Linking quality of healthcare and health-related quality of life of patients with type 2 diabetes: an evaluative study in Mexican family practice

Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.

Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study

BACKGROUND

Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine healthrelated quality of life (HRQOL) and its predictors in patients with type 2 diabetes.

METHODS

A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes.

RESULTS

Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor's degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001).

CONCLUSION

Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Health-related quality of life and associated factors among type 2 diabetic adult patients in Debre Markos Referral Hospital, Northwest Ethiopia

Health-related quality of life (HRQOL) is a multifaceted concept that is strongly impacted by Type II diabetes in developing countries. The majority of studies indicate diabetes mellitus prevalence without looking at people's quality of life.

This study was conducted using an Institution-based cross-sectional design in Debre Markos Referral Hospital from March 03 to March 31, 2020. We evaluated HRQOL using the WHO quality of life BREF and data were obtained through face-to-face interviews. We used a systematic random sampling technique to select study participants. Data were entered into Epi data version 3.1 and exported to STATA version 14.0. Candidates for multivariable analysis were variables with a P-value less than 0.25 in the bivariable analysis and P-value less than 0.05 were considered to declare a statistically significant association. The final model was tested for its goodness of fit using Hosmer and Lemeshow's statistics.

The analysis included a total of 368 adult individuals with type II diabetes and 206 (56%) had a good HRQOL. Being male (AOR = 4.28, 95%CI:2.36, 7.78), having duration of disease of more than 59 months (AOR = 2.93, 95%CI:1.61, 5.34), doing a physical exercise (AOR = 2.33,95%CI:1.34, 4.05) and got counseling (AOR = 3.33; 95%CI:1.82, 5.94) were directly associated with good HRQOL whereas the presence of diabetic complications (AOR = 0.46, 95%CI:0.26, 0.80), comorbidity (AOR = 0.45; 95%CI:0.25, 0.84) and drinking alcohol (AOR = 0.27, 95%CI:0.16, 0.48) had an inverse relationship with good HRQOL.

More than half of type 2 diabetic adult patients had a good HRQOL. Being male, drinking alcohol, getting counseling, doing physical exercise, absence of diabetic complications, and comorbidity and long duration of disease were predictors of good HRQOL. Therefore, avoiding drinking alcohol and promoting physical exercise and counseling should be encouraged.

SELF-CARE AND QUALITY OF LIFE PEOPLE WITH TYPE 2 DIABETES DURING THE COVID-19: CROSS-SECTIONAL STUDY

Background

. Social distancing and emotional stress during the COVID-19 pandemic have affected the self-care management of type 2 diabetes mellitus patients. There was a shift in self-care management during the COVID-19 that will impact the quality of life of type 2 diabetes mellitus (T2DM) patients. This study aims to determine the relationship between self-care management and quality of life of T2DM patients in the community health center during the lockdown.

Methods

. This research was a quantitative study with a cross-sectional study approach. The sampling technique used a non-probability sampling with total sampling of 89 respondents. The instruments used in this study were WHO Quality of Life-BREF and Summary of Diabetes Self Care Activities.

Findings

The results showed a significant relationship between self-care management and the quality of life of people with type 2 diabetes (p = 0.000) with moderate strength and a positive direction.

Conclusions

People with diabetes coped well with their disease management which was supported by family and health professionals. Sustainable health education and motivation for patients and families are important so that the patients always carry out self-care management to improve the quality of life of type 2 diabetes mellitus patients.

Factors Associated with Quality of Life in Patients with Type 2 Diabetes of South Benin: A Cross-Sectional Study

Background: Type 2 diabetes (T2D) adversely affects health-related quality of life (QoL). However, little is known about the QoL of diabetic patients in Benin, where the disease is a growing concern. Thus, this study aims to assess the QoL and its associated factors among T2D patients in Cotonou, southern Benin. Methods: A total of 300 T2D patients (age > 18 years) were enrolled, and the diabetes-specific quality of life (DQoL) and Natividad self-care behaviors’ (SCB) instruments were used for data collection. DQoL scores were calculated, and factors associated with DQoL explored using logistic regression. Results: The mean of patients’ DQoL was 38.1 ± 4.1, with 43% having low QoL. In terms of DQoL, 56.3% reported a high diabetes impact, followed by low life satisfaction (53%) and high worry about diabetes (32.7%). In the logistic regression analysis, education, marital status, occupation, family history of diabetes, complications, and social support were associated with DQoL. SCB factors, including healthy eating, problem-solving, coping strategies, and risk reduction, were significant predictors of DQoL. Conclusions: Patients’ empowerment, starting with self-management education, is essential to improve the QoL of T2D patients in Cotonou. However, the programs need to target low education, low socioeconomic status, low social support, and overweight patients.

Quality criteria/key components for high quality of diabetes management to avoid diabetes-related complications

Aim

The aim of this review shoud be to map data and to identify quality indicators for good practices for diabetes management and secondary prevention, specifically of type 2 diabetes.

Methods

To achieve this aim we performed the following steps: (i) a literature review on evaluation criteria, (ii) selection of quality criteria and key components for high quality of care, (iii) creation of a checklist to identify the best practice of diabetes management based on the detected criteria.

Results

The literature search about the quality indicators for diabetes care resulted in the following: identifying of key components and quality indicators for structure, process and outcome quality.

Conclusions

The set of quality criteria will be discussed and used to identify the best practice diabetes management programs for secondary prevention of type 2 diabetes.

Heath related quality of life and associated factors among diabetes patients in sub-Saharan countries: a systemic review and meta-analysis

Background

Various primary studies have been conducted in sub-Saharan countries on the level of health related quality of life (HRQoL) and their associated factors among diabetic patients. However, the result of these studies lacks consistency. Therefore, this systematic review and meta-analysis estimates the pooled level of HRQoL and their associated factors among diabetic patients in sub-Saharan countries.

Methods

Electronic databases predominantly PubMed were searched. Databases, such as Google and Google scholar, were searched for gray literature. A funnel plot and Egger’s regression test were used to see publication bias. Heterogeneity of the studies was checked by Forest plot and I-squared statistic. Both inverse-variance fixed-effect and DerSimonian and Laird random-effects methods were applied to estimate the pooled level of HRQoL (for both WHO-QoL-BREF and SF-36) and the effect size of associated factors.

Result

From a total 776 retrieved studies, 16 studies were included for systematic review and meta-analysis. The pooled mean score of physical health, psychological, social relation and environmental health domain of WHO-QoL-BREF were 43.12, 47.40, 46.60 and 45.59 respectively. Age had a significant association (pooled β = − 0.47), (pooled β = − 0.24), (pooled β = − 0.32) and (pooled β = − 0.03) with physical health, psychological health, social relation and environmental health domains respectively. Being rural residence (pooled β = − 0.32) was inversely associated with environmental health domain of WHO-QoL-BREF. Increased fasting blood sugar had a significant association (pooled β = − 0.08, 95% CI − 0.11, − 0.05), (pooled β = − 0.07) and (pooled β = − 0.004) with physical health, psychological health and environmental health domains respectively. Having Co-morbidity (pooled β = − 6.25) and diabetes related complication (pooled β = − 5.65) were contrarily related to physical health domain of WHO-QoL-BREF.

Conclusion

The pooled mean of physical and environmental domains of HRQOL scores was the least compared to the psychological and social domains. Being Old age and rural residence, increased fasting blood sugar, having co-morbidity and diabetic related complications were contrarily related to level of HRQoL. Therefore, we recommend that early detection and treatment of diabetes related complication and comorbidity and control of fasting blood sugar. While doing that due attention should be given for old and rural dwellers.

Patient-reported outcomes for diabetes and hypertension care in low- and middle-income countries: A scoping review

INTRODUCTION

Patient-reported outcome measures (PROMs) assess patients' perspectives on their health status, providing opportunities to improve the quality of care. While PROMs are increasingly used in high-income settings, limited data are available on PROMs use for diabetes and hypertension in low-and middle-income countries (LMICs). This scoping review aimed to determine how PROMs are employed for diabetes and hypertension care in LMICs.

METHODS

We searched PubMed, EMBASE, and ClinicalTrials.gov for English-language studies published between August 2009 and August 2019 that measured at least one PROM related to diabetes or hypertension in LMICs. Full texts of included studies were examined to assess study characteristics, target population, outcome focus, PROMs used, and methods for data collection and reporting.

RESULTS

Sixty-eight studies met the inclusion criteria and reported on PROMs for people diagnosed with hypertension and/or diabetes and receiving care in health facilities. Thirty-nine (57%) reported on upper-middle-income countries, 19 (28%) reported on lower-middle-income countries, 4 (6%) reported on low-income countries, and 6 (9%) were multi-country. Most focused on diabetes (60/68, 88%), while 4 studies focused on hypertension and 4 focused on diabetes/hypertension comorbidity. Outcomes of interest varied; most common were glycemic or blood pressure control (38), health literacy and treatment adherence (27), and acute complications (22). Collectively the studies deployed 55 unique tools to measure patient outcomes. Most common were the Morisky Medication Adherence Scale (7) and EuroQoL-5D-3L (7).

CONCLUSION

PROMs are deployed in LMICs around the world, with greatest reported use in LMICs with an upper-middle-income classification. Diabetes PROMs were more widely deployed in LMICs than hypertension PROMs, suggesting an opportunity to adapt PROMs for hypertension. Future research focusing on standardization and simplification could improve future comparability and adaptability across LMIC contexts. Incorporation into national health information systems would best establish PROMs as a means to reveal the effectiveness of person-centered diabetes and hypertension care.

Heath related quality of life and associated factors among adults with and without diabetes in Adama city East Shewa, Ethiopia 2019; using generalized structural equation modeling

BACKGROUND

Diabetes mellitus (DM) is a chronic disease, leading to many complications and substantial decrease in patients' Health Related Quality of Life (HRQoL). HRQoL among diabetic patients could affect by concurrent various factors. Therefore, analysis of these concomitant factors using generalized structural equation model (GSEM) that takes account the complex network of relationship could be a more utilitarian approach to better understand factor affecting HRQoL. The present study aimed to assesses the level of HRQoL and its associated factors among adults with and without diabetes.

METHODS

A comparative cross-sectional study was conducted from March 13 to April 4, 2019 in Adama Hospital and Medical College and Adama city Kebele 2, 4 and 5, East Shewa Ethiopia. Data related to socio-demographics, behavioral, clinical factors and HRQoL were collected from 359 adults with diabetes & 415 adults without diabetes through face to face interviews. Data was entered to Epi-data 3.1 then it was exported to STATA 14 for further analysis. GSEM was employed to verify relationships and association among exogenous, mediating and endogenous variable concurrently.

RESULTS

Diabetic groups had a significant lower mean score in all domains of HRQoL than non- diabetic group (p-value< 0.0001). Depression had a direct negative effect on all domains of HRQoL in both groups. Fasting blood sugar also had a direct negative effect on all domains of HRQoL except social relation. Diabetes mellitus complication had a direct negative effect on both physical and psychological health. Low Medication adherence and poor diabetic self-care activity had a negative direct, indirect and total effect on physical and environmental health through fasting blood sugar.

CONCLUSION

Diabetic patients had lower HRQoL in all the domains of quality of life. Socio-demographic factor (Age, residence and marital status), clinical factor (Depression & Diabetes mellitus complication) and behavioral factor (diabetic self-care activity and medication adherence) mediated by fasting blood sugar were factor associated HRQoL among the diabetic group. Thus, we recommend that integration of screening for depression and give counseling on medication adherences and diabetic self-care activity along with the already existing DM treatment.

Health-related quality of life and its associated factors among adult patients with type II diabetes attending Mizan Tepi University Teaching Hospital, Southwest Ethiopia

Background

Health-related quality of life (HRQOL) has become an important measure for evaluating patient treatment with non-curable chronic disease. The aim of the study was to assess HRQOL and its associated factors among patients with type II diabetes.

Methods

This is an institution-based, cross-sectional study conducted from March 13 to May 9, 2018. A total of 267 patients with type II diabetes who visited the clinic for follow-up for at least 3 months and who were 18 years or older were included in the study. The WHO Quality of Life-BREF was used to assess quality of life. Multivariable linear regression was employed to identify associated factors with HRQOL among patients with type II diabetes.

Results

The mean score for overall HRQOL was 51.50±15.78. The mean scores for physical health, psychological, environmental and social relationship domains were 49.10±18.14, 53.51±19.82, 49.72±16.09 and 53.68±17.50, respectively. Age, disease duration and fasting blood glucose level were inversely associated with all domains of HRQOL (p<0.001). Body mass index was inversely related with all domains of HRQOL except with the physical health domain.

Conclusion

The findings from this study indicated that all dimensions of HRQOL of patients with diabetes in this study setting were compromised. The study also identified important predictors such as age, duration of disease and level of fasting blood sugar. This entails the need to intervene in improving the HRQOL of patients with diabetes beyond the provision of standard treatments.

Living With Type 2 Diabetes in San Jose Tecoh, Yucatan, Mexico: A Phenomenological Study

INTRODUCTION

Understanding the psychosocial aspects that accompany and influence type 2 diabetes mellitus (T2DM) has become increasingly important for culturally appropriate health care in Mexico. The purpose of this study was to understand the lived experience of individuals' with T2DM in Merida, Yucatan.

METHOD

A phenomenological method guided data collection and analysis. Patients in San Jose Tecoh, diagnosed with T2DM for at least 5 years, were interviewed.

RESULTS

Eight (six female, two male) patients described their lived experience. Individuals discussed knowledge of the disease (e.g., care, beliefs about origin, consequences, type, symptoms) and changes arising from diagnosis (e.g., emotional, dietary, physiological, lifestyle and self-care, economic).

DISCUSSION

The Mayan-Yucatecan cultural perceptions of factors that influence physical health are unique to this region. Nurses can facilitate improvement in T2DM health outcomes through providing information and encouraging self-care. Our results emphasize the importance of considering T2DM in terms of differences between and within culture.

The role of stable housing as a determinant of poverty-related quality of life in vulnerable individuals

OBJECTIVE

The aim of this study was to identify potential socio-demographic and socio-economic determinants associated with quality of life (QoL) in impoverished individuals admitted in emergency departments (EDs) using a self-administered multidimensional poverty-related QoL questionnaire (PQoL) and a generic QoL questionnaire (Duke).

DESIGN

cross-sectional study.

SETTING

Ten EDs in France.

PARTICIPANTS

All participants included in this study lived in impoverished conditions.

INTERVENTION AND OUTCOME MEASURES

We collected socio-demographic information, economic data, and data related to the ED visit. Multiple linear regressions were performed to determine which variables were linked to QoL scores.

RESULTS

Three-hundred and eighty-seven individuals were enrolled, and 378 (98%) responded to the QoL questionnaires. PQoL was significantly lower for single individuals (β from -0.15 to -0.23), without a stable home (β from -0.17 to -0.34) and individuals without general health coverage (β = 0.20). Compared with men, women reported lower scores in the psychological well-being dimension (β = -0.19) and higher scores in the relationships with friends dimension (β = 0.17).

CONCLUSIONS

Not having stable housing was the most important factor associated with low QoL in impoverished people. This finding demonstrates the need for support from policymakers at the national and local levels for these vulnerable populations.