Qualidade de vida de pacientes com diabetes utilizando o instrumento Diabetes 39 (D-39)

Translation and Cross-Cultural Adaptation of the Questionnaire on Stress in Diabetic Patients (QSD-R) to Brazilian Portuguese

BACKGROUND

Diabetes mellitus is a chronic disease that can cause psychological stress. This study was conducted to perform the translation and cross-cultural adaptation of the QSD-R for diabetic patients into Portuguese (Brazil).

METHODS

This study was a cross-cultural adaptation process carried out in a public university in São Paulo, Brazil, in three stages: translation and backtranslation by two native-speaking independent professionals, analysis by a committee of specialists, and a pre-test phase.

RESULTS

The final version was created by seven experts after making semantic, idiomatic, and cultural changes to eighteen items. The results indicated a satisfactory content validation index (CVI ≥ 0.80). This version was applied to 30 patients. No item was excluded from the instrument.

CONCLUSION

The translated version of the QSD-R was considered adequate and culturally adapted for use in Brazil to enable the psychometric validation of the instrument.

Assessing health-related quality of life and clinical outcomes of patients with diabetes accessing healthcare in two public hospitals in south-eastern Ghana: a cross-sectional descriptive study

BACKGROUND

Diabetes is a significant contributor to kidney failure, heart attack, strokes, lower limb amputation, blindness, and other complications that negatively impact health-related quality of life (HRQOL). This study assessed the HRQOL and clinical outcomes of patients with diabetes accessing healthcare in south-eastern Ghana.

METHODS

This was a hospital-based cross-sectional descriptive study conducted in the Ho Municipal and Ho Teaching Hospitals in Ghana among patients with type 2 diabetes who were seeking healthcare at both hospitals for at least 12 months. Systematic random sampling technique was used to select 310 respondents out of the total sample size of 326 patients with type 2 diabetes and data were collected using diabetes-39 questionnaire. The data were analysed using STATA 16.0. Socio-demographic and clinical variables were expressed as frequencies and percentages. Differences between proportions were tested using Chi-square to identify predictors of poor HRQOL and Pearson correlation for association. The p < 0.05 was considered significant.

RESULTS

Out of 310 respondents, 171 (55.0%) had poor HRQOL. The predictors of poor HRQOL were age (p < 0.008), education (p < 0.028), employment (p < 0.001), residence (p < 0.01), duration of diabetes (p < 0.002), diabetes education (p < 0.001), BMI (p < 0.005), and glycaemic control (p < 0.001). Energy and mobility (63.2%), anxiety and worry (53.9%), and diabetes control (49.6%) dimensions were the most prevalent of poor HRQOL. Diabetes education, complications, being diabetic for 16 years and above, earning income, resident in rural area, being married, being pensioner and national Service Personnel, and diabetes comorbidities were significantly associated with HRQOL.

CONCLUSIONS

More than half of the respondents had poor HRQOL. Clinical and public health efforts should focus on effective control and screening measures for the individual patients and general population.

Impact of magnesium supplementation on clinical outcome and disease progression of patients with diabetic nephropathy: a prospective randomized trial

Background

Magnesium (Mg) deficiency is closely linked with proteinuria.

Objectives

To assess the impact of oral Mg citrate supplementation on the clinical outcome of diabetic nephropathy (DN) patients.

Design

This was a prospective, randomized, controlled, open-label study.

Methods

Sixty DN patients were recruited from Nephrology and Endocrinology departments, Ain Shams University Hospitals, Cairo, Egypt. Patients were assigned by stratified randomization based on their Mg status, to either Mg citrate group, (n = 30), who received the standard regimen + oral Mg citrate 2.25 g/day or Control group, (n = 30), who received the standard regimen only. The primary endpoint was a change in urinary albumin to creatinine ratio (UACR) after 12 weeks. Secondary outcomes were insulin resistance, glycemic control, lipid profile, serum osteocalcin, quality of life (QoL) and Mg tolerability.

Results

Out of a total of 60 patients enrolled, only 54 patients (26 in Mg citrate group and 28 in the control group) completed the study. Groups were comparable at baseline. The UACR median percent reduction was significantly higher in the Mg citrate group (-6.87%) versus (-0.9%) in the Control group, p = 0.001. After 12 weeks, the estimated glomerular filtration rate significantly improved in the Mg citrate group versus Control group (p = 0.001). Comparable change was observed in glycemic indices. Lipid profile significantly improved in the Mg citrate group versus Control group (p = 0.001). Serum osteocalcin levels significantly declined in the Mg citrate group (p = 0.001) versus control group. Regarding QoL, the total score and all domains significantly improved in the Mg citrate group compared to control. The Mg supplement was tolerable with only mild reported side effects that required no intervention.

Conclusion

Oral Mg citrate supplementation improved microalbuminuria in DN patients. It also had favorable effects on serum osteocalcin, lipid profile and QoL with no reported major side effects.

Trial registration

ClinicalTrials.gov identifier: NCT03824379.

Cross-cultural adaptation and validation of diabetes-39 in Turkish patients with type 2 diabetes

PURPOSE

To translate Diabetes-39 quality of life scale (D-39) into Turkish, to accomplish a cross-cultural adaptation, to demonstrate validity and reliability of Turkish version (D-39-TR).

METHODS

A total of 214 patients with type 2 diabetes were included, with an average age of 52.59 ± 14.83, a female/male ratio of 51/49%. Internal consistency and test-retest reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient (ICC), respectively. For structural validity, factor analysis was used. The SF-36 was used for convergent validity, and hemoglobin A1c (HbA1c) was used for differential validity.

RESULTS

The Cronbach's alpha coefficient was over 0.70 for all subscales of D-39-TR and it was 0.93 for whole D-39-TR. No problematic items were detected in the scale. The ICC for test-retest reliability was 0.91 (95% CI 0.91-0.94). The test-retest consistency for the total score was r = 0.94, p < 0.001. D-39-TR was explained by five factors. The ratio of explaining the total variance of these 5 factors was determined as 53.97%. SF-36 (r=-0.48, p < 0.001) and HbA1c values (r = 0.31, p < 0.001) were moderately correlated with total score of D-39-TR. A significant difference was found between QoL values of patients with poor and good glycemic control (p < 0.001).

CONCLUSION

Turkish version of D-39 is a reliable and valid scale for measuring QoL in patients with type 2 diabetes.IMPLICATIONS FOR REHABILITATIONThe Turkish version of the Diabetes-39 (D-39) is a valid and reliable questionnaire and can be used in patients with type 2 diabetes.The Turkish version of the D-39 offers a useful tool for better identifying quality of life of patients with type 2 diabetes who are at risk for adverse outcomes.The Turkish version of the D-39 can be used to evaluate the effectiveness of attempts to increase quality of life in patients with type 2 diabetes.

Good Quality of Life among People Living with Diabetes Mellitus Visiting the Outpatient Department of Endocrinology in a Tertiary Care Centre

Introduction

Assessing the quality of life of individuals living with diabetes is crucial for ensuring optimal care and effective management of complications related to their condition. Diabetes is one of the leading causes of preventable mortality and morbidity among non-communicable diseases. The study aims to find out the prevalence of the good quality of life of people living with Diabetes mellitus visiting a tertiary care centre.

Methods

A descriptive cross-sectional study was conducted among type 2 diabetic patients visiting the Outpatient Department of Endocrinology in a tertiary care centre from 30 June 2022 to 20 July 2022. Ethical approval was obtained from the Institutional Review Committee. A systematic random sampling technique was used. D-39 questionnaires were administered via face-to-face interviews. Point estimate was calculated at 95% Confidence Interval.

Results

Among 118 patients living with diabetes, good quality of life was seen in 97 (82.20%) (75.30-89.10, 95% Confidence Interval). This study found that the energy and mobility domain has the highest mean score of 26.7±7.8.

Conclusions

The prevalence of good quality life of people living with Diabetes mellitus was found to be higher than other similar studies done in similar settings.

Keywords

diabetes mellitus; patients; quality of life.

Health-related Quality of Life and Domain-specific Associated Factors among Patients with Type2 Diabetes Mellitus in South India

OBJECTIVE

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder that has a major impact on health-related quality of life (HRQOL). The economic burden of the disease, along with its complications, negatively impact the individual, family, and society of Indian diabetic patients. This study explored the perception of the diabetic HRQOL of South Indian type2diabetic patients.

METHODS

This study was a cross-sectional descriptive quantitative study conducted in a tertiary care hospital in Chennai, Tamil Nadu, South India. Using the simple random sampling technique, we collected data from 352 T2DM patients aged ≥ 30 years of age who were diagnosed for a minimum of one year. Data collection occurred from June to August 2017. Data were analysed using IBM SPSS, Version 22.

RESULTS

Overall, 90% of patients with T2DM perceived poor HRQOL. The total and the domain- specific mean scores of HRQOL were high indicating poor HRQOL in energy mobility, diabetes control, anxiety and worry, social burden, and sexual functioning domains. Being female, increasing age, lower education levels, lower family income, and uncontrolled fasting blood glucose levels predicted poor HRQOL of patients with T2DM.

CONCLUSIONS

T2DM impacted the HRQOL in all measured domains of participants. A patient-centred approach to diabetes management can be incorporated to improve or enhance the health-related quality of patients’ lives. Improved HRQOL also may lead to fewer hospitalizations, and hence, reduce healthcare costs.

Validation of a reduced instrument Diabetes-21 for assessing health-related quality of life among people with diabetes

OBJECTIVE

To analyze the validity, reliability and interpretability of a short form instrument for assessing health-related quality of life among people with diabetes mellitus.

METHODS

This was a validation study, comprised of the adaptation phases of the Diabetes-39 instrument (consisting of 5 domains and 39 items), pre-test, structural validity analyses (exploratory and confirmatory), reliability, concurrent validity and interpretability.

RESULTS

The factorial structure of the short final version differed from the original instrument. The items were reduced from 39 to 21 and domains from 5 to 4. The factor loading, in exploratory and confirmatory analyses, ranged between 0.41 and 0.90 and between 0.51 and 0.89, respectively. Reliability was adequate (Cronbach's alpha=0.91; Kappa≥0.60 in all items; intraclass correlation coefficient =0.91).

CONCLUSION

Diabetes-21, a short form instrument, was considered valid, reliable and interpretable for assessing health-related quality of life among people with diabetes mellitus.

Qualidade de vida em diabéticos assistidos em Estratégia de Saúde da Família na região metropolitana de Porto Alegre, RS, Brasil

Objetivo: Avaliar a qualidade de vida (QV) de pacientes diabéticos utilizando o instrumento Medical Outcomes Study 36-item Short Form Health Survey (SF-36). Métodos: estudo quantitativo, transversal e descritivo, realizado com 98 pacientes diabéticos assistidos em uma Estratégia de Saúde da Família da região metropolitana de Porto Alegre, Brasil, por meio de questionário sociodemográfico e do SF-36.  Resultados: 59 (60,2%) eram do sexo feminino e a faixa etária entre 50 e 69 anos correspondia a 46,9% da amostra. O diabetes mellitus tipo 2 foi o mais prevalente (68,4%) e a maioria (80,6%) fazia uso exclusivo de hipoglicemiantes orais. As médias dos domínios do SF-36 variaram entre 42,6 ± 44,9(Limitação por Aspectos Físicos) e 70,0 ± 30,1 (Aspectos Sociais). Os diabéticos participantes de atividade educativa apresentaram melhores escores de QV no domínio Dor (61,2 ± 24,8 vs. 45,4 ± 26,2; p = 0,015).  Conclusão: os escores do SF-36 apresentaram-se medianos, sugerindo influência negativa do diabetes na qualidade de vida dos participantes. As atividades educativas em grupo mostraram-se associadas a pontuações médias mais elevados dos domínios do escore de QV.

Uso dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos

Resumo Este estudo investigou a utilização dos serviços de saúde segundo determinantes sociais, comportamentos em saúde e qualidade de vida entre diabéticos. A amostra foi composta por 416 diabéticos cadastrados na Estratégia Saúde da Família de um município do Nordeste do Brasil. A análise dos dados incluiu estatísticas descritivas, bivariadas e multivariada por meio da modelagem de Árvore de Decisão usando o algoritmo Chi-squared Automatic Interaction Detector (CHAID). Evidenciou-se expressiva utilização dos serviços públicos de saúde (80,7%). A utilização do serviço público de saúde com regularidade envolveu indivíduos com escolaridade baixa ou média (p < 0,001), empregados ou aposentados e/ou pensionistas (p = 0,019), com alto impacto do diabetes na qualidade de vida (p = 0,032), e que realizavam a quantidade recomendada de exames de glicemia em jejum ao ano (p < 0,001). A utilização dos serviços de saúde pôde ser explicada por diferenças relacionadas aos determinantes sociais, aos comportamentos em saúde e ao impacto do diabetes na qualidade de vida dos usuários.

Study of Health-Related Quality of Life and Healthcare Utilization among Type 2 Diabetic Population in an Urban Area of Eastern Nepal

INTRODUCTION

Diabetes mellitus is a major cause of morbidity and mortality and places huge burden on public health funding. Diabetes affects quality of life through associated complications, comorbidity, and disease burden. Consequently, people have frequent healthcare visits. This study assessed quality of life and healthcare utilization patterns among type 2 diabetic populations in an urban area of eastern Nepal.

METHODS

A cross-sectional study was conducted among 270 participants of age ≥20 years with type 2 diabetes in Itahari using a semistructured questionnaire. A D-39 questionnaire was used to assess quality of life. Five wards were selected by systematic random sampling, and the population was proportionate according to the sample size. Multiple linear regressions were conducted to identify the factors associated with quality of life and its domains.

RESULTS

The highest mean score ± SD was found in the domain anxiety and worry (57.34 ± 11.08). About 18.5% of the participants perceived extremely affected quality of life. Hypertension (55.55%) was the most common comorbidity. Age, marital status, literacy, alcohol, disease duration, comorbidity, and complications were significantly associated with overall quality of life. In last 6 months of duration, 93.7% had hospital visits. Among them, 8.1% had emergency visit and 5.9% were admitted in the hospital.

CONCLUSION

People with diabetes in this study were more affected in the domain anxiety and worry. The frequency of healthcare access and utilization in patients with type 2 diabetes was high. The quality of life among them could be improved by taking care on healthy behavior, comorbid conditions, and complications.

Demographic and clinical predictors of health-related quality of life among people with type 2 diabetes mellitus living in northern Thailand: A cross-sectional study

Background

Type 2 Diabetes Mellitus (T2DM) is a chronic disease which is growing global health problems. However, research on such prediction of health-related quality of life (HRQOL) in Thailand is limited, in particular on the demographic and clinical characteristic in each HRQOL domains. Therefore, the aim of the present study was to determine the demographic and clinical predictors of health-related quality of life among people with type 2 diabetes mellitus (T2DM) in Northern Thailand.

Methods

A cross-sectional study of people with T2DM at a large teaching hospital in Northern Thailand was conducted. The HRQOL was evaluated using the Thai version of Diabetes-39. Descriptive analysis was used to summarize the demographic and HRQOL scores. Multiple regression analysis was used to determine the predictors of overall HRQOL and the predictors of each D-39 dimension.

Results

A total of 502 people with T2DM were recruited. Forty-one were identified as having diabetic foot ulcers. The mean score for perception of overall HRQOL was 61.18 (SD 18.74). Scores in the D-39 questionnaire showed a poor HRQOL among people with T2DM. The predictors of demographic and clinical characteristics of people with T2DM were calculated for overall HRQOL and all six domains.

Conclusion

These results demonstrate that people with T2DM have a poor HRQOL. The presence of diabetic foot ulcers and smoking status were identified as significant predictors of low HRQOL in the domains relating to diabetes control, social burden and energy and mobility presence of obesity, receiving insulin injection or a combination of insulin and oral medication were predictors of poor HRQOL in the domain of other health problems and diabetes complications. These findings allow for a nursing care plan for diabetes management to achieve optimal glycaemic control and improve their HRQOL.

Health-related quality of life among people living with type 2 diabetes: a community based cross-sectional study in rural Nepal

Background

Diabetes as being a chronic disease with a number of complications deteriorates the quality of life among the people with type 2 diabetes. Health related quality of life is widely used as an important health outcome measure worldwide. This study assessed the quality of life among the people living with type 2 diabetes in rural area of eastern Nepal.

Methods

A cross sectional study was conducted among type 2 diabetic patient of rural area of eastern Nepal. Pre-tested Nepali version of D-39 questionnaire was administered through face to face interview to assess the quality of life. Door to door visit was done to identify all the type 2 diabetic patients residing in Baniyani village. Data was entered in Micro-soft excel 2007 and further processed in SPSS v.11.5 for analysis.

Results

Highest quality of life mean (SD) score was in social burden domain (56.26 ± 12.07), followed by sexual functioning domain (54.35 ± 9.47), Anxiety and worry domain (54.33 ± 7.76), energy and mobility domain (51.46 ± 8.73) and diabetes control domain (50.08 ± 10.84). There was negative correlation between age and domains sexual functioning (p = 0.001) and energy and mobility (p = 0.002). In bivariate analysis, there was significance difference by sex in sexual functioning (p = 0.002), educational status in diabetes control (p = 0.021), smoking habit in energy and mobility (p = 0.038), duration of disease in diabetes control (p = 0.002) and sexual functioning (p = 0.001), presence of co-morbidity in social burden (p = 0.034) and family history of diabetes in anxiety and worry (p = 0.042).

Conclusion

Increasing age affects sexual life and mobility of the type 2 diabetic patient. The domain sexual functioning is difference by sex and presence of co-morbidity. Similarly, domain diabetic control is affected by duration of disease and educational status of the patient. And having family history of diabetes affects the mental state of the type 2 diabetic patient.

Quality of life of people with diabetes mellitus

ABSTRACT Objective: To analyze the quality of life of people with type 2 diabetes mellitus in the three levels of the healthcare system. Method: A quantitative, cross-sectional and descriptive study carried out in primary, secondary and tertiary healthcare units with individuals in outpatient care. The validated Diabetes-39 instrument was used to evaluate quality of life. Results: The sample consisted of 53 people. There was a decreasing tendency in the quality of life impairment from the primary to the tertiary care levels. In the total sample, there were differences between domains of quality of life with the variables gender, insulin use and occupation, greater perception of quality of life impairment and disease severity in people with higher rates of glycated hemoglobin. Conclusion: Quality of life tends to worse as the disease worsens. The results suggest that quality of life is related to sociodemographic and clinical variables, therefore, these should be considered in the care.

Hepatitis B vaccination coverage in patients with diabetes mellitus

OBJECTIVE

Analyze the factors associated with full hepatitis B vaccination (three doses) in patients with diabetes mellitus.

METHOD

Cross-sectional study, conducted in a health unit in a city in the state of São Paulo, with 255 patients on outpatient follow-up, in 2014. Data were obtained from the computerized system of the Municipal Health Department and via a structured questionnaire. A logistic regression model was used for analysis.

RESULTS

Full hepatitis B vaccination was noted in 13.7% of the patients and shown to be directly associated with their educational level (OR=1.30; CI: 1.07-1.57) and current or previous work as a health professional (OR=3.21; CI: 1.16-8.89).

CONCLUSION

Hepatitis B vaccination coverage was found to be low in patients with diabetes mellitus, indicating their vulnerability to this serious and potentially fatal disease. Higher educational level and working in the field of health were associated with better vaccination coverage.

OBJETIVO

Analisar os fatores associados à vacinação completa contra hepatite B (3 doses) em pacientes com diabetes mellitus.

MÉTODO

Estudo transversal, realizado em uma Unidade de Saúde, de uma cidade do interior paulista, com 255 pacientes em seguimento ambulatorial, em 2014. Os dados foram obtidos no sistema informatizado da Secretaria Municipal de Saúde e por meio de um questionário estruturado e, para análise, modelo de regressão logística.

RESULTADOS

Vacinação completa contra hepatite B foi observada em 13,7% dos pacientes e mostrou-se diretamente associada ao nível de escolaridade (OR=1,30; IC: 1,07-1,57) e ao trabalho atual ou pregresso como profissional da saúde (OR=3,21; IC: 1,16-8,89).

CONCLUSÃO

A cobertura vacinal contra hepatite B mostrou-se baixa em pacientes com diabetes mellitus, evidenciando a vulnerabilidade a essa doença grave e potencialmente fatal. Maior escolaridade e o trabalho na área da saúde foram associados a melhor cobertura vacinal.

Medication Adherence Contributes to an Improved Quality of Life in Type 2 Diabetes Mellitus Patients: A Cross-Sectional Study

INTRODUCTION

Diabetes mellitus is a chronic disease with a high prevalence world wide. This disease has also been reported to affect the quality of life (QOL) of the patient and their family due to its chronic nature and multi organ involvement. The aim of this study was to analyze the association between adherence to prescribed diabetes medication and diabetes-specific QOL in patients attending Secondary Health Care Facility in Bandung City, Indonesia.

METHODS

A cross-sectional survey was conducted in the Secondary Health Care Facility in Bandung City, Indonesia. Data were collected between February and April 2014 using consecutive sampling. Adherence was assessed using the eight-item Morisky Medication Adherence Scale while diabetes-specific-QOL was assessed using the Diabetes 39 instrument.

RESULTS

The results showed that among the patients, 49.4% exhibited low adherence, 29.7% exhibited medium adherence, and 20.9% exhibited high adherence to diabetes medication. Diabetes-specific QOL proved to be highly affected in the sexual functioning domain. Social-burden domain scores were better than overall QOL scores. There was a significant association between adherence and diabetes-specific QOL (p = 0.009) using The Kruskall-Wallis test of significance. The results of the post hoc Mann-Whitney tests (high vs medium adherence, p = 0.084; medium vs low adherence, p = 0.86; and high vs low adherence, p = 0.001) indicated that higher adherence to prescribed diabetes medication contributed to an improved QOL. Multiple regression analysis showed that the predictors of diabetes-specific QOL were adherence and patient income.

CONCLUSIONS

Adherence to prescribed medication showed a positive effect on diabetes-specific QOL in patients. Patients with a high adherence to medication had an improved QOL. This result is important not only in developing intervention programs for patients but also in improving their QOL through sustainable health promotion.

Evaluation of the quality of life of patients with diabetes mellitus treated with conventional or analogue insulins

AIMS

The results of two scales that measure quality of life of patients with diabetes mellitus treated with conventional or analogue insulin were evaluated and compared.

METHODS

Descriptive, observational, cross-sectional study, conducted in the cities of Pereira and Manizales, Colombia, in a care facility between 1 August 2013 and 30 March 2014. A total of 238 patients diagnosed with diabetes mellitus type 1 or type 2 who had been undergoing treatment with conventional or analogue insulin for at least 6months. Comparison of the results of the Diabetes 39 (specific) and European Quality of Life-5 Dimensions (EQ-5D) (generic) tools it was performed. Comparisons between the results of the two instruments were performed. Tests for parametric and non-parametric distribution (Pearson's correlation coefficient, Mann-Whitney U test, Student's t-test and Wilcoxon test) were used.

RESULTS

The mean age was 57.7±16.6years. Conventional insulin was prescribed to 69.6% of patients, and analogue insulin was prescribed to 30.4% of patients. Diabetes-39 (D-39) showed 24.7% of subjects with a high quality of life. No statistically significant differences were found when comparing patients prescribed conventional or analogue insulin (p=0.35; 95% confidence interval [CI]: 0.375-1.419). In the EQ-5D survey, 45.7% claimed to have a high quality of life, without statistically significant differences between groups (p=0.56; 95%CI: 0.676-2.047).

CONCLUSIONS

No differences between patients receiving conventional insulin versus analogue insulin were detected in terms of quality of life. The group aged over 60years requires special attention to improve their quality of life, and programs should focus on those individuals.