DSM and QoL, as well as the mediating role of self-efficacy.

RESULTS

It was found that the DSM score (mean 37.42, SD 7.70) was less than half of the maximum theoretical score. The QoL score (mean 48.92, SD 8.88) accounted for 36% of the maximum theoretical score. Social support directly and positively affected the DSM and QoL of Chinese rural patients with T2D (P<.01); an increase of 1 unit in social support was associated with a direct increment of 0.339 units in DSM and 0.397 units in QoL. Self-efficacy played a positive mediating role (P<.01), further increasing DSM and QoL by 0.147 and 0.159 units, respectively. The mediating effect of self-efficacy accounted for 30.2% and 28.6% of the total effect of social support on DSM and QoL. Furthermore, the family and friend dimension of social support, along with the symptom and disease management dimensions of self-efficacy, were significantly associated with DSM or QoL (P<.01).

CONCLUSIONS

The study confirmed the direct and indirect influences of social support on DSM and QoL and elucidated the mediating effect of self-efficacy among rural patients with T2D in eastern China. Interventions should be developed to enhance both social support and self-efficacy, creating a positive cycle of mutual reinforcement to improve DSM and QoL among this group.

Person-Centred Diabetes Care: Examining Patient Empowerment and Diabetes-Specific Quality of Life in Slovenian Adults with Type 2 Diabetes

Patient empowerment is crucial for promoting and strengthening health. We aimed to assess patient empowerment and diabetes-specific health-related quality of life (HRQoL) in adults with type 2 diabetes (T2D). A multi-centre, cross-sectional survey was conducted among adults with T2D in urban and rural primary care settings in Slovenia between April and September 2023. The survey utilised convenience sampling and included sociodemographic and clinical data, the Diabetes Empowerment Scale (DES), and the Audit of Diabetes-Dependent QoL (ADDQoL). The study included 289 people with T2D and a mean age of 67.2 years (SD 9.2). The mean overall DES score was 3.9/5 (SD 0.4). In a multivariable linear regression model, higher empowerment was significantly associated with residing in a rural region (p = 0.034), higher education (p = 0.028), and a lack of comorbid AH (p = 0.016). The median overall ADDQoL score was -1.2 (IQR [-2.5, -0.6]). The greatest negative influence of diabetes on HRQoL was observed in the domain 'Freedom to eat', followed by 'Freedom to drink', 'Leisure activities', and 'Holidays'. Despite high empowerment among adults with T2D, the condition still imposes a personal burden. Integrated primary care models should prioritise the importance of implementing targeted interventions to enhance diabetes empowerment, address comorbidities, and improve specific aspects of QoL among individuals with T2D.

Facilitators and Barriers to Scaling-Up Integrated Care for Arterial Hypertension and Type 2 Diabetes in Slovenia: Qualitative Study

Introduction

Arterial hypertension and type 2 diabetes are significant contributors to global non-communicable disease-related mortality. Integrated care, centred on person-centred principles, aims to enhance healthcare quality and access, especially for vulnerable populations. This study investigates integrated care for these diseases in Slovenia, providing a comprehensive analysis of facilitators and barriers influencing scalability.

Methods

Qualitative methods, including focus group discussions and semi-structured interviews, were employed in line with the grounded theory approach. Participants represented various levels (micro, meso and macro), ensuring diverse perspectives. Data were collected from May 2019 to April 2020, until reaching saturation. Transcripts were analysed thematically using NVivo software.

Results

Nine categories emerged: Governance, Health financing, Organisation of healthcare, Health workforce, Patients, Community links, Collaboration/Communication, Pharmaceuticals, and Health information systems. Some of identified barriers were political inertia and underutilisation of research findings in practice; outdated health financing system; accessibility challenges, especially for vulnerable populations; healthcare workforce knowledge and burnout; patients' complex role in accepting and managing their conditions; collaboration within healthcare teams; and fragmentation of health information systems. Peer support and telemedicine were the only two potential solutions identified.

Conclusions

This study offers a comprehensive evaluation of integrated care for hypertension and type 2 diabetes in Slovenia, featuring insights into facilitators and barriers. These findings have implications for policy and practice. Monitoring integrated care progress, refining strategies, and enhancing care quality for patients with these two diseases should be priorities in Slovenia.

An Overview of Pharmaceutical Care in Type II Diabetes Mellitus Patients: Current Position and Prospects

Diabetes mellitus is an ongoing disease that is related to a high mortality rate due to severe complications. Diabetes mellitus type 2 (DMT2) is a persistent metabolic deficiency and its prevalence has been increasing consistently worldwide. As a result, it is rapidly turning into a plague in some parts of the world, and the number of people affected is expected to double in the following decade due to an increase in the maturing populace, adding to the overall existing importance for medical service providers, particularly in the underdeveloped nations. Extensive diabetes care is an intricate task that takes a whole group of medical care experts, including drug specialists, to provide multidisciplinary care for the patients. The duty of drug experts has changed significantly in recent years, changing from conventional drug dispensing in the drug store to patient- centered clinical support services. Upgrading the medication treatment to accomplish better remedial results without causing drug-related issues has been considered the essential objective of treatment for diabetic patients. This review discusses the healthcare needs of patients with T2DM, the current evidence for the role of pharmacists in diabetes care, and insight into the upcoming role of pharmacists in its management. The advanced role of clinical pharmacists in diabetes control through drug treatment, diabetes care centers, and diabetes health counselor schooling, is also discussed in this review.

Determinants of knowledge, attitude, and practice among patients with type 2 diabetes mellitus: A cross-sectional multicenter study in Tanzania

Improvement of primary care for patients with type 2 diabetes mellitus (T2DM) through the promotion of good knowledge, attitude, and practice is of paramount importance for preventing its related complications. This study aimed to assess the levels of knowledge, attitude, and practice and associated factors among patients with T2DM. This was a cross-sectional multicenter hospital-based study that included 979 patients from 8 health facilities in Tanzania. A standardized semi-structured interviewer-administered questionnaire was used to extract the required data. Factor analysis was used to determine the level of knowledge, attitude, and practice. Multivariable analysis under binary logistic regression analysis was used to determine the predictors of knowledge, attitude, and practice. P<0.05 was considered significant. The levels of adequate knowledge, positive attitude, and appropriate practice were 62.1%, 54%, and 30.9%, respectively. Being self-employed (AOR = 1.74, 95% CI = 0.28-0.91, p = 0.040) predicted adequate knowledge. Being male (AOR = 1.46, 95% CI = 1.06-2.01, p = 0.021 and visiting regional hospitals (AOR = 2.17, 95% CI = 1.33-2.51, p = 0.013) were predictors of positive attitude. Residing in rural areas and not having adequate knowledge of diabetes were less likely associated with appropriate practice. This study has shown a significantly low level of appropriate practice among patients with T2DM towards general issues on diabetes, risk factors, and related complications. Therefore, emphasis should be placed on improving good practices that can help prevent related complications.

Self-Reported Satisfaction to Treatment, Quality of Life and General Health of Type 2 Diabetes Patients with Inadequate Glycemic Control from North-Eastern Romania

Type 2 diabetes mellitus (T2DM) undermines health and quality of life (QoL). This cross-sectional study surveyed 138 consenting T2DM patients from North-Eastern Romania with regard to their satisfaction with treatment, diabetes-related impact on QoL, and general health. The Romanian versions of Diabetes Treatment Satisfaction Questionnaire (DTSQ), Audit of Diabetes Dependent Quality of Life (ADDQoL-19), and 36-Item Short Form Health Survey (SF-36) questionnaires were used. Self-reports were analyzed in conjunction with clinical and metabolic profiling. The patients were 57.86 ± 8.82 years old, 49.3% men, treated with oral glucose-lowering drugs, presenting with inadequate glycemic control but without cardiovascular manifestations. The mean DTSQ and ADDQoL scores were 25.46 ± 0.61 and −2.22 ± 1.2, respectively. Freedom to eat, holidays, journeys, leisure, physical health, sex life, freedom to drink, and feelings about the future scored below average. The mean SF-36 physical and mental health scores were 47.78 ± 1.03 and 50.44 ± 1.38, respectively. The mean SF-6D score was 0.59 ± 0.04 (generated retrospectively using SF-36 data). Negative associations were significant between ADDQoL, age (r = −0.16), and body mass index (r = −0.23), p < 0.01. Overall scores did not correlate with diabetes duration (except DTSQ, r = −1.18, p = 0.02) or HbA_1c. The results confirm other researchers’ findings in Europe and nearby countries. Our patients seemed satisfied with treatment despite glycemic imbalance and viewed diabetes as a burden on QoL and especially freedom to eat.

Impact of diabetes and periodontal status on life quality

Objectives

To investigate impact of periodontal status on quality of life (QoL) in type-1 (T1D) and type-2 (T2D) diabetes patients pre- and post-periodontal treatment using the Well-being Questionnaire 12 (W-BQ12) and Audit of Diabetes-Dependent Quality of Life-19 (ADDQoL-19).

Methods

W-BQ12 and ADDQoL-19 were self-completed by 56 T1D and 77 T2D patients at baseline and by those with periodontitis 3 and 6-months after therapy.

Results

At baseline, T1D patients had significantly higher general W-BQ12 [Median (IQR); 24.00 (20.25–27.75)] and positive well-being scores [8.00 (6.00–9.00)] (indicating better QoL) compared to T2D patients [22.00 (15.50–26.00) and 6.00 (3.50–9.00)], respectively (p < 0.05). Within both groups, general W-BQ12 scores did not differ significantly between patients with periodontal health, gingivitis, or periodontitis (p > 0.05). Significantly higher general W-BQ12 scores were observed in T1D patients at month 3 [28.00 (22.00–29.50)] compared to baseline [22.00 (17.00–24.50)] (p < 0.01), suggesting an initial improvement in QoL post-treatment. ADDQoL-19 identified that diabetes had greatest impact on the domain ‘freedom to eat’, with participants placing most importance on ‘family life’. No significant changes in ADDQoL-19 scores were seen post-treatment (p > 0.05).

Conclusions

Diabetes had impacts upon aspects of life quality in both T1D and T2D patients, though any additional impact based on periodontal status was not observed when using W-BQ12 and ADDQoL-19.

Comparison of Diabetes-Dependent Quality of Life (ADDQoL) in Patients with T2DM in Poland, The Czech Republic, and Slovakia

INTRODUCTION

The purpose of the paper was to perform a comparative analysis of the impact of T2DM on QoL, including specific ADDQoL domains and associations between QoL, selected socio-demographic factors (including gender, age, education, residence, marital status, professional activity) or clinical parameters (HbA1c levels, fasting blood glucose, BMI, duration of DM, complications, treatment used), in adult diabetic patients from Poland, the Czech Republic and Slovakia. The study group included 608 patients diagnosed with T2DM. There were 214 patients from Poland, 196 from the Czech Republic and 198 from Slovakia.

RESULTS

Overall, respondents from all three countries rated their QoL as good or very good. The mean scores for the item "If I did not have diabetes, my quality of life would be" were slightly higher for Poles than for Slovaks and Czechs. In the ADDQoL results, the weighted impact scores were negative for all domains. The lowest scores in all three countries were found for "freedom to eat" for all patients; the highest for "living conditions". For Polish patients, the linear regression model demonstrated the following significant AWI predictors: pre-university education and past smoking. For Czech patients, the linear regression model demonstrated that none of the characteristics analyzed were significant independent predictors of AWI. In the For Slovak patients, the linear regression model demonstrated the following significant AWI predictors: higher education and concurrent heart failure.

CONCLUSION

In summary, our findings demonstrate that T2DM has a negative impact on all aspects of patients' QoL, which is the strongest in terms of the freedom to eat and dietary habits, regardless of the country. Education, past smoking, and concurrent heart failure were the only independent predictors of QoL in our study. This suggests a need for further research that would include more variables and a larger number of patients.

Health status and quality of life in patients with diabetes in Switzerland

AIMS

We aimed to assess the health status and quality of life (QoL) of patients with diabetes and explore the associated factors in a French-speaking region of Switzerland.

METHODS

This cross-sectional study analyzed self-reported data from 585 patients with diabetes. We ran univariate and multivariate regressions analyses on health status (Physical and Mental Component Summary scores (PCS, MCS) of the SF-12) and diabetes-specific QoL (ADDQoL score).

RESULTS

Mean PCS was 43.1±10.4 and mean MCS was 46.7±11.1. The overall ADDQoL score was -1.6±1.6; the life domains of the ADDQoL with the lowest scores were freedom to eat, sex life and freedom to drink. Being older was independently and significantly associated with higher mental health and QoL, while lower income was associated with lower physical health, mental health, and QoL. Having diabetes for over 10 years was associated with lower QoL, while insulin treatment and complications were correlated with lower physical health and QoL.

CONCLUSIONS

This study provides key information on the health status and QoL of patients with diabetes in Switzerland and their associated factors, which can help healthcare providers to identify patients at higher risk of lower health and QoL.

Medication Adherence and Diabetes Self-Care Activities Among Patients With Type 2 Diabetes Mellitus

BACKGROUND

The prevalence of type 2 diabetes mellitus (T2DM) is increasing at an alarming rate in developing countries. The accompanying complications of T2DM can be reduced by maintaining a good adherence to medication and self-care activities.

OBJECTIVES

To evaluate medication adherence and self-care behaviors among patients with T2DM.

METHODS

A total of 497 subjects with T2DM were recruited from three hospitals and a government clinic in the state of Selangor, Malaysia. Previously validated scales were used to measure medication adherence (Morisky Medication Adherence Scale) and diabetes self-care activities (Summary of Diabetes Self-Care Activities). Pearson correlation coefficient was used to investigate the relationship between the risk factors and medication adherence. Pearson χ² test of association was used to test significant association.

RESULTS

The mean age of the subjects was 55.5 years. The mean Morisky Medication Adherence Scale score was 5.65 ± 1.97, indicating a moderate adherence level to medication. Among the subjects who had low adherence level, 50.9% were Malays, followed by 34.2% Indians. The Pearson χ² test of association indicated a significant association (P = 0.000) between ethnicity and medication adherence. The subjects had better self-care behaviors in their general diet (mean 5.04 ± 1.88) and poor self-care behaviors in blood sugar testing (mean 2.13 ± 2.34).

CONCLUSIONS

The Malaysians had a moderate medication adherence level, whereas they were nonadherent to blood glucose testing. Emphasis on self-care activities and medication adherence is relevant to improve outcomes in the management of T2DM.

An audit of diabetes-dependent quality of life in patients with type 2 diabetes mellitus in Malaysia

PURPOSE

The aim of this study was to evaluate and validate the ADDQoL and to assess the impact of diabetes on QoL among the type 2 diabetes mellitus patients in Malaysia.

METHODS

The Malay and English versions of the ADDQoL questionnaire were administered to patients attending routine outpatient visits in three primary hospitals and a public clinic. The construct validity of the ADDQoL was validated using confirmatory factor analysis (CFA). The sample comprised 350 Malay respondents who rated the ADDQoL Malay version and 246 non-Malay respondents (Chinese or Indian) who answered using the ADDQoL original English version.

RESULTS

CFA confirmed the presence of one-factor structure for both samples. The internal consistency was high with Cronbach's alpha values of 0.945 and 0.907 for the ADDQoL Malay and English versions, respectively. Results showed that for all three ethnicities, the most important domain is 'family life'. Overall, Malay patients stated their 'living conditions' is the most negatively affected, while for Chinese and Indians, diabetes has the greatest impact on their 'freedom to eat'.

CONCLUSIONS

The ADDQoL was found to be culturally appropriate, valid and reliable among Malay- and English-speaking type 2 diabetes mellitus patients in Malaysia.

Are changes in glycaemic control associated with diabetes-specific quality of life and health status in screen-detected type 2 diabetes patients? Four-year follow up of the ADDITION-Cambridge cohort

BACKGROUND

Interventions that improve HbA1c levels do not necessarily improve health-related quality of life (QoL). This issue may be particularly relevant in asymptomatic diabetes patients detected earlier in the course of the disease.

METHODS

HbA1c , diabetes-specific QoL (ADDQoL) and health status were measured in 510 screen-detected diabetes patients from the ADDITION-Cambridge trial at 1 and 5 years post diagnosis. Multivariable logistic/linear regression was used to quantify the longitudinal association between change in HbA1c from 1 to 5 years and ADDQoL and health status at 5 years, adjusting for age, sex, education and trial group; alcohol consumption, smoking, physical activity, plasma vitamin C, HbA1c , ADDQoL or health status at 1 year, and glucose-lowering medication at 5 years.

RESULTS

From 1 to 5 years, median HbA1c interquartile range increased from 6.3% (5.9-6.8) to 6.8% (6.4-7.4); the median ADDQoL score and mean health status physical health summary score decreased from -0.4 (-1 to -0.08) to -0.5 (-1.08 to -0.09) (suggesting an adverse impact of diabetes on QoL) and by -0.79 (8.94) points, respectively. Increases in HbA1c were independently associated with reporting a negative impact of diabetes on QoL (OR = 1.38, 95% CI: 1.03 to 1.85) but not with the health status summary scores.

CONCLUSIONS

Increases in HbA1c from 1 to 5 years post-diagnosis were independently associated with increased odds of reporting a negative impact of diabetes on QoL. While our results suggest that efforts to reduce HbA1c do not adversely affect health-related QoL, large numbers of participants still report a negative impact of diabetes on their QoL 5 years post-diagnosis.