Quality of life and its predictors among Hong Kong Chinese patients with diabetes

Diabetic Neuropathy: Prevalence and Impact on Quality of Life in Al-Ahsa, Saudi Arabia

Objective This study aims to measure the prevalence of diabetic neuropathy (DN) in patients with type 1 and type 2 diabetes mellitus (DM) and to explore the impact of DN on quality of life (QoL) in type 1 and type 2 DM patients in Al-Ahsa, Saudi Arabia. Methods This cross-sectional study targeted type 1 and type 2 DM patients who live in Al-Ahsa, Saudi Arabia. Self-reported online questionnaires distributed randomly on social media were used. The survey included three parts: sociodemographic data, the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire, and the modified Arabic Diabetes Quality of Life (DQoL) questionnaire. The data have been collected from April 2022 to May 2022. Results The study included participants (n = 329) of both type 1 and type 2 DM. Patients' age ranged from 18 to 82 years with a mean age of 45.9 ± 15.2 years. A total of 166 (50.5%) patients were males and 319 (97%) were Saudi nationals. The prevalence of DN in the study population was 44.1%. Of the patients with DN, 73.1% have low QoL, which means DN increased the risk of low QoL by about four times (OR = 3.9; 95% CI: 2.5-6.3). Conclusion In conclusion, the study showed that the prevalence of DN in Al-Ahsa, Saudi Arabia was 44.1%. The presence of DN was associated with reduced QoL. Type 2 DM, low educational level, and the presence of other comorbidities were significantly associated with low QoL.

The Health-Related Quality of Life of Patients with Type 2 Diabetes in Saudi Arabia

OBJECTIVE

Diabetes mellitus (DM) is one of the most common chronic diseases in the world. Diabetes mellitus has a major effect on patients' quality of life, especially when the patient has other comorbidities. Therefore, this study aims to assess the quality of life of type 2 diabetic patients in the Al-Ahsa region of Saudi Arabia.

METHODS

This was a cross-sectional study, which was conducted from September 2020 to May 2021 on patients with type 2 diabetes mellitus in the Al-Ahsa region of Saudi Arabia. Inclusion criteria were patients diagnosed with T2DM and aged 18 years and older. The EQ-5D-5L tool was used in this study to measure the quality of life.

RESULTS

A total of 321 patients with T2DM participated in the study. Only 8.4% of the study participants reported that their disease did not let them do their daily activities at all. The most commonly reported problems related to diabetes mellitus and its effect on patients' quality of life were pain/discomfort (around 68.0% of the patients reported some sort of problems in this dimension), followed by mobility, and depression and anxiety. There was a significant difference between males and females in terms of their quality of life, specifically self-care, pain and discomfort, and depression and anxiety (p<0.05). Patients from different marital statuses, education levels, employment status, and duration of the disease showed a significant difference in quality of life, except for depression and anxiety (p>0.05).

CONCLUSION

Pain/discomfort, mobility, and depression/anxiety are the main problems that are affecting diabetic patients' quality of life. Future studies are recommended to explore the effectiveness of patient tailored interventions to decrease the negative impact of these dimensions on patients' quality of life.

The influence of hypoglycemia on the specific quality of life in type 2 diabetes mellitus: a comparative cross-sectional study of diabetics with and without hypoglycemia in Xi'an, China

Purpose

This study aims to explore the incidence of hypoglycemia in patients with type 2 diabetes mellitus (T2DM) and the influence of hypoglycemia on the specific quality of life in T2DM patients.

Methods

It was a comparative cross-sectional study consisting of 519 T2DM patients in Xi'an, China and patients were investigated by self-reported hypoglycemia and specific quality of life questionnaires from September 2019 to January 2020. Descriptive analysis, t-test, Chi-square test, hierarchical regression analysis and stepwise multiple regression analysis were applied to assess the influence of hypoglycemia on the specific quality of life.

Results

The incidence of hypoglycemia in T2DM patients was 32.18%. The mean score of specific quality of life in diabetes without hypoglycemia was 57.33 ± 15.36 and was 61.56 ± 17.50 in those with hypoglycemia, which indicated that hypoglycemia had a serious impact on the quality of life of diabetics (t = − 5.172, p = 0.000). In the Univariate analysis of specific quality of life, age, education background, marital status, living status, duration of diabetes, monthly income per capita were independent and significant factors associated with specific quality of life of two groups of T2DM patients (p < 0.05). In the hierarchical regression analysis, the duration of the diabetes more than 11 years and the frequency of hypoglycemia more than 6 times in half a year entered the equation of specific quality of life of 519 diabetics respectively (p < 0.001). In multiple linear regression analysis, age, marital status and income all entered the regression equation of quality of life of the two groups (p < 0.05).

Conclusion

Hypoglycemia will have a serious impact on the quality of life of T2DM patients. In order to improve the living quality in diabetics, effective measurements should be taken to strengthen the management of blood glucose and to avoid hypoglycemia.

A randomized study on the usefulness of an electronic outpatient hypoglycemia risk calculator for clinicians of patients with diabetes in a safety-net institution

Objective: Hypoglycemia (HG) occurs in up to 60% of patients with diabetes mellitus (DM) each year. We assessed a HG alert tool in an electronic health record system, and determined its effect on clinical practice and outcomes.Methods: The tool applied a statistical model, yielding patient-specific information about HG risk. We randomized outpatient primary-care providers (PCPs) to see or not see the alerts. Patients were assigned to study group according to the first PCP seen during four months. We assessed prescriptions, testing, and HG. Variables were compared by multinomial, logistic, or linear model. ClinicalTrials.gov ID: NCT04177147 (registered on 22 November 2019).Results: Patients (N = 3350) visited 123 intervention PCPs; 3395 patients visited 220 control PCPs. Intervention PCPs were shown 18,645 alerts (mean of 152 per PCP). Patients' mean age was 55 years, with 61% female, 49% black, and 49% Medicaid recipients. Mean baseline A1c and body mass index were similar between groups. During follow-up, the number of A1c and glucose tests, and number of new, refilled, changed, or discontinued insulin prescriptions, were highest for patients with highest risk. Per 100 patients on average, the intervention group had fewer sulfonylurea refills (6 vs. 8; p < .05) and outpatient encounters (470 vs. 502; p < .05), though the change in encounters was not significant. Frequency of HG events was unchanged.Conclusions: Informing PCPs about risk of HG led to fewer sulfonylurea refills and visits. Longer-term studies are needed to assess potential for long-term benefits.

Predictive modeling of hypoglycemia for clinical decision support in evaluating outpatients with diabetes mellitus

Objective: Hypoglycemia occurs in 20-60% of patients with diabetes mellitus. Identifying at-risk patients can facilitate interventions to lower risk. We sought to develop a hypoglycemia prediction model. Methods: In this retrospective cohort study, urban adults prescribed a diabetes drug between 2004 and 2013 were identified. Demographic and clinical data were extracted from an electronic medical record (EMR). Laboratory tests, diagnostic codes and natural language processing (NLP) identified hypoglycemia. We compared multiple logistic regression, classification and regression trees (CART), and random forest. Models were evaluated on an independent test set or through cross-validation. Results: The 38,780 patients had mean age 57 years; 56% were female, 40% African-American and 39% uninsured. Hypoglycemia occurred in 8128 (539 identified only by NLP). In logistic regression, factors positively associated with hypoglycemia included infection, non-long-acting insulin, dementia and recent hypoglycemia. Negatively associated factors included long-acting insulin plus sulfonylurea, and age 75 or older. The models' area under curve was similar (logistic regression, 89%; CART, 88%; random forest, 90%, with ten-fold cross-validation). Conclusions: NLP improved identification of hypoglycemia. Non-long-acting insulin was an important risk factor. Decreased risk with age may reflect treatment or diminished awareness of hypoglycemia. More complex models did not improve prediction.

Minimally important difference and predictors of change in quality of life in type 2 diabetes: A community-based survey in China

BACKGROUND

To identify the minimally important difference (MID) of the EQ-5D-3L and determinants of change in quality of life (QoL) as measured by the EQ-5D-3L over 1 year for Chinese type 2 diabetic patients (T2DPs).

METHODS

Clinically diagnosed T2DPs were recruited from 66 community health centres in five Chinese cities using a multistage quota sampling method between December 2010 and October 2011. Demographics, diabetes-related information, and health-related behaviours were collected at baseline. The EQ-5D-3L was administered at baseline and at 12 months. Anchor-based and distribution-based approaches were employed to estimate MIDs. Using the MIDs as cut-points, we identified the change in EQ-5D-3L-measured QoL into "worsening," "no change," and "bettering." Logistic and ordered logistic regressions were conducted for those who reported best possible EQ-5D health state ("best possible HS") and impaired EQ-5D health states ("impaired HS") at baseline, respectively. Explanatory variables included demographics, diabetes-related information, and health-related behaviours.

RESULTS

A total of 1958 patients (54.9% female, mean age 61.2 years, mean diabetes duration 7.9 years) were included in our analysis. MIDs of the EQ-5D-3L for deterioration and improvement were estimated as -0.066 to -0.003, and 0.049 to 0.077, respectively. For the impaired HS group, older age, lower education, and less exercise were significant predictors for worsening in QoL; whereas, those predictors were older age, female gender, and lower income for the best possible HS group.

CONCLUSIONS

Minimally important differences for deterioration and improvement were estimated for the EQ-5D-3L. Age, gender, education, income, and exercise were significant determinants of QoL change for Chinese T2DPs.

Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis

BACKGROUND

Diabetes is a chronic disease, and it could affect both health and quality of life (QOL). A lot of studies have reported some predictors of QOL of type 2 diabetes patients. While their results were not completely consistent. So the aim of our study was finding out the related factors (including characteristics related to the disease, life styles and mental health factors) of QOL of type 2 diabetes patients.

METHODS

We searched Cochrane library, EmBase, PubMed and CNKI databases for published studies that evaluated the related factors of QOL of type 2 diabetes patients by using a proper statistic method and had effect sizes (OR or β) and 95% confidence intervals from January 1st 2000 to May 31st 2016. Any study types were acceptable, and we excluded the reviews, letters, editorials and pooled analyses. The data were analyzed using STATA software (Version 12.0; Stata Corporation). Effect sizes and 95% confidence intervals were calculated to evaluate the relationship between these factors and QOL.

RESULTS

Eighteen studies were included into our systematic review and meta-analysis, totaling 57,109 type 2 diabetes patients. Do more physical exercises (The pooled ORs ranged from 0.635 to 0.825 for different scales, less than 1.00), glucose check more frequently [pooled OR (95%CI): 0.175 (0.041, 0.756)] were associated with a better QOL. Presence of complications (The pooled ORs ranged from 1.462 to 3.038 for different scales, more than 1.00), presence of hypertension [pooled OR (95%CI): 1.389 (1.173, 1644)], longer duration of diabetes [pooled OR (95%CI): 1.865 (1.088, 3.197)], diet with more red meat [pooled OR (95%CI): 2.085 (1.063, 4.089)] and depression (The pooled ORs ranged from 3.003 to 11.473 for different scales, higher than 1.00) were associated with a worse QOL.

CONCLUSION

The results of this study show that physical exercise, glucose check frequently, complications, hypertension, duration of diabetes, diet with more red meat, and depression were associated with the QOL of type 2 diabetes patients.

Measuring the reliability and validity of the Greek edition of the Diabetes Quality of Life Brief Clinical Inventory

BACKGROUND

The present study focuses on studying the validity and reliability of the Greek edition of DQOL-BCI. DQOL-BCI includes 15 questions-elements that are evaluated on a 5-grade scale like Likert and two general form-shapes.

METHODS

The translation process was conducted in conformity with the guidelines of EuroQol group. A non-random sample of 65 people-patients diagnosed with diabetes I and II was selected. The questionnaire that was used to collect the data was the translated version of DQOL-BCI, and included the demographic characteristics of the interviewees. The content validity of DQOL-BCI was re-examined from a team of five experts (expert panel) for qualitative and quantitative performance. The completion of the questionnaire was done via a personal interview.

RESULTS

The sample consisted of 58 people (35 men and 23 women, 59.9 ± 10.9 years). The translation of the questionnaire was found appropriate in accordance to the peculiarities of the Greek language and culture. The largest deviation of values is observed in QOL1 (1.71) in comparison to QOL6 (2.98). The difference between the standard deviations is close to 0.6. The statistics results of the tests showed satisfactory content validity and high construct validity, while the high values for Cronbach alpha index (0.95) reveal high reliability and internal consistency.

CONCLUSIONS

The Greek version of DQOL-BCI has acceptable psychometric properties and appears to demonstrate high internal reliability and satisfactory construct validity, which allows its use as an important tool in evaluating the quality of life of diabetic patients in relation to their health.

Performance of the Malay Audit of Diabetes Dependent Quality of Life-18 and Associates of Quality of Life among Patients with Type 2 Diabetes Mellitus from Major Ethnic Groups of Malaysia

INTRODUCTION

Diabetes Mellitus (DM) is notorious for its metabolic effect, acute and chronic complications and impact on Quality of Life (QoL). Successful intervention to improve QoL necessitates a valid and reliable measurement tool to identify areas of concern to patients with diabetes.

OBJECTIVES

To (1) assess the factor structure of the Malay Audit of Diabetes Dependent Quality of Life-18 (ADDQoL-18) questionnaire; (2) determine the impact of DM on QoL; and (3) identify areas of concern to patients with type 2 DM from three major ethnic groups in Malaysia.

METHODS

Data was obtained from a cross sectional study involving 256 patients with type 2 DM attending the diabetes clinic of the National University of Malaysia Medical Centre. The Malay version of ADDQoL-18 survey was translated from its English version according to standard guidelines and administered by a trained research assistant. Exploratory Factor Analysis (EFA) with oblimin rotation was used to determine factor structure of the data. Confirmatory Factor Analysis (CFA) was used to confirm the factor structure. Hierarchical liner regression was used to determine factors associated with QoL.

RESULTS

Unforced factor solution yielded two factors for the whole sample. Forced one factor solution was ascertained for the whole sample and for each ethnic group. Loadings ranged between 0.588 and 0.949. Reliability coefficients were all higher than 0.955. CFA showed that the two factor model had better fit statistics. QoL was associated with the use of insulin and desired glycaemic control, longer diabetes duration, worry about diabetes, and diabetes complications.

CONCLUSIONS

The Malay ADDQoL-18 is a valid tool to be used among patients with diabetes from different ethnic groups in Malaysia. The use of insulin to achieve desired glycaemic control had more negative impact on QoL than the use of tablets and/or dietary changes.

Valuing Health-Related Quality of Life in Type 2 Diabetes Patients in China

OBJECTIVE

To determine health-state utility (HSU) values for type 2 diabetes (T2D) patients with various clinical conditions in China, and to examine how these conditions are correlated with HSU values.

METHODS

A consecutive sample of T2D patients was recruited from a tertiary hospital in Suzhou, China. HSU values of T2D patients were measured using the EQ-5D-5L, a new version of the EQ-5D. T2D patients' clinical data were collected from the survey and the clinical examination; sociodemographic data were obtained from the survey. Ordinary least square (OLS) models were employed to estimate the impact of clinical conditions on HSU values controlling for sociodemographic conditions. Nonparametric biased-corrected and accelerated (BCA) bootstrap was used to calculate the 95% confidence intervals (CIs).

RESULTS

A total of 289 T2D patients provided data. The mean HSU value of the sample was 0.876 (standard deviation: 0.14), with a median of 0.895 (range: -0.063 to 1). Using the OLS model and BCA bootstrap, the impact of significant conditions on HSU values and 95% CIs are as follows: neuropathy (-0.057, [-0.093, -0.017]), heart disease (-0.074, [-0.122, -0.018]), cerebrovascular disease (-0.160, [-0.287, -0.030]), and increasing diabetes duration (-0.004, [-0.007, -0.001]).

CONCLUSION

The HSU values estimated can be used to assess the cost-effectiveness of health care interventions for T2D patients in China.

Modelling of diabetes knowledge, attitudes, self-management, and quality of life: a cross-sectional study with an Australian sample

BACKGROUND

Quality of life (QoL) is an important aspect of wellbeing for people with chronic conditions like type 2 diabetes, making it a noteworthy outcome. Knowledge about diabetes, attitudes, and self-management of diabetes are key factors that might directly or indirectly impact QoL. However, little is known about the inter-relationships between diabetes knowledge, attitudes, self-management and QoL among people with type 2 diabetes mellitus (T2DM). The aim of this study was to examine a model describing the relationship between diabetes knowledge, attitudes, self-management, and QoL of people with T2DM that is based on previous research linking pairs of these variables.

METHODS

A cross-sectional study design was employed in this research. A total of 291 participants, 192 males and 99 females, with T2DM, whose mean age was 55.8 (standard deviation = 11.09) completed questionnaires measuring diabetes knowledge (Diabetes Knowledge Scale), attitudes (Diabetes Integration Scale -19), self-management (Summary of Diabetes Self-care Activities Scale), including the aspects of diet, exercise, blood glucose testing, and foot care, and QoL (Diabetes Quality of Life Scale), comprising the aspects of satisfaction and impact on QoL respectively. To examine the model we proposed relating these variables, data were analysed using the path analysis.

RESULTS

In the final model, diabetes knowledge was a significant predictor for attitudes and self-management in terms of blood glucose testing. Attitudes was a significant predictor for self-management in terms of diet. In addition, self-management in terms of blood glucose testing was a significant predictor of impact of QoL, and self-management in terms of diet was a significant predictor of satisfaction and impact of QoL. Self-management in terms of exercise was a significant predictor of satisfaction in QoL. The final model reflected a good fit (χ(2) (14) = 22.52, p = 0.069; CFI = 0.983; GFI = 0.983; RMSEA = 0.046).

CONCLUSIONS

Diabetes knowledge, attitudes, and self-management are important factors that can impact the QoL among people with type 2 diabetes.

Do Perceptions of Empowerment Affect Glycemic Control and Self-Care Among Adults with Type 2 Diabetes?

Background:

The Arab adult with T2DM is understudied with less known facts about the perception of empowerment and its relationship with self-care and glycemic control.

Purpose:

The purpose of this study was to determine the extent to which perception of empowerment by Arab adults living with Type 2 Diabetes Mellitus (T2DM) was associated with better glycemic control and self-care management.

Methods:

A cross-sectional descriptive study was led among 300 Arab adults living in Oman with T2DM in an outpatient diabetes clinic. The Diabetes Empowerment Scale (DES), glycosylated haemaglobin (HbA1c) and Body mass index was assessed. The DES was found to be valid and reliable for the population. ANOVA, Regression analysis, and Structural equation modeling was used for analysis.

Results:

The composite score and three subscales of DES were a significant and strong predictor of good glycemic control among Omani adults with T2DM (p<0.001). Age, education, duration of DM, prior DM education program and medications were significantly associated with DES.

Conclusion:

Diabetes nurse educators engaged in the care of adults with T2DM should assess self-empowerment and tailor interventions to increase empowerment for better glycemic control. Patient empowerment plays an essential role in maintaining self-care behaviours and HbA1c.

Application of a health-related quality of life conceptual model in community-dwelling older Chinese people with diabetes to understand the relationships among clinical and psychological outcomes

AIMS/INTRODUCTION

The present study applied the Wilson-Cleary model of health-related quality of life (HRQOL) by using the structural equation modeling (SEM) approach to understand the interrelationships among clinical, sociodemographic and psychological characteristics in older people with diabetes.

MATERIALS AND METHODS

This was a cross-sectional study with 452 Chinese older people with diabetes recruited from three primary care clinics. A series of assessments were made, including four instruments: the Chinese version of the Short Form 36 Health Survey, Older American Resources and Services Multidimensional Functional Assessment Questionnaire, Rand Mental Health Inventory and Medical Outcomes Study Social Support Survey; and clinical outcomes (diabetes-related characteristics and physiological data).

RESULTS

In the present study, we identified six patient individual and environmental characteristics, namely, age, sex, physical activity, psychological distress, social support and adequacy of income, that significantly influence HRQOL directly or by way of physical functional status and general health perception.

CONCLUSIONS

Improving social and financial support as well as providing interventions to promote physical activity and to cope with psychological distress in this patient population might be effective to eventually enhance their HRQOL. The present findings add to the literature the underlying complex biological and psychological processes of HRQOL, and take the body of knowledge in HRQOL of older people with diabetes to a theoretical level, and provide insights for development of appropriate strategies to optimize their HRQOL.

Glycaemic control and quality of life among ethnically diverse Malaysian diabetic patients

PURPOSE

To assess the relationship between glycaemic control and quality of life (QoL) among a sample of Malaysians with type 2 diabetes mellitus.

METHODS

This study is a cross-sectional hospital-based study involving 256 patients from three major ethnic groups in Malaysia. Data about QoL were collected with the 18-item Audit of Diabetes Dependent QoL questionnaire. Other data about putative predictors of QoL including personal characteristics and disease-related factors were also collected. Hierarchical multiple linear regression was used to determine factors associated with QoL and to control for confounding variables.

RESULTS

The mean age of participants was 56.79 years. Participants were mostly women, employed and married and had attained secondary education. More than a third of the patients had a disease duration of more than 10 years, and about two-thirds had HbA1c ≥ 6.5 %. Those with desired glycaemic control had poorer QoL than those with less than desired glycaemic control moderated by the use of insulin. Hierarchical multiple linear regression showed that desired glycaemic control (HbA1c), diabetes worry, use of insulin, more than 10 years' duration of diabetes, neuropathy and retinopathy were associated with poor QoL, whereas being satisfied with waiting time for consultation was associated with better QoL.

CONCLUSIONS

The results of this study show that diabetes was associated with negative impact on quality of life. The use of insulin to achieve desired glycaemic control was particularly associated with negative impact on QoL.

The associations of body mass index with physical and mental aspects of health-related quality of life in Chinese patients with type 2 diabetes mellitus: results from a cross-sectional survey

BACKGROUND

This study aimed to determine the associations of various clinical factors with generic health-related quality of life (HRQOL) scores among Hong Kong Chinese patients with type 2 diabetes mellitus (T2DM) in the outpatient primary care setting using the short-form 12 (SF-12).

METHODS

A cross-sectional survey of 488 Chinese adults with T2DM recruited from a primary care outpatient clinic was conducted from May to August 2008. Data on the standard Chinese (HK) SF-12 Health Survey and patients' socio-demographics were collected from face-to-face interviews. Glycaemic control, body mass index (BMI), chronic co-morbidities, diabetic complications and treatment modalities were determined for each patient through medical records. Associations of socio-demographic and clinical factors with physical component summary (PCS-12) and mental component summary scores (MCS-12) were evaluated using multiple linear regression.

RESULTS

The socio-demographic correlates of PCS-12 and MCS-12 were age, gender and BMI. After adjustment for socio-demographic variables, the BMI was negatively associated with PCS-12 but positively associated with MCS-12. The presence of diabetic complications was associated with lower PCS-12 (regression coefficient:-3.0 points, p < 0.05) while being on insulin treatment was associated with lower MCS-12 (regression coefficient:-5.8 points, p < 0.05). In contrast, glycaemic control, duration of T2DM and treatment with oral hypoglycaemic drugs were not significantly associated with PCS-12 or MCS-12.

CONCLUSIONS

Among T2DM subjects in the primary care setting, impairments in the physical aspect of HRQOL were evident in subjects who were obese or had diabetic complications whereas defects in the mental aspect of HRQOL were observed in patients with lower BMI or receiving insulin injections.

Exploring the meaning of hypoglycaemia to community-dwelling Singaporean Chinese adults living with type 2 diabetes mellitus

This study aimed to explore how community-dwelling Singaporean Chinese adults diagnosed with type 2 diabetes mellitus experience hypoglycaemia. A qualitative interpretive research design was employed. Semi-structured interviews were conducted with six participants from a Singaporean diabetes specialist outpatient clinic, transcribed verbatim and analysed using qualitative manual thematic analysis. Eight major themes emerged: experiencing symptoms, knowing hypoglycaemia is manageable, using acute measures, using preventative strategies; applying knowledge, identifying causes of hypoglycaemia, forming relationships and working with health-care professionals. Participants underestimated the impact of hypoglycaemia mainly due to their experiencing mild and infrequent episodes, and knowledge deficits. Health-care professionals' roles were limited to information providers, and they were perceived as detached and impersonal. Theimplications are that health-care professionals need to provide more client-focused education, and improve the quality of their interpersonal relationships to ensure shared decision-making with their clients.

Feasibility, reliability and validity of the Iranian version of the Diabetes Quality of Life Brief Clinical Inventory (IDQOL-BCI)

AIMS

To validate and culturally adapt the Diabetes-specific Quality of Life Brief Clinical Inventory (DQOL-BCI) for the Iranian population.

METHODS

After translation - back translation, content validity was assessed utilizing a panel of six experts. Based on a sample of 180 diabetic patients referred to two Diabetics Clinic Centers from September to May 2011 in Karaj, Iran, construct validity via detecting the factor structure, and convergent and discriminant validity were evaluated by scale-item correlations and known group analyses. Internal consistency and test-retest reliability were assessed in sample of 30 patients by Cronbach's and intraclass correlation coefficient (ICC).

RESULTS

The IDQOL-BCI showed good content validity (CVI values>0.75 and CVR values>0.99), internal consistency (α=0.75) and test-retest reliability (ICC=0.81). A 3-factor solution was found. In addition, high values of item-scale correlations confirmed the convergence validity, and some subscales and total scores differentiate between groups defined by sex, disease duration, income levels, drug using status and physical activity demonstrated the discriminant validity.

CONCLUSIONS

Our findings demonstrate the initial feasibility, reliability and validity of the Iranian version of the IDQOL-BCI as a measure of diabetic-specific QOL measure in Iranian patients.

Hypoglycemia is associated with increased worry and lower quality of life among patients with type 2 diabetes treated with oral antihyperglycemic agents in the Asia-Pacific region

AIMS

We examined the relationship of hypoglycemic symptoms with health-related quality of life and worry about hypoglycemia among type 2 diabetic patients using oral antihyperglycemic agents (AHA) in the Asia-Pacific region.

METHODS

A total of 2257 type 2 diabetic patients with at least 6 months of oral AHA were enrolled in China, Korea, Malaysia, Thailand, and Taiwan. Quality of life was measured with the EuroQol Visual Analog Scale (EQ-VAS) and EuroQol-5 Dimensions questionnaire (EQ-5D), and worry about hypoglycemia with the worry subscale of the Hypoglycemic Fear Survey-II (HFS).

RESULTS

The mean (SD) age was 58.7 (10.2) years and HbA(1c) was 7.5% (1.5). The proportion of patients with an HbA(1c) <6.5% and <7% was 24.9% and 41.8%, respectively. Hypoglycemic symptoms in the prior 6 months were reported by 35.8% of patients. Mean scores on the EQ-VAS and the EQ-5D were significantly lower for patients who had hypoglycemic symptoms compared to those who did not (73.6 vs. 76.9, p<0.001; 0.88 vs. 0.90, p<0.0001, respectively), whereas mean score on the HFS was significantly higher (12.5 vs. 6.3, p<0.001). In multivariate models, hypoglycemic symptoms were independently associated with scores on the EQ-5D, EQ-VAS, and HFS (all p ≤ 0.01-0.001). Symptom severity was positively associated with fear of hypoglycemia (all p ≤ 0.001).

CONCLUSION

Hypoglycemic symptoms were associated with reduced quality of life and increased patient worry in patients with type 2 diabetes treated with AHA.