Health related quality of life in older Mexican Americans with diabetes: a cross-sectional study

Type 2 diabetes and health-related quality of life among older Medicare beneficiaries: The mediating role of sleep

OBJECTIVE

To examine mediating effects of sleep quality and duration on the association between T2D and QoL among Medicare beneficiaries 65+.

METHODS

Data from the Medicare Health Outcome Survey (2015-2020) were used. The outcome was QoL (physical and mental health component-summary scores [PCS and MCS]) measured by the Veterans-Rand-12. The main predictor was diagnosed T2D. Mediators were sleep duration and sleep quality. The effect modifier was race/ethnicity. Structural Equation Modeling was used to estimate moderated-mediating effects of sleep quality and duration across race/ethnicity.

RESULTS

Of the 746,400 Medicare beneficiaries, 26.7% had T2D, and mean age was 76 years (SD ± 6.9). Mean PCS score was 40 (SD ± 12.2), and mean MCS score was 54.0 (SD ± 10.2). Associations of T2D with PCS and MCS were negative and significant. For all racial/ethnic groups, those with T2D reported lower PCS. For White, Black, Asian, and Hispanic beneficiaries only, those with T2D reported lower MCS. The negative impact of T2D on PCS and MCS was mediated through sleep quality, especially very bad sleep quality.

CONCLUSION

Improving sleep may lead to improvement in QoL in elderly adults with T2D.

GC-MS- and NMR-Based Metabolomics and Molecular Docking Reveal the Potential Alpha-Glucosidase Inhibitors from Psychotria malayana Jack Leaves

Psychotria malayana Jack leaf, known in Indonesia as “daun salung”, is traditionally used for the treatment of diabetes and other diseases. Despite its potential, the phytochemical study related to its anti-diabetic activity is still lacking. Thus, this study aimed to identify putative inhibitors of α-glucosidase, a prominent enzyme contributing to diabetes type 2 in P. malayana leaf extract using gas chromatography-mass spectrometry (GC-MS)- and nuclear magnetic resonance (NMR)-based metabolomics, and to investigate the molecular interaction between those inhibitors and the enzyme through in silico approach. Twenty samples were extracted with different solvent ratios of methanol–water (0, 25, 50, 75, and 100% v/v). All extracts were tested on the alpha-glucosidase inhibition (AGI) assay and analyzed using GC-MS and NMR. Multivariate data analysis through a partial least square (PLS) and orthogonal partial square (OPLS) models were developed in order to correlate the metabolite profile and the bioactivity leading to the annotation of the putative bioactive compounds in the plant extracts. A total of ten putative bioactive compounds were identified and some of them reported in this plant for the first time, namely 1,3,5-benzenetriol (1); palmitic acid (2); cholesta-7,9(11)-diene-3-ol (3); 1-monopalmitin (4); β-tocopherol (5); α-tocopherol (6); 24-epicampesterol (7); stigmast-5-ene (8); 4-hydroxyphenylpyruvic acid (10); and glutamine (11). For the evaluation of the potential binding modes between the inhibitors and protein, the in silico study via molecular docking was performed where the crystal structure of Saccharomyces cerevisiae isomaltase (PDB code: 3A4A) was used. Ten amino acid residues, namely ASP352, HIE351, GLN182, ARG442, ASH215, SER311, ARG213, GLH277, GLN279, and PRO312 established hydrogen bond in the docked complex, as well as hydrophobic interaction of other amino acid residues with the putative compounds. The α-glucosidase inhibitors showed moderate to high binding affinities (−5.5 to −9.4 kcal/mol) towards the active site of the enzymatic protein, where compounds 3, 5, and 8 showed higher binding affinity compared to both quercetin and control ligand.

Systematic Review and Meta-Analysis on Quality of Life in Diabetic Patients in Iran

Background:

Diabetes is the fifth leading cause of death in the world, which reduces the patients' quality of life (QOL) and is considered as an important subject especially in medicine and medical community. The present study aimed at investigating the QOL of diabetic patients in Iran through meta-analysis.

Methods:

The search was conducted using relevant keywords in national and international databases including Iranmedex, SID, Magiran, IranDoc, Medlib, Science Direct, PubMed, Scopus, Cochrane, Embase, Web of Science. Questionnaires WHOQOL, SF-36, SF-20, DQOL, QOL, PedsQL, ADDQOL, D-39, DQOL-BCI, SWED-QUAL, IRDQOL, PHG-2, EQ-5D, and IDQOL-BCI were used to assess the QOL. Heterogeneity of studies was assessed using I² index. Data were analyzed using STATA version 11.

Results:

In 96 studies of 17,994 people, the mean score of QOL in diabetic patients was based on the questionnaires WHOQOL [66.55 (95% CI: 45.83, 87.26)], D-39 [129.43 (95%CI: 88.77, 170.10)], SF-36 [65.64 (95% CI: 59.82, 71.46)], SF-20 [46.50 (95% CI: 37.19, 55.81], DQOL [61.19 (95% CI: 35.73, 86.66)], QOL [117.91 (95% CI: -62.97, 298.79)], PedsQL [34.36 (95% CI: -31.49, 100.22)], ADDQOL [41.76 (95% CI: 12.01-71.50)], SWED-QUAL [59.19 (95% CI: 21.15, 97.23)], IRDQOL [105.92 (95% CI: 102.73, 109.10)], PHG-2 [61.00 (95%CI: 59.63, 62.37)], EQ-5D [0.62 (95% CI: 0.61, 0.64)], DQOL-BCI [3.40 (95% CI: 3.31, 3.49)], and IDQOL-BCI [22.63 (95% CI: -2.38, 47.64)].

Conclusions:

The QOL of diabetic patients was evaluated according to different types of questionnaires and the QOL of diabetic patients was found to be lower than normal population.

Characterization of α-Glucosidase Inhibitors from Psychotria malayana Jack Leaves Extract Using LC-MS-Based Multivariate Data Analysis and In-Silico Molecular Docking

Psychotria malayana Jack has traditionally been used to treat diabetes. Despite its potential, the scientific proof in relation to this plant is still lacking. Thus, the present study aimed to investigate the α-glucosidase inhibitors in P.malayana leaf extracts using a metabolomics approach and to elucidate the ligand–protein interactions through in silico techniques. The plant leaves were extracted with methanol and water at five various ratios (100, 75, 50, 25 and 0% v/v; water–methanol). Each extract was tested for α-glucosidase inhibition, followed by analysis using liquid chromatography tandem to mass spectrometry. The data were further subjected to multivariate data analysis by means of an orthogonal partial least square in order to correlate the chemical profile and the bioactivity. The loading plots revealed that the m/z signals correspond to the activity of α-glucosidase inhibitors, which led to the identification of three putative bioactive compounds, namely 5′-hydroxymethyl-1′-(1, 2, 3, 9-tetrahydro-pyrrolo (2, 1-b) quinazolin-1-yl)-heptan-1′-one (1), α-terpinyl-β-glucoside (2), and machaeridiol-A (3). Molecular docking of the identified inhibitors was performed using Auto Dock Vina software against the crystal structure of Saccharomyces cerevisiae isomaltase (Protein Data Bank code: 3A4A). Four hydrogen bonds were detected in the docked complex, involving several residues, namely ASP352, ARG213, ARG442, GLU277, GLN279, HIE280, and GLU411. Compound 1, 2, and 3 showed binding affinity values of −8.3, −7.6, and −10.0 kcal/mol, respectively, which indicate the good binding ability of the compounds towards the enzyme when compared to that of quercetin, a known α-glucosidase inhibitor. The three identified compounds that showed potential binding affinity towards the enzymatic protein in molecular docking interactions could be the bioactive compounds associated with the traditional use of this plant.

IMPACT OF DIABETIC NEUROPATHY ON QUALITY OF LIFE AND POSTURAL BALANCE IN BRAZILIAN OLDER ADULTS

OBJECTIVE

To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults.

METHODS

A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance).

RESULTS

PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004).

CONCLUSION

This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.

Cognitive predictors of physical activity behaviors among rural patients with type 2 diabetes: applicability of the Extended Theory of Reasoned Action (ETRA)

Background: This study aims to examine the cognitive-behavioral determinants of physical activity behaviors (PABs) of patients diagnosed with type 2 diabetes. Subjects and methods: In this cross-sectional study, census sampling was employed to enroll 120 rural patients with type 2 diabetes in the Chalderan County in 2015. To collect data, a valid and reliable instrument, based on the Extended Theory of Reasoned Action (ETRA) constructs, was used. Data were analyzed by SPSS 21 software using descriptive and inferential statistical methods. Results: Using the one-way ANOVA test, it was found that PABs had statistically significant correlation with all ETRA constructs except subjective norms (P=0.574). Knowledge (P=0.015), self-efficacy (P<0.001) and behavioral intention (P<0.001) had a significant association with PABs, respectively. Also, ETRA structures were able to reflect 41.0% of the behavioral changes. Among structures, knowledge (P=0.014), self-efficacy (P<0.001), and behavioral intention (P=0.020) were significant predictors of PABs (R2=0.414). Conclusions: Health care providers may consider the ETRA an appropriate framework to design educational interventions aimed at improving PABs among rural patients with type 2 diabetes.

Health-related quality of life of patients with diagnosed type 2 diabetes in Felege Hiwot Referral Hospital, North West Ethiopia: a cross-sectional study

OBJECTIVE

Diabetes mellitus is a chronic non-communicable disease with considerable impact on health status and quality of life. It has a profound effect on quality of life in terms of social and psychological as well as physical well-being. This study was conducted to assess health related quality of life among patients with diagnosed type 2 diabetes.

RESULT

A cross-sectional study design was conducted from April to May, 2015. World Health Organization quality of life-BREF tool was used for collecting the data. A total of 344 patients with diagnosed type 2 diabetes were involved in the study. The overall health related quality of life mean score of the study participants was 52.6 ± 12.1 SD. Social domain has higher mean score (57.8 ± 14.8 SD). Educational status, marital status, occupation, duration of the diabetes and diabetes related complications had statistically significant association with health-related quality of life. An intervention that give special attention to the breaking of the cycle of low occupational status and literacy; and which encourage patients with type 2 DM to have good control of their diabetes and prevent complication should be implemented to improve their quality of life.

Frailty and sarcopenia - newly emerging and high impact complications of diabetes

Diabetes increases the risk of physical dysfunction and disability. Diabetes-related complications and coexisting morbidities partially explain the deterioration in physical function. The decline in muscle mass, strength and function associated with diabetes leads to sarcopenia, frailty and eventually disability. Frailty acts as a mediator in the pathogenesis of disability in older people with diabetes and its measurement in routine daily practice is recommended. Frailty is a dynamic process which progresses from a robust condition to a pre-frail stage then frailty and eventually disability. Therefore, a multimodal intervention which includes adequate nutrition, exercise training, good glycaemic control and the use of appropriate hypoglycemic medications may help delay or prevent the progression to disability.

The effect of free diabetes care on metabolic control and on health-related quality of life among youths with type 1 diabetes in Cameroon

OBJECTIVE

To assess the effect of free diabetes care on metabolic control and on health-related quality of life (HRQoL) of youths living with type 1 diabetes in Cameroon.

RESEARCH DESIGN AND METHODS

We conducted a clinical audit of a multicenter prospective cohort, performed in three of the nine clinics of the 'Changing Diabetes in Children' (CDiC) project in Cameroon. We collected data on demography, glycemic control, diabetes acute complications, and patients' HRQoL at baseline and after 1 year of follow-up.

RESULTS

One hundred and four patients (51 female) were included. The mean age was 16±2 years (min-max: 9-18), the mean duration of diabetes was 5±3 years, and the mean HbA1C level was 11.4%±2.7%. A significant reduction in HbA1c (11.4%±2.7% vs 8.7±2.4%), episodes of severe hypoglycemia (27/104 vs 15/104), and episodes of ketoacidosis (31/104 vs 7/104) were observed after 1 year (p<0.05). We did not observe any significant difference in the total HRQoL score (p=0.66). However, we observed a significant decrease in diabetes-associated symptoms (p<0.05). Age, level of education, duration of diabetes, glycemic control, and the presence or absence of diabetes complications did not significantly affect the total HRQoL score.

CONCLUSIONS

One year after free diabetes care offered through the CDiC project, a significant improvement was observed in glycemic control and acute complications of diabetes, but not in the total score of HRQoL of youths living with type 1 diabetes enrolled in the project.

The Psychosocial Challenges and Care of Older Adults with Diabetes: "Can't Do What I Used To Do; Can't Be Who I Once Was"

The prevalence of diabetes is increasing in older populations worldwide. Older adults with diabetes have unique psychosocial and medical challenges that impact self-care and glycemic control. These challenges may include psychological factors such as depression or anxiety, social factors such loss of independence and removal from home environment/placement in a facility, and medical factors such as multiple comorbidities and polypharmacy. Importantly, these challenges interact and complicate the everyday life of the older adult with diabetes. Thus, timely identification and interventions for psychosocial and medical challenges are a necessary component of diabetes care. This review summarizes the current literature, research findings, and clinical recommendations for psychosocial care in older adults with diabetes.

A Family-Based, Culturally Tailored Diabetes Intervention for Hispanics and Their Family Members

PURPOSE

The purpose of this study was to test efficacy of a family-based, culturally tailored intervention for Hispanics with type 2 diabetes and their family members.

METHODS

Hispanic patients with type 2 diabetes and their family members recruited from community clinics and ethnic churches were assigned to groups (N = 186). The intervention group received an 8-week culturally tailored diabetes educational program delivered in Spanish while the attention control group received 8 weekly sessions on general health information and 2 sessions on diabetes after completion of the study. Data were collected at baseline, after intervention, and at 1- and 6-month follow-ups for both patients and families. Comparisons of change over time were performed using growth curve analyses after propensity score adjustment.

RESULTS

Intervention patients improved in diabetes knowledge and diabetes self-efficacy over time (but did not sustain at 6-month follow-up). A1C was lower at 1-month follow-up. Family members had improvements in diabetes knowledge and physical health-related quality of life.

CONCLUSIONS

Including families in the interventions may improve glycemic control, diabetes knowledge, self-efficacy, and physical health-related quality of life. However, strategies for sustaining improvements are needed.

Impact of Acceptance and Commitment Therapy on Perceived Stress and Special Health Self-Efficacy in Seven to Fifteen-Year-Old Children With Diabetes Mellitus

Background:

Diabetes Mellitus (DM) imposes restrictions on physical, emotional and social functioning of children and adolescents.

Objectives:

The aim of this study was to determine the impact of acceptance and commitment therapy (ACT) on perceived stress and special health self-efficacy in seven to fifteen-year-old children with DM.

Patients and Methods:

The present study was a clinical trial with a pretest-posttest control group design. The study population included all seven to fifteen-year-old patients who had referred to the Diabetes Mellitus Association of Tabriz, Iran, of whom 40 participants were selected using convenient sampling. They were randomly allocated to two matched groups (experimental and control). The experimental group participated in therapy sessions, while the control group did not receive any interventions. The research instruments were perceived stress and special health self-efficacy scales.

Results:

The multiple analysis of covariance (MANCOVA) results showed that the treatment was effective on variables of perceived stress and special health self-efficacy (P < 0.001).

Conclusions:

The ACT is effective for reducing perceived stress and increasing special health self-efficacy in children with DM.

Association Between Lower Extremity Performance and Health-Related Quality of Life in Elderly Mexican Americans

OBJECTIVE

To examine the longitudinal association between levels of lower extremity performance (LEP) and health-related quality of life (HRQoL) in older Mexican Americans aged 72 years or older participating in the Hispanic Established Population for the Epidemiological Study of the Elderly (2000-2006).

METHOD

LEP was measured in 621 non-institutionalized participants with the Short Physical Performance Battery (SPPB). Participants were divided into high (SPPB score 10-12), intermediate (SPPB score 7-9), and low (SPPB score 0-6) groups based on LEP. HRQoL was assessed using the Medical Outcomes Study Short Form (SF-36), which includes a Physical Composite Scale (PCS) and a Mental Composite Scale (MCS).

RESULTS

Participants in the high LEP group had slower rates of decline in the PCS, and those in the intermediate LEP group had slower rates of decline in the MCS score over time.

DISCUSSION

Increased LEP was associated with slower rates of decline in physical and mental HRQoL in older Mexican Americans.

An automated telephone nutrition support system for Spanish-speaking patients with diabetes

In the United States, Spanish-speaking patients with diabetes often receive inadequate dietary counseling. Providing language and culture-concordant dietary counseling on an ongoing basis is critical to diabetes self-care. To determine if automated telephone nutrition support (ATNS) counseling could help patients improve glycemic control by duplicating a successful pilot in Mexico in a Spanish-speaking population in Oakland, California. A prospective randomized open-label trial with blinded endpoint assessment (PROBE) was performed. The participants were seventy-five adult patients with diabetes receiving care at a federally qualified health center in Oakland, California. ATNS, a computerized system that dialed patients on their phones, prompted them in Spanish to enter (via keypad) portions consumed in the prior 24 hours of various cultural-specific dietary items, and then provided dietary feedback based on proportion of high versus low glycemic index foods consumed. The control group received the same ATNS phone calls 14 weeks after enrollment. The primary outcome was hemoglobin A1c % (A1c) 12 weeks following enrollment. Participants had no significant improvement in A1c (-0.3% in the control arm, -0.1% in the intervention arm, P = .41 for any difference) or any secondary parameters. In our study, an ATNS system did not improve diabetes control in a Spanish-speaking population in Oakland.

Health-related quality of life (HRQOL) decreases independently of chronic conditions and geriatric syndromes in older adults with diabetes: the Fujiwara-kyo Study

Background

Very few studies have investigated the association between diabetes and impaired health-related quality of life (HRQOL) in older adults, independent of chronic conditions and geriatric syndromes.

Methods

We conducted a self-administered questionnaire survey and structured interviews with 3946 people aged 65 years or older to obtain medical histories of diabetes, chronic conditions, and geriatric syndromes. Blood tests were performed to measure glycated hemoglobin (HbA1c) and plasma glucose levels. HRQOL was evaluated using the Medical Outcomes Study 36-Item Short-Form General Health Survey (SF-36), and multiple logistic regression analysis was used to calculate adjusted odds ratios and 95% CIs for low HRQOL.

Results

A total of 3521 participants had not received a physician diagnosis of diabetes. Of these, 2345 participants with an HbA1c less than 5.7% were defined as the referent group. As compared with the referent group, 1029 participants with an HbA1c of at least 5.7% but less than 6.5% showed no significant decrease in QOL on the SF-36 physical, mental, and role component summaries, after adjustment for chronic conditions, geriatric syndromes, and other potential confounders. However, 572 patients who had received a physician diagnosis of diabetes and/or had an HbA1c of 6.5% or higher had a significantly higher adjusted odds ratio (1.48; 95% CI, 1.18–1.84) for the low physical component summary. No significant differences in relation to glycemic control, treatment regimen, or diabetes duration were found in any of the 3 component summaries among the 425 participants who were undergoing diabetes treatment.

Conclusions

Older Japanese adults with diabetes had decreased physical QOL, independent of chronic conditions and geriatric syndromes.

Health-related quality of life (hr-qol) in patients with type 2 diabetes mellitus

BACKGROUND

Quality of life is an important aspect in diabetes because poor quality of life leads to diminished self-care, which in turn leads to worsened glycemic control, increased risks for complications, and exacerbation of diabetes overwhelming in both the short run and the long run.

AIMS

The aim of our study is to examine the health-related quality of life of diabetic patients in rural India.

MATERIALS AND METHODS

This case-control study was done among type 2 diabetes mellitus patients attending Medicine Outpatient department of a 780-bedded rural medical college located in central India. We used the World Health Organization Quality of Life Questionnaire - short version (WHOQOL-BREF) to assess quality of life.

RESULTS

The HRQOL among diabetics and non-diabetic controls is comparable to each other with bad physical health, bad psychological health, deteriorating social relationships, and bad environmental conditions affecting the HRQOL of both the groups equally. The overall HRQOL of the total study population (cases and controls) was poor.

CONCLUSION

The finding of this study will help in health promotion in rural medical practice in India. It would beckon the much awaited avenue of holistic care of a diabetic patient with equal importance to the mental wellbeing and quality of life, as compared to physical well being.

A family-based diabetes intervention for Hispanic adults and their family members

AIMS

The purpose of this quasi-experimental, 1-group longitudinal study is to examine the effects of a family-based intervention program on diabetes self-management behaviors, A1C, other biomarkers, psychosocial factors, and health-related quality of life in Hispanics with diabetes.

METHODS

Adult patients with diabetes (n = 36) and family members (n = 37) were recruited from a community clinic in rural central North Carolina. Patients and family members attended an 8-week culturally tailored diabetes educational program taught in Spanish. Data were collected pre- and post-intervention for both patients and family members, with an additional data collection for patients 1 month post-intervention.

RESULTS

Most patients and family members were female, and almost all were immigrants. A1C decreased by 4.9% on average among patients from pre-intervention to 1 month post-intervention. Patients showed significant improvements in systolic blood pressure, diabetes self-efficacy, diabetes knowledge, and physical and mental components of health-related quality of life. Higher levels of intake of healthy foods and performance of blood glucose tests and foot inspections were reported. Family members significantly lowered body mass index and improved diabetes knowledge from pre-intervention to immediately post-intervention. No significant changes in levels of physical activity were found among patients with diabetes or family members.

CONCLUSIONS

Findings suggest that including family members in educational interventions may provide emotional and psychological support to patients with diabetes, help to develop healthy family behaviors, and promote diabetes self-management.

Correlates of health-related quality of life in French people with type 2 diabetes

AIM

Diabetes is known to impair health-related quality of life (HrQol). Our aim was to analyse a comprehensive set of potential determinants of HrQol in a large sample of patients with diabetes.

METHODS

This study is based on the ENTRED 2007 study, a representative sample of adults (18 years and older) with diabetes. Data were extracted from postal self-reported questionnaires (from patients and medical practitioners) and from reimbursements from the National health insurance data system. HrQol was assessed with the MOS SF-12 for mental (MCS) and physical (PCS) component summaries. Multivariate linear regression models were used to analyse the variables associated with HrQol.

RESULTS

SF-12 MCS and PCS were available in 2832 patients with T2DM, with a mean age 64 years (1715 males, 56%). Lower income, severe hypoglycaemic episodes, hospitalisation ≥24 h, instrumental daily living (IADL) restriction, low satisfaction for social support and an HbA1c within the 8.1-10.0% range were associated with lower MCS rating, whereas an older age and male gender were associated with higher MCS. Older age, female sex, higher BMI, lower income, insulin treatment, macrovascular complications, severe hypoglycaemic episodes, hospitalisation ≥24 h, and IADL restriction were associated with lower PCS values whereas having no need for social support was associated with higher PCS values.

DISCUSSION

HrQol associated factors are multiple but mainly linked with socio-demographic factors, diabetes complications and satisfaction for social support. A patient centred approach should be tested to prevent impairment of HrQol and thus to decrease the burden of diabetes. Assessment of social support should be included.

Quality of life in relation to social and disease factors in patients with type 2 diabetes in Lithuania

Background

Diabetic patients are more than twice as costly to manage as non-diabetic patients, due mainly to the high costs associated with management of diabetic complications. As in most nations of the world, the number of patients with DM is increasing every year in Lithuania. The aim of this study was to determine relation between quality of the life and disease and social factors of patients with type 2 diabetes in Lithuania.

Material/Methods

Independently prepared questions about the subjects of the survey were: gender; age; weight; education; social and marital status; duration of the disease (in years); treatment method; complications; morbidity with arterial hypertension; change in dietary habits after diagnosis of diabetes (started to eat accordingly to recommendations of the therapist); how often nourishment is taken accordingly to recommendations of the therapist; if beginning to exercise after diagnosis of the diabetes; and if exercising, exercises at least 2–3 times per week. Body mass index was calculated as the relation between body mass in kg and height m square (BMI=kg/m²). The hospital anxiety and depression (HAD) scale was used for the evaluation of depression and anxiety. Quality of life of patients was evaluated with the SF-36 questionnaire. We surveyed 1022 patients with type 2 diabetes (372 men and 650 women). Association between quality of the life and explanatory parameters (disease and social factors) were analyzed using the logistic regression analysis model.

Results

We found that women had lower scores than men in all fields of quality of life (p<0.001). Peroral treatment had a positive impact on the quality of life (QL) fields of the role limitations due to emotional problems (OR_a 0.16. 95% CI 0.07–0.34; p<0.001). Treatment with insulin had a positive effect on restriction of activity because of emotional problems (OR_a − 0.23. 95% CI 0.11–0.49; p<0.001) and mental health (OR_a − 0.38. 95% CI 0.19–0.78; p=0.008), but had a negative impact on bodily pain (OR_a − 3.95. 95% CI 1.41–11.09; p=0.009) and physical health (OR_a − 4.14. 95% CI 2.03–8.47; p<0.001).

Conclusions

Age and BMI are less important factors that can influence quality of life. Peroral treatment positively acted on the role limitations due to emotional problems, bodily pain, and mental health, but had a strong negative effect on emotional state.

Aging, diabetes, and the public health system in the United States

Diabetes (diagnosed or undiagnosed) affects 10.9 million US adults aged 65 years and older. Almost 8 in 10 have some form of dysglycemia, according to tests for fasting glucose or hemoglobin A1c. Among this age group, diagnosed diabetes is projected to reach 26.7 million by 2050, or 55% of all diabetes cases. In 2007, older adults accounted for $64.8 billion (56%) of direct diabetes medical costs, $41.1 billion for institutional care alone. Complications, comorbid conditions, and geriatric syndromes affect diabetes care, and medical guidelines for treating older adults with diabetes are limited. Broad public health programs help, but effective, targeted interventions and expanded surveillance and research and better policies are needed to address the rapidly growing diabetes burden among older adults.

Disability in older people with diabetes: issues for the clinician

Diabetes may become a disabling disease due to diverse mechanisms. Many patients have evidence of physical or cognitive impairments that can markedly influence their ability to diabetes self manage and adversely affect possible outcomes of diabetes care. A screening process for impairment is therefore needed and in frail patients a comprehensive gerontological assessment should be used to improve the efficiency of care. A diabetes educational programme adapted to this population, which has involved the main care-giver has shown its efficacy to improve risk factor control and quality of life in a safer way. The experience of case-managers according to a model of heart failure may be promising for the future.

Experience of mexican-american elders with diabetes: a phenomenological study

ABSTRACT  The purpose of this study was to gain insight about the lived experience of Mexican-American elders and the psychosocial issues that can impede or facilitate making the necessary lifestyle changes to adhere to a diabetes self-care regimen. As a phenomenological study, focus group discussions of male and female Mexican-Americans, ages 60-85, were conducted to capture their perspectives. Four themes emerged from the discussions which included (1) our social discomfort gets in the way of taking care of ourselves, (2) commonalities that bond us support us, (3) we do not have clear goals, and (4) we have lost control of our lives. Discussion how the experience of adapting to the demands of diabetes is ever changing and Mexican-American elders with diabetes may benefit at any stage of the adaptation process from supportive relationships that target psychosocial adjustment. Implications for occupational therapy practice, education, and research are discussed.

Correlates of the incidence of disability and mortality among older adult Brazilians with and without diabetes mellitus and stroke

Background

The combined effect of diabetes and stroke on disability and mortality remains largely unexplored in Brazil and Latin America. Previous studies have been based primarily on data from developed countries. This study addresses the empirical gap by evaluating the combined impact of diabetes and stroke on disability and mortality in Brazil.

Methods

The sample was drawn from two waves of the Survey on Health and Well-being of the Elderly, which followed 2,143 older adults in São Paulo, Brazil, from 2000 to 2006. Disability was assessed via measures of activities of daily living (ADL) limitations, severe ADL limitations, and receiving assistance to perform these activities. Logistic and multinomial regression models controlling for sociodemographic and health conditions were used to address the influence of diabetes and stroke on disability and mortality.

Results

By itself, the presence of diabetes did not increase the risk of disability or the need for assistance; however, diabetes was related to increased risks when assessed in combination with stroke. After controlling for demographic, social and health conditions, individuals who had experienced stroke but not diabetes were 3.4 times more likely to have ADL limitations than those with neither condition (95% CI 2.26-5.04). This elevated risk more than doubled for those suffering from a combination of diabetes and stroke (OR 7.34, 95% CI 3.73-14.46). Similar effects from the combination of diabetes and stroke were observed for severe ADL limitations (OR 19.75, 95% CI 9.81- 39.76) and receiving ADL assistance (OR 16.57, 95% CI 8.39-32.73). Over time, older adults who had experienced a stroke were at higher risk of remaining disabled (RRR 4.28, 95% CI 1.53,11.95) and of mortality (RRR 3.42, 95% CI 1.65,7.09). However, risks were even higher for those who had experienced both diabetes and stroke. Diabetes was associated with higher mortality.

Conclusions

Findings indicate that a combined history of stroke and diabetes has a great impact on disability prevalence and mortality among older adults in São Paulo, Brazil.

Correlates of quality of life in older adults with diabetes: the diabetes & aging study

OBJECTIVE

To evaluate associations between health-related quality of life (HRQL) and geriatric syndromes, diabetes complications, and hypoglycemia in older adults with diabetes.

RESEARCH DESIGN AND METHODS

A race-stratified random sample of 6,317 adults with type 2 or type 1 diabetes, aged 60 to 75 years, enrolled in Kaiser Permanente Northern California, who completed a survey that included a HRQL instrument based on the Short Form 8-item health survey. Administrative records were used to ascertain diagnoses of geriatric syndromes, diabetes complications, and hypoglycemia. Associations were estimated between HRQL and exposures in exposure-specific and combined exposure models (any syndrome, any complication, or hypoglycemia). Conservatively, differences of ≥3 points were considered the minimally important difference in HRQL scores.

RESULTS

HRQL was lower with nearly all exposures of interest. The lowest physical HRQL was associated with amputation. In combined exposure models, geriatric syndromes (-5.3 [95% CI -5.8 to -4.8], P < 0.001) and diabetes complications (-3.5 [-4.0 to -2.9], P < 0.001) were associated with lower physical HRQL. The lowest mental HRQL was associated with depression, underweight (BMI <18 kg/m(2)), amputation, and hypoglycemia. In combined exposure models, only hypoglycemia was associated with lower mental HRQL (-4.0 [-7.0 to -1.1], P = 0.008).

CONCLUSIONS

Geriatric syndromes and hypoglycemia are associated with lower HRQL to a comparable degree as diabetes complications. Addressing geriatric syndromes and avoiding hypoglycemia should be given as high a priority as preventing diabetes complications in older adults with diabetes.

Physical activity, obesity, nutritional health and quality of life in low-income Hispanic adults with diabetes

The study examined relationships among age, body mass index (BMI), physical activity, nutritional health, quality of life, and health-related quality of life in Hispanic adults with diabetes (N = 59) using the PRECEDE-PROCEED planning model as a framework. Data were collected through face-to-face interviews at clinics and communities. A regression model with predisposing factors (age, BMI), and behavior (nutritional health and physical activity) significantly predicted quality of life (R(2) = 0.21, F = 3.63, p < .05) explaining 21% of variance. Physical activity and nutrition were the strongest predictors. Culturally competent intervention strategies must include factors that improve and enhance quality of life.

Measuring quality of life in low-income, Spanish-speaking Puerto Ricans with type 2 diabetes residing in the mainland U.S

PURPOSE

This study assessed the psychometric properties of the Audit of Diabetes-Dependent Quality of Life (ADDQoL) modified for low-income, low-education, Spanish-speaking Puerto Ricans with type 2 diabetes residing in the northeastern United States.

METHODS

Cross-sectional data from 226 patients were analyzed. Scale modifications included simplification of instructions, question wording and response format, and oral administration. Reliability was assessed with Cronbach's alpha coefficient and internal structure by exploratory factor analysis. Criterion validity was assessed using correlation analysis and linear and logistic regression models assessing the association of the ADDQoL with standardized physical health status, mental health status, depression, and comorbidity indices.

RESULTS

Two ADDQoL items were dropped. The modified scale had excellent internal consistency and supported the original scale factor structure. Criterion validity results supported the validity of this measure.

CONCLUSIONS

The modified ADDQoL showed psychometric properties that support its use in low-income, Spanish-speaking Puerto Ricans with type 2 diabetes who reside in mainland U.S.

Evidence of reduced health-related quality of life in older Mexican Americans with arthritis

OBJECTIVE

To examine the association between self-reported physician-diagnosed arthritis and health-related quality of life among older Mexican Americans.

DESIGN

Cross-sectional study involving population-based survey.

SETTING

Hispanic Established Population for the Epidemiologic Study of the Elderly (EPESE) survey conducted in Texas, Arizona, New Mexico, Colorado, and California.

PARTICIPANTS

839 non-institutionalized Mexican American older adults (> or = 75 years) participating in Hispanic EPESE.

MAIN OUTCOME MEASURES

Self-reported physician-diagnosed arthritis; sociodemographic variables; medical conditions; body mass index; and the physical and mental composite scales from the Medical Outcomes Study Short Form 36 Health Survey (SF-36).

RESULTS

518 (62%) of the subjects reported physician-diagnosed arthritis. Participants with arthritis had significantly lower scores on the physical composite scale (PCS) (mean = 35.3, SD = 11.3) and the mental composite scale (MCS) (mean = 53.5, SD = 10.8) of the SF-36 compared to persons without arthritis (PCS mean = 42.9, SD = 10.9; MCS mean = 57.0, SD = 8.8). Multiple regression showed that arthritis was associated with decreased PCS and MCS (model estimates of -5.74 [SE = .83]; and -3.16 [SE = .64]), respectively, after controlling for sociodemographic and clinical covariates.

CONCLUSIONS

Arthritis is a highly prevalent medical condition in Mexican American older adults. Our findings suggest that deficits in both physical health and mental function contribute to reduced quality-of-life in this population.

Measuring the impact of diabetes on life expectancy and disability-free life expectancy among older adults in Mexico

OBJECTIVES. The aim of the present study is to investigate differences in total life expectancy (TLE), disability-free life expectancy (DFLE), disabled life expectancy (DLE), and personal care assistance between individuals with and without diabetes in Mexico.

METHODS

The sample was drawn from the nationally representative Mexican Health and Aging Study. Disability was assessed through a basic Activities of Daily Living (ADL) measure, the Instrumental Activities of Daily Living (IADL) scale, and the Nagi physical performance measure. The Interpolation of Markov Chains method was used to estimate the impact of diabetes on TLE and DFLE.

RESULTS

Results indicate that diabetes reduces TLE at ages 50 and 80 by about 10 and 4 years, respectively. Diabetes is also associated with fewer years in good health. DFLE (based on ADL measures) at age 50 is 20.8 years (95% confidence interval [CI]: 19.2-22.3) for those with diabetes, compared with 29.9 years (95% CI: 28.8-30.9) for those without diabetes. Regardless of diabetes status, Mexican women live longer but face a higher disability burden than men.

CONCLUSION

Among older adults in Mexico, diabetes is associated with shorter TLE and DFLE. The negative effect of diabetes on the number of years lived, particularly in good health, creates significant economic, social, and individual costs for elderly Mexicans.