Quality of Life Assessment in Diabetic Patients Using a Validated Tool in a Patient Population Visiting a Tertiary Care Center in Bhubaneswar, Odisha, India

Assessment of Health-Related Quality of Life and Its Determinants in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

Background Type 2 diabetes mellitus is a complex metabolic disorder associated with several complications that determine the quality of life of the patients. Health-related quality of life (HRQoL) is a measurable outcome of the self-perception of a patient's health which is affected due to age, lifestyle changes, medication, and treatment modalities. This study was undertaken to understand the impact of individual parameters of age, medication type and duration, diabetes-associated complications, and levels of glycated hemoglobin (HbA1c) on the quality of life (QoL) of the patient.  Methodology This single-center prospective, cross-sectional study was conducted at the Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. Participants were recruited from the Outpatient Department of General Medicine, IGIMS. HRQoL was measured using a validated and reliable EuroQol 5-dimensions 5-levels (EQ-5D-5L) questionnaire developed by the EuroQol Research Foundation, along with the EuroQol-Visual Analogue Scale (EQ-VAS). The eligibility criteria included adult diabetic patients above 18 years of age with complete medical records, who had been treated at the outpatient department for a minimum of three months and could be interviewed. Results The results from this study show that 46% of the patients belonged to the age group of 45-65 years. The quality of health index scores and EQ-VAS scores significantly correlated with age (p-values: 1.11 e-4 and 3.09 e-5; <0.05). Of the subjects, 66.4%, 6.7%, and 26.8% were under oral hypoglycaemic agents (OHA), insulin, and both insulin with OHA medications respectively. HbA1C levels were statistically significantly correlated with mobility, self-care, usual activities, pain or discomfort, and anxiety or depression (p-value 0.032; <0.05), along with self-perception of the patient's health (p-value 0.00026; <0.05). Also, the perception of having slight problems in mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was similar irrespective of gender (EQ-5D-5L score for males: 9.47 and females: 9.3). Despite suffering from diabetes-associated chronic complications, 60.5% of the subjects perceived their overall health to be good as indicated by the scores. Conclusion The self-perception of HRQoL concerning mobility, self-care, usual activities, pain or discomfort, and anxiety or depression was correlated with age, duration of anti-diabetic medication, and HbA1C level. Good mobility, self-care, and performing usual activities reduce anxiety or depression as opposed to age, pain, and discomfort. However, the subjects in this study cohort perceived overall good health in themselves in terms of EQ-VAS and 5D-5L scores, indicating effective diabetic care and management options available to them.

Assessment of quality of life and its determinants in type-2 diabetes patients using the WHOQOL-BREF instrument in Bangladesh

BACKGROUND

Diabetes mellitus (DM) is rising at a rapid rate worldwide. As a chronic, incurable metabolic disease, diabetes affects a person's life in all ways. Studies thus far have focused on the impact of diabetes on the physical and mental health of persons affected by the quality of life (QoL). This study aimed to explore the whole range of QoL deficits using the World Health Organization Quality of Life brief version (WHOQOL-BREF) in type-2 diabetic patients.

METHODS

This cross-sectional study was carried out among individuals aged at or above 15 years with type 2 diabetes (T2DM). Patients with prior mental health illness and unwillingness to give consent were excluded. A pretested structured questionnaire including the 26-item WHOQOL-BREF questionnaire was used for face-to-face interviews. Appropriate ethical measures were ensured. All statistical analyses were carried out using the statistical software STATA (Version 16.1). Graphs were created using R (Version 4.0.0).

RESULTS

A total of 500 T2 DM patients with a mean age of 55.8 ± 13.2 years (± SD) and a female proportion of 50.8% were included. Overall, 22.2% of participants rated their QoL as poor, and 25% were dissatisfied with their health (as assessed by questions 1 and 2 of the WHOQOL-BREF questionnaire). More than half (54% and 51.2%, respectively) had an average evaluation of their QoL and health. The QoL scores were below average, with mean scores (± SD) for the physical health, psychological, social relationship, and environmental domains of 37.2 ± 20.5, 44.2 ± 21.0, 39.6 ± 23.2, and 41.6 ± 19.5, respectively. Multiple regression analysis revealed that the patient's level of education and monthly family income were significant positive modifiers and that complications (nephropathy, retinopathy, and peripheral artery disease) were significant negative determinants of the QoL score in different domains.

CONCLUSION

This study found the overall quality of life among T2DM patients below average. Health authorities and clinicians should take these findings into account and incorporate necessary measures to ameliorate negative modifiers of the quality of life of sufferers.

Effect of pandemic on Quality of life in Diabetics (QOLID) assessment: Data from a teaching hospital in Bhubaneswar, Odisha, India

Background:

Quality of life in Diabetics (QOLID) questionnaire is a validated tool to assess the quality of life affected by diagnosed diabetic patients and has 8 sub domains, which are essential factors that have proven effect on the management. In a state of art Diabetic clinic in Bhubaneswar city, the tool was used to add more quality to diabetic management.

Methods:

The ongoing assessment through the months of 2020 (study period being from December 2019 to August 2020), offered an opportunity to assess the effect of the pandemic on QOLID scores and review some nascent or strong factors which may be affecting chronic disease management.

Results:

Complete data could be collected from 599 subjects, 343 from pre pandemic and 256 from pandemic period. The overall scores which were on 100, did not show any significant difference for pre covid and the Covid period, interestingly nearly 1.93 points better in Covid period (69.69±11.10 vs71.62±8.49; p=0.396). Mild difference in overall scores of 4.82 points is seen in females in Covid period; and as seen in age group data maximum gain in sub domains, more for females is seen in the emotional and mental health. Though women reporting to the clinic in both periods are usually in 1:2 ratios, as against men; but QOLID scores in both men and women in Covid period was 71 to 80 points. After the univariate analysis for significant factors, it was that Covid (1.50; 1.08 - 2.07) ; compliance to medications (2.27; 1.48 - 3.50) and reporting of all diabetic complications especially that of eye and depression are coming out to be strong associative factors to affect QOLID scores. Interestingly, rising education has a protective effect on QOLID scores that was significant as higher awareness and better job or earning opportunities may be a contributor for higher QOLID scores for the well educated.

Conclusion:

This brings out a strong emphasis on QOL assessments to be made an inbuilt part of Diabetic management at all centers to maximize treatment outcomes