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

Quality of Life and Its Association With Time in Range Among People With Type 2 Diabetes Mellitus Following Different Dietary Interventions: A Crossover Clinical Trial

Background Quality of Life (QoL) is an essential consideration in healthcare. Numerous studies have examined QoL in India; however, data on QoL following different dietary interventions are lacking. Similarly, the use of technology such as continuous glucose monitoring (CGM) for diabetes care has independently demonstrated improvements in glycemic control; however, its association with QoL remains limited. Purpose The purpose was to study the role of different dietary interventions on QoL and its association with Time in Range (TIR), Time Above Range (TAR), and Time Below Range (TBR) among the Type 2 Diabetes Mellitus (T2DM) population. Methodology A crossover interventional clinical trial (CTRI/2022/07/044356) was conducted among participants with T2DM of less than 5 years' duration, aged between 25 and 55 years, with an HbA1c level of less than 8%, and who were on Metformin only. Their QoL was assessed after following two diet patterns: the Continuous Calorie Restricted Diet (CCRD) - calorie reduction with small frequent meals, and Time Restricted Intermittent Fasting (TRIF) - calorie reduction with only two meals a day, using the Modified QoL (MDQOL-17) questionnaire. The association between post-dietary interventions QoL and TIR was studied using a 14-day CGM device. Results The overall QoL of 51 participants at the end of the dietary interventions was significantly better compared to their QoL before any dietary intervention (85.6±19.0% and 63.1±13.0%, respectively, p = 0.000). Decreased TIR correlated with increased role limitations due to physical functioning (p = 0.002) and decreased energy levels (p = 0.00). As TBR increased, role limitation due to emotional well-being increased, and energy levels decreased significantly (p = 0.01). As TAR increased, energy levels decreased (p = 0.01). A simple linear regression model was statistically significant for role limitations due to physical functioning (p = 0.003) and energy fatigue (p = 0.000), suggesting that higher TIR is associated with higher scores in these domains. Conclusion Dietary interventions that improve the TIR and reduce the TAR and TBR can enhance the QoL of individuals with T2DM.

Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand

Introduction

Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition.

Material and Methods

A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD).

Results

Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities.

Conclusion

Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Correlation of health-related quality of life for older adults with diabetes mellitus in South Korea: theoretical approach

BACKGROUND

While some studies have explored the health-related quality of life (HRQOL) of older adults with diabetes mellitus (DM) in South Korea using a theoretical framework, these studies suffer sample-related limitations, as they focus only on a specific subgroup of older adults. To address this gap, this study aimed to investigate the predictors of HRQOL of older adults with DM in South Korea, using extensive national data and based on the theory of Health-Related Quality of Life in South Korean Older Adults with Type 2 Diabetes (The HIKOD theory).

METHODS

A secondary data analysis was conducted using data from 1,593 participants aged 65 years and older with DM sourced from the 2015-2019 Korea National Health and Nutrition Examination Survey (KNHANES). The variables included in this study are as follows: demographic factors (gender, age, household income, and education level), disease-specific factors (duration of DM, treatment of DM, and control of HbA1c), barriers (number of comorbidities), resources (living alone status), psychosocial factors (perceived stress), and health-promoting behaviors (physical activity and fundus examination). Considering the complex sampling design employed in this study, statistical analyses including Rao-Scott chi-square tests, correlation analysis, and hierarchical multiple regression analysis were conducted.

RESULTS

Mobility (45.0%) was the HRQOL dimension with which participants experienced the highest number of problems. Number of comorbidities (r = -0.36, p < 0.001), living alone status (rpb = 0.16, p < 0.001), perceived stress (rpb = 0.14, p < 0.001), and physical activity (rpb = 0.12, p < 0.001) were correlated with HRQOL. While adjusting for background factors, HRQOL was negatively predicted by higher number of comorbidities (estimate B = -0.03, p < 0.001), living alone (estimate B = -0.03, p = 0.043), higher perceived stress (estimate B = -0.09, p < 0.001), and lower physical activity (estimate B = -0.03, p < 0.001).

CONCLUSION

Complex and diverse factors influence HRQOL among older adults with DM in South Korea. To improve their HRQOL, intervention programs that integrally regard HRQOL, along with various predictors, are necessary.

Predicting Factors of Health-Related Quality of Life Among Adults With Type 2 Diabetes: A Systematic Review

Introduction

One of the most important outcomes of diabetes care and treatment is an improvement in patients' health-related quality of life (HRQoL).

Objective

This study aimed to review the empirical evidence regarding the predictors of HRQoL among adults with type 2 diabetes mellitus (T2DM).

Methods

To find all English-language articles published between 2012 and 2022, a comprehensive literature search was conducted using ProQuest, Scopus, PubMed, Science Direct, and CORE. Cross-sectional studies were the focus of this analysis. Search terms included "type 2 diabetes" OR "T2DM" AND "health-related quality of life" OR "HRQoL" AND ("predicting factors" OR "influencing factors" OR "associated factors"). The original search yielded a total of 1,089 studies, from which 35 met the review's inclusion criteria. The systematic review protocol was registered with PROSPERO CRD42023431229.

Results

The final analysis comprised 24,346 people with type 2 diabetes and used data from 35 cross-sectional studies conducted during the preceding decade. Socio-demographic factors (age, marital status, gender, monthly income, education, area of residence, and religiosity), patient-centered factors (diabetes knowledge and self-efficacy), disease characteristics (comorbidities, duration of diabetes, and insulin treatment), self-management behaviors (physical activity, medication adherence, and frequent glucose checks), and family support were found to be predictors of HRQoL.

Conclusion

A diabetes program to enhance the HRQoL among people with T2DM is highly encouraged to address these factors, which can be focused on promoting self-management behaviors, diabetes distress management, and encourage family support.

Study on dengue severity in diabetic and non-diabetic population of tertiary care hospital by assessing inflammatory indicators

Background

Dengue fever is a highly endemic tropical infectious disease that is quickly spreading over the world. Diabetes Mellitus has been linked to chronic inflammation. This present study was designed to compare the severity of dengue infection among diabetic and non-diabetic populations.

Methods

A prospective observational study was conducted on 40 patients (20 diabetic and 20 non-diabetic) who suffered from dengue infection. The study involved the collection of data of the dengue patients includes patient's demographic details, medical condition as well as biochemical investigations.

Results

Dengue-infected individuals with diabetes showed greater CRP, Endocan levels, IL-8 and Perfusion Index than those without diabetes (CRP; 35.308 ± 1.32 vs. 18.6365 ± 0.64) mg/dl (p≤ 0.001) (Endocan 42.316 ± 1.46vs. 32.839 ± 0.33), ng/dl (p≤ 0.001), (142.98 ± 1.05 vs 103.69 ± 0.64) (p ≤ 0.001) and (3.695 ± 0.18 vs. 1.98 ± 0.08) (p ≤ 0.001) respectively.

Conclusion

In conclusion the results indicate that prognosis of DHF grade II with diabetes mellitus tends to be more prone to bleeding disorder and can result into morbidity and mortality considering by triggering of the various inflammatory cascade resulting in hyperglycaemia and poor glycemic control.

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Dengue fever is a highly endemic tropical infectious disease.

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Present study aims compares the severity of dengue infection among diabetic and non-diabetic populations.

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The study involved the collection of data of the dengue patients includes patient's demographic details.

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The results indicate that prognosis of DHF grade II with diabetes mellitus tends to be more prone to bleeding disorder.