Impact of socio-demographic characteristics and long-term complications on quality of life in patients with diabetes mellitus

The relationship between quality of life and some mental problems in women with gestational diabetes mellitus (GDM): a cross-sectional study

BACKGROUND

Women with medical problems during pregnancy, including women with Gestational Diabetes Mellitus (GDM), experience an increased prevalence of mental health disorders which can affect their quality of life. This study aimed to assess the relationship between GDM-related quality of life and depression, anxiety, and stress.

METHODS

This analytical cross-sectional study was performed on 150 women with GDM. The participants were selected using a multi-stage sampling including quota and then randomized method from maternal care centers affiliated with Shahid Beheshti University of Medical Sciences, Tehran-Iran. The data were collected using a personal information questionnaire, the GDM-related quality of life questionnaire (GDMQoL-36), and the depression, anxiety, and stress scale (DASS). The data were analyzed using SPSS-23 software and statistical tests of coefficient Spearman's correlation, t-test, analysis of variance, and multiple linear regression.

RESULTS

The mean ± SD score for the GDM-related quality of life and the DASS scale were 55.51 ± 8.87 and 27.12 ± 19.43%, respectively. Different degrees of depression, anxiety, and stress were present in 40, 61.3, and 42% of women, respectively. The total score of GDM-related quality of life had a significant negative correlation with the total score of DASS and the scores of the subscales including depression, anxiety, and stress (P < 0.001). There were significant correlations between the total score of GDM-related quality of life with age, BMI, length of marriage, educational level of the woman and her spouse, the occupation of the woman and her spouse, income, and economic class of the family. Multiple linear regression revealed that depression, education, and job are predictive factors for GDM-related quality of life.

CONCLUSION

GDM-related quality of life is related to some mental disorders. Therefore, it is important to consider the mental health promotion of pregnant women with GDM in future prenatal health programs to improve their quality of life. This also shows the importance of integrating mental health promotion strategies to enhance the quality of life of pregnant women with GDM.

The effect of reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes: a randomised controlled trial

BACKGROUND

Evidence suggests that reminiscence therapy can effectively reduce cognitive and psychological symptoms. This study was conducted to examine the effect of individual reminiscence therapy on cognitive level, quality of life and depressive symptoms in older adults with type 2 diabetes.

METHODS

This study is an experimental type, randomised controlled study designed in pre-test - post-test design. The sample size of the study consisted of 58 older adults with type 2 diabetes, consisting of 29 intervention and 29 control subjects. The older adults in the intervention group were individually subjected to 5 weeks of reminiscence therapy in two sessions (each session 40-45 min) per week. No intervention was applied to the control group. Personal Information Form, Standardised Mini Mental Test, SF-36 Quality of Life and Beck Depression Inventory were used to collect the data.

RESULTS

While there was no significant difference between the pre-test Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group and the mean scores of those in the control group (P > 0.05), the difference between the Mini Mental Test, Beck Depression Inventory total score and SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention and control groups in the post-test was found to be statistically significant (P < 0.05). The post-test Mini Mental Test total score, SF-36 Quality of Life Scale mental and physical health sub-dimension mean scores of the older adults in the intervention group were higher than the older adults in the control group. It was determined that the post-test Beck Depression Inventory total mean scores of the older adults in the intervention group were lower than the older adults in the control group.

CONCLUSION

Reminiscence therapy can positively affect cognitive levels, quality of life and depression symptoms of older adults living in the community. Individual reminiscence therapy can be used as a nursing intervention in primary healthcare.

The Pattern of Initial Presentation of Diabetes, Treatment Outcome and Its Predictors Among Diabetic Pediatrics Attended Service at Selected Public Hospitals of Southern Ethiopia: A Multi-Center Study

Background

Diabetes mellitus is the most common metabolic disorder in the pediatric population. Globally the incidence of diabetes increased from 11.3 million (95% UI 10.6-12.1) in 1990 to 22.9 million (21.1-25.4) in 2017, with a 102.9% increase and there was a 3% increase in diabetes mortality rates by age between 2000 and 2019.

Objective

This study aims to assess the pattern of initial presentation of pediatric diabetes mellitus, treatment outcome, and its predictors among pediatrics who attended service at selected public hospitals in southern Ethiopia from 2015 to 2019.

Methods

A cross-sectional study was conducted among 422 randomly selected pediatrics from October 1st, 2021 to December 30, 2021, and participants were selected randomly from 8 randomly selected public hospitals in southern Ethiopia after proportional to client flow allocation of samples. Data was extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences (SPSS) version 24, and logistic regression analysis were applied to determine the presence of an association between dependent and independent variables, and significance was declared at p-value <0.05.

Results

In this study, most (74.6%) of the pediatrics initially presented with Diabetic ketoacidosis (DKA). This study found that Two-thirds (67.1%) of the respondents in the study had a good treatment outcome. In this study residence, presenting signs and symptoms; poly symptoms and weight loss, history of hospitalization, and comorbidity were predictors of treatment outcome of pediatric diabetes mellitus.

Conclusion

Diabetes mellitus with Diabetic ketoacidosis is the predominant pattern of initial presentation in the study. The magnitude of poor treatment outcomes of diabetes mellitus among pediatrics in this study is high and unacceptable Residence, signs, and symptoms at initial presentation, history of hospitalization, and comorbidity were found to be significant independent predictors of treatment outcome of pediatric diabetes mellitus.

Cardiovascular disease and risk factors in adults with diabetes mellitus in Hungary: a population-based study

Introduction

Diabetes mellitus (DM) and cardiovascular disease (CVD) such as acute myocardial infarction, stroke, and coronary artery disease are highly prevalent conditions that are responsible for significant morbidity and mortality, particularly in Hungary. The conditions are attributed to identical risk factors, and individuals with DM are primarily susceptible to cardiovascular complications, which are the leading causes of death and disability in patients with DM. The objective of this study was to estimate the prevalence of CVD in individuals with DM and to investigate the association between potential risk factors and the presence of CVD among individuals with DM in a population-based sample.

Methods

The study was based on data from three waves of the European Health Interview Surveys (EHIS) conducted in Hungary in 2009, 2014, and 2019.

Results

The prevalence of CVD among patients with DM decreased during the study period and that socioeconomic factors, cardiometabolic risk factors including high blood pressure and high cholesterol, and depression are major contributors to CVD burden in patients with DM in Hungary.

Discussion

Our findings suggest the importance of regular check-up for hypertension and hypercholesterolemia, better focus on socioeconomic status, as well as ongoing monitoring of mental health among patients with diabetes. Further research is needed to understand the potential causes behind the observed decrease in CVD prevalence.

Identification of Sociodemographic and Clinical Factors Influencing the Feeling of Stigmatization in People with Type 1 Diabetes

BACKGROUND

A large percentage of people with type 1 diabetes experience stigma, which may directly affect diabetes management. Moreover, it may adversely influence the acceptance of the disease and, thus, the treatment process, including compliance with medical and dietary recommendations. Therefore, it is important to seek adequate forms of counteracting the phenomenon of stigmatization. Thus, the aim of the study was to determine the factors influencing the level of perceived stigma by T1D patients, with particular emphasis on sociodemographic factors (including sex, place of residence, and education) and clinical factors related to the course of the disease.

METHODS

An observational cross-sectional online questionnaire was conducted in a group of 339 people with T1D. The link to the questionnaire was shared via social media. The DSAS-1 questionnaire translated into Polish was used as the research tool.

RESULTS

A moderate level of stigmatization was found (49.78 ± 14.54 points). It was significantly lower in people living in small towns compared to rural residents (ß = -0.121, p = 0.038), lower in people in relationships compared to those who are single (ß = -0.175, p = 0.001), in people diagnosed with T1D at an older age (ß = -0.107, p = 0.048), and in those who rated their financial situation as very good vs. bad (ß = -0.314, p < 0.001). It was also found that the level of stigma significantly decreased with age (ß = -0.181, p = 0.001). In addition, a significantly higher stigma perception was uncovered in the group of people with HbA1C > 7% than in the group ≤ 7% (ß = 0.118, p = 0.030).

CONCLUSIONS

Due to the occurrence of stigma among people with T1D, which can directly affect the management of diabetes, effective and comprehensive efforts should be made to provide support to people with diabetes. It is also necessary to raise awareness among the general public and disseminate knowledge about diabetes, which can reduce stigmatization as a result. Anti-stigma messages should be included in the prevention programs about the potential side effects and risks associated with mistreating people with T1D.

The Effect of a Diabetes Self-Management Mobile Application on Self-Efficacy, Self-Care Agency, and Self-Care Management Among Patients With Type 1 Diabetes Mellitus

Background: Diabetes mellitus is a chronic disease that needs long-term management. Mobile health is an emerging field that is being used for diabetes self-management. Aim: Evaluate the effect of a diabetes self-management mobile application on self-efficacy, self-care agency, and self-care management among 128 Jordanian patients with Type 1 Diabetes Mellitus. Methods: The study utilized a non-equivalent controlled groups quasi-experimental design, with 64 patients in the control and in the intervention groups. Results: There was significant improvement in mean self-efficacy in the intervention group, improved self-care agency between the groups, and improved self-care management both within the intervention group and between the groups, after controlling for self-efficacy and self-care agency. Conclusion: Using a diabetes self-management mobile application may help improve patients' confidence in managing diabetes, and better commitment to and performance of self-care activities.

Health-Related Quality of Life Assessment in Older Patients with Type 1 and Type 2 Diabetes

Type 1 (T1D) and type 2 diabetes (T2D) are determinants of health-related outcomes including health-related quality of life (HRQOL). We aimed to determine differences in HRQOL between older adults with T1D and T2D and specific factors influencing HRQOL in this age group. This study used a cross-sectional design with 56 age- and HbA1c-matched T1D and T2D patients (aged 68.9 ± 7.8 years; 55% had T2D). We employed several validated questionnaires (Short Form-36 (SF-36) and the EuroQol-5 Dimensions/Visual Analog Scale (VAS)) to investigate the relationships between HRQOL domains and diabetes type, glycemic control, complications, and comorbidities. T1D was associated with better self-reported general health (assessed with the SF-36 general health domain (p = 0.048) and the EuroQol-5 VAS (p = 0.002), whereas no significant differences in the other SF-36 domains, self-reported diabetes distress, anxiety, or depression were found. Most HRQOL domains were not associated with HbA1c or the presence of diabetes complications. The most significant reduction in HRQOL was experienced by patients with higher BMIs, irrespective of the diabetes type. The obtained HRQOL data could be used in clinical settings for evidence-based patient education focused on specific subgroups of patients, as well as in national healthcare policies, e.g., interventions designed to alleviate obesity.

Factors predicted quality of life of people with type 2 diabetes in western Ethiopia

BACKGROUND

Multiple factors predict the quality of life of adults with diabetes. However, the relationships of demographics, self-management practice, and support status with the quality of life of people with diabetes are unknown. Therefore, the study aimed to assess factors related with the quality of life of adults with type 2 diabetes in western Ethiopia.

METHODS

A hospital-based cross-sectional study involving adults with type 2 diabetes was conducted in western Ethiopia from June 02, 2020, to August 31, 2020. Convenience sampling technique was used in selecting subjects. The translated and psychometrically tested summary of diabetes self-management activities (expanded), diabetes quality of life, and diabetes care profile support scales were used in measuring self-management practice, quality of life, and support status, respectively. Data were collected via face-to-face interviews. Factors related with quality of life were examined through bivariate analysis and multivariable linear regression. In all statistical tests, P value <0.05 and confidence level that excluded zero were considered statistically significant.

RESULTS

A total of 417 adults with type 2 diabetes participated in the study. In a multivariable linear regression, seven factors including age, male, homemakers, those separated/divorced, number of years since diabetes diagnosis, self-management practice and support needed were related with quality of life. Male patients (β = 2.786, 95% CI = 1.285 to 4.287, p < 0.001), homemakers (β = 0.366, 95% CI = 0.056; 0.677, p = 0.021), self-management practice (β = 4.528, 95% CI = 3.851 to 5.205, p < 0.001) and those who needed support from their families or peers (β = 1.623, 95% CI = 0.458; 2.788, p = 0.006) were related positively with quality of life whereas those who separated or divorced (β = -1.698, 95% CI = -3.371 to -0.025, p = 0.047), older age (β = -0.195, 95% CI = -0.269 to -0.121, p < 0.001) and those who lived with diabetes for a longer duration (β = -2.206, 95% CI = -4.151 to -0.261, p = 0.026) were related negatively with quality of life.

CONCLUSION

Quality of life of people with type 2 diabetes living in western Ethiopia was predicted positively by being male, homemakers, having self-management practice, and support needed, whereas negatively influenced by old age, separation or divorce, and long diabetes life. Thus, encouraging self-management practice, and continuous family or friend support are necessary to enhance quality of life of people with type 2 diabetes. Further study should employ random sampling techniques and involve participants from multiple study settings to increase representativeness of the samples.

An evaluation of lower urinary tract symptoms in diabetic patients: a cross-sectional study

BACKGROUND

Lower urinary tract symptoms (LUTS) are common among diabetic patients and represent hidden and mysterious morbidity. The pathophysiology of LUTS among diabetes mellitus (DM) patients is multifactorial. Importantly, LUTS is known to cause physical and psychological distress. Thus, this study describes LUTS among DM patients, investigates factors that may associate with it, and assesses the possible relationship between LUTS and the quality of life of diabetics.

METHODS

Over 6 months, data were collected from 378 diabetic patients in primary health care clinics. Demographic and clinical characteristics, Urogenital Distress Inventory-6 (UDI-6), and Incontinence Impact Questionnaire-7 (IIQ-7) were used to collect data. Univariate and multivariate analyses were performed.

RESULTS

Three hundred seventy-eight participants were included in this study. (29.9%) were (58-67) years old. 49% were female. Half of the cohort was overweight, and a third were obese. 81% were Type 2 DM. Almost all of them are on medical treatment. A median score of 5.50 (2.00-8.00) for the UDI-6 scale and a median score of 5 (0.00-10.00) for the IIQ-7 scale were reported. Multiple linear regression models showed that residency (p = 0.038) and regular exercise (p = 0.001) were significantly and negatively correlated with the UDI-6 score, while female gender (p = 0.042), insulin use (p = 0.009) and the presence of comorbidities (p = 0.007) were positively correlated with this score. Furthermore, age (p = 0.040) and body mass index (BMI) (p < 0.001) were significantly and positively associated with the IIQ-7 score.

CONCLUSION

LUTS is significant morbidity among DM patients. Factors such as age, BMI, and co-morbidities exacerbate LUTS, which can be modified and controlled. On the other hand, regular exercise and weight loss strategies help diabetic patients to improve LUTS.

Healthcare use among people with diabetes mellitus in Europe: a population-based cross-sectional study

OBJECTIVE

This study aimed to determine the association of health determinants, lifestyle and socioeconomic variables on healthcare use in people with diabetes in Europe.

DESIGN

A cross-sectional study was conducted using data from the European Health Interview Survey wave 2 (ie, secondary analysis).

SETTING

The sample included data from 25 European countries.

PARTICIPANTS

The sample included 16 270 patients with diabetes aged 15 years or older (49.1% men and 50.9% women).

RESULTS

The survey data showed that 58.2% of respondents had seen their primary care physician in the past month and 22.6% had been admitted to the hospital in the past year. Use of primary care was associated with being retired (prevalence ratio (PR) 1.13, 95% CI 1.07 to 1.19) and having very poor self-perceived health (PR 1.80, 95% CI 1.51 to 2.15), long-standing health problems (PR 1.14, 95% CI 1.04 to 1.24), high blood pressure (PR 1.06, 95% CI 1.03 to 1.10) and chronic back pain (PR 1.07, 95% CI 1.04 to 1.11). Hospital admission was associated with very poor self-perceived health (PR 3.03, 95% CI 2.14 to 4.31), accidents at home (PR 1.54, 95% CI 1.40 to 1.69), chronic obstructive pulmonary disease (COPD) (PR 1.34, 95% CI 1.22 to 1.47), high blood pressure (PR 1.08, 95% CI 1.01 to 1.17), chronic back pain (PR 0.91, 95% CI 0.84 to 0.98), moderate difficulty walking (PR 1.33, 95% CI 1.21 to 1.45) and severe difficulty walking (PR 1.67, 95% CI 1.51 to 1.85).

CONCLUSIONS

In the European diabetic population, the high cumulative incidences of primary care visits and hospital admissions are associated with labour status, alcohol consumption, self-perceived health, long-standing health problems, high blood pressure, chronic back pain, accidents at home, COPD and difficulty walking.

Influence of Diabetes Knowledge, Self-Stigma, and Self-Care Behavior on Quality of Life in Patients with Diabetes

Globally, almost 9.3% of the population aged 20-80 years have been diagnosed with diabetes making diabetes management a global health problem beyond specific regions or races. This study aimed to determine the effect of diabetes knowledge, self-stigma, and self-care behavior on the quality of life of patients with diabetes. This descriptive research study evaluated 180 patients receiving diabetes treatment at the outpatient Department of Endocrinology at C University Hospital. Data were collected between 30 July 2019, and 30 August 2019. The study variables were general patient characteristics, disease-related characteristics, quality of life, diabetes knowledge, self-stigma, and self-care behavior. Factors affecting the quality of life were analyzed by hierarchical regression. Self-stigma (β = -0.298), monthly income (β = 0.270), and self-care behavior (β = 0.140) significantly affected the quality of life, in that order. The higher the self-stigma, the lower the quality of life, and the higher the monthly income and the level of self-care behavior, the higher the quality of life. A psychosocial support program to positively change the attitude toward diabetes is needed to improve the quality of life among patients with diabetes.

The Effect of Diabetes on Health-Related Quality of Life in Emirati Patients

<b><i>Background:</i></b> Diabetes mellitus (DM) is known to negatively affect quality of life (QoL), yet very few studies have been done on QoL of patients with diabetes in the United Arab Emirates population. <b><i>Objectives:</i></b> The aim of this study was to assess the impact of DM on health-related QoL (HRQoL) of patients with diabetes of Emirati nationality. <b><i>Methods:</i></b> Two hundred and forty Emirati patients with diabetes, treated at the Dubai Diabetes Center, were randomly selected and interviewed using the Short Form-36 questionnaire to assess HRQoL domains. Appropriate statistical measures were performed to associate HRQoL domains with diabetes-related factors. <b><i>Results:</i></b> HRQoL satisfaction scores for physical and mental health domains were very high for the majority of participants. Male participants ranked significantly higher median scores in all HRQoL domains than females (77.36 vs. 65.28, <i>p</i> = 0.004). There was a significant (<i>p</i> &#x3c; 0.001) negative correlation between diabetes duration and the total averaged score for all sub-domains, and significant (<i>p</i> &#x3c; 0.001) negative correlations between glycated hemoglobin percentage (HBA1c%) and all sub-domains of HRQoL. Patients without complications had significantly better scores in all HRQoL sub-domains than patients suffering from any complications. Median total HRQoL score for those with neuropathy compared to those without neuropathy was 63.9 versus 82.6 (<i>p</i> &#x3c; 0.001), for nephropathy was 43.6 versus 72.5 (<i>p</i> &#x3c; 0.001), for retinopathy 50.7 versus 76.0 (<i>p</i> &#x3c; 0.001), for ischemic heart disease 54.1 versus 77.3 (<i>p</i> &#x3c; 0.001), and for cerebrovascular disease 36.7 versus 72.4 (<i>p</i> &#x3c; 0.001). Multiple regression showed 3 significant predictors for the total averaged score from all HRQoL sub-domains; these were age (<i>p</i> = 0.007), HbA1c% (<i>p</i> &#x3c; 0.001), and the number of complications related to DM (<i>p</i> = 0.001). <b><i>Conclusion:</i></b> HRQoL in Emirati patients with diabetes was significantly associated with the presence of diabetes-related complications, glycemic control, and age of the patient. The assessment of QoL in patients with diabetes can be a valuable measure for the healthcare providers to assess patient’s well-being.

Do Long-Term Complications of Type 2 Diabetes Increase Susceptibility to Geriatric Syndromes in Older Adults?

Background and Objectives: Type 2 diabetes is one of the common chronic diseases in the elderly. It is thought that long-term complications of type 2 diabetes will negatively affect the quality of life in elderly individuals. It is possible that geriatric syndromes, especially frailty syndrome, are associated with diabetic complications, too. In this study, we aimed to evaluate the effect of macrovascular and microvascular complications of type 2 diabetes on frailty and other geriatric syndromes. In addition, the effect of these complications on quality of life was also reviewed. Materials and Methods: We conducted a cross-sectional study for four months. Comprehensive geriatric assessment tests were done on all patients. The Fried frailty index (FFI) was used for the evaluation of frailty syndrome. We assessed malnutrition by mini nutritional assessment short-form (MNA-SF), and Global Leadership Initiative on Malnutrition criteria (GLIM). The EWGSOP 2 criteria were used for the diagnosis of sarcopenia. Quality of life (QoL) was evaluated using the short form-36 (SF-36) questionnaire. Data analysis was done by SPSS version 22. Results: 237 females and 142 males with a mean age of 71.7 ± 6.1 years were included in the study. The frequency of macrovascular and microvascular complications was 41.4% and 68.1%, respectively. Frailty was found to be associated with macrovascular complications (p = 0.003). Handgrip strength, skeletal muscle mass index, and gait speed were decreased in the presence of macrovascular complications (p = 0.043, p < 0.001, p < 0.001). QoL was also decreased in patients with macrovascular complications (p = 0.003). Nutritional status and handgrip strength were negatively affected in patients with diabetic neuropathy (p = 0.019, p = 0.014). Polypharmacy was also found to be associated with macrovascular complications (p < 0.001, p < 0.001). Macrovascular complications were 2.5 times more common in malnourished patients according to GLIM and 3.2 times more common in patients with decreased gait speed. Conclusion: In this study, we observed that both macrovascular and microvascular complications of diabetes increase susceptibility to geriatric syndromes in elderly individuals. It could be useful to conduct prospective studies in which we can compare the effectiveness of treatment methods on this subject.

Quality of Life and its Determinants in Patients with Diabetes Mellitus from Two Health Institutions of Sub-himalayan Region of India

BACKGROUND

Diabetes mellitus (DM) causes serious deterioration in general quality of life (QoL) mainly affecting the health-related quality of life (HRQOL). Routine assessment of QoL improves communication with the patient, helps to predict treatment response, and supports clinical decision-making. QoL can predict an individual's capacity to manage the disease and maintain long-term health and wellbeing.

AIMS

To find out the QoL and its socio-demographic, anthropometric, and clinical determinants among DM patients attending health institutions from sub-Himalayan region, catering rural population.

SETTINGS AND DESIGN

This cross-sectional study was conducted in two hospitals mostly catering rural population from 2014 to 2018. Purposive sampling technique was used.

MATERIALS AND METHODS

Socio-demographic, anthropometric, and clinical data of DM patients (N = 300) were collected. They were administeredHindi translation of QoL Instrument for Indian Diabetes Patients (QOLID) and Patient Health Questionnaire-9 (PHQ-9). All statistical analyses were carried out using Statistical Package for Social Sciences (SSPS) (Version 17.0, USA).

RESULTS

About 10% had very poor, 13% poor, 11% average, 16% good, and 50% very good QoL on QOLID. General health (GH) and treatment satisfaction (TS) were the most affected domains. Fatigue was the most common symptom (79%) reported in QOLID. Age more than 55 years, rural background, and PHQ-9 score of more than 7 were predictors of poorer QoL.

CONCLUSION

There is a need for a holistic and collaborative care of DM patients, to maintain a good HRQoL. Screening of depression, fatigue, and regular assessment of QoL should be emphasized.

The modifying role of physical activity in the cross-sectional and longitudinal association of health-related quality of life with physiological functioning-based latent classes and metabolic syndrome

BACKGROUND

Single cardio-metabolic risk factors are each known modifiable risk factors for adverse health and quality of life outcomes. Yet, evidence on the clustered effect of these parameters and the metabolic syndrome (MetS) on health-related quality of life (HRQoL) is still limited and mostly cross-sectional. The objectives of this study were to identify clusters of cardio-metabolic physiological functioning, to assess their associations with HRQoL in comparison with the MetS, to elucidate the modifying role of physical activity, and to assess differences in health service utilization.

METHODS

This study is based on longitudinal data from two time points (2010/11 & 2017/18) of the Swiss Study on Air Pollution and Lung and Heart Diseases (SAPALDIA). Latent class analysis (LCA) grouped participants based on a priori selected cardio-metabolic and MetS related physiological functioning variables (Body mass index, body fat, glycated hemoglobin, blood triglycerides, blood pressure). The 36-item Short-Form Health Survey (SF-36) was used to assess HRQoL. Quantile regressions were performed with and without adjustment for physical activity, to detect independent associations of the latent classes, MetS and physical activity with HRQoL. To assess the modifying role of physical activity, we additionally grouped participants based on the combination of physical activity and latent classes or MetS, respectively. Logistic regressions were used to investigate health service utilization as outcome.

RESULTS

The LCA resulted in three classes labeled "Healthy" (30% of participants in 2017/18), "At risk" and "Unhealthy" (29%). The Unhealthy class scored lowest in all physical component scores of HRQoL. Compared to healthy and active participants, inactive participants in the "Unhealthy" class showed lower scores in the physical functioning domain both cross-sectionally (- 9.10 (- 12.02; - 6.18)) and longitudinally. This group had an odds ratio of 2.69 (1.52; 4.74) for being hospitalized in the previous 12 months.

CONCLUSIONS

These results point to subjects with adverse cardio-metabolic physiological functioning and low activity levels as an important target group for health promotion and maintenance of well-being. The promotion of physical activity at the early stages of aging seems pivotal to mitigate the impact of the MetS on HRQoL at higher age.

Impaired glucose regulation, depressive symptoms, and health-related quality of life

INTRODUCTION

This study aims to investigate whether the associations between impaired glucose regulation and health-related quality of life are modified by severity or type of depressive symptoms.

RESEARCH DESIGN AND METHODS

For this cross-sectional study, we included 1939 individuals (mean age 61.5 years) from the Helsinki Birth Cohort Study. Between 2001 and 2004, a standard 2-hour 75 g oral glucose tolerance test was applied to define normoglycemia, pre-diabetes, and newly diagnosed diabetes. Information on previously diagnosed diabetes was collected from national registers and questionnaires. Pre-diabetes was defined as having either impaired fasting glucose or impaired glucose tolerance. The Mental and Physical Component Scores of health-related quality of life were assessed with Short Form-36. Beck's Depression Inventory was employed to investigate the severity of depressive symptoms and to define minimal (depression score <10), non-melancholic, and melancholic types of depression. We analyzed data with general linear models adjusted for sex, age, lifestyle factors, comorbidities, and body mass index.

RESULTS

Glucose regulation subgroups, especially previously known diabetes, were associated with lower Physical Component Score (p=0.001) and higher depression score (p=0.015), but not with the Mental Component Score (p=0.189). Non-melancholic depression was associated with lower Physical and Mental Component Scores compared with those with depression score <10 and melancholic depression (p<0.001), independently of glucose regulation status (p for glucose regulation status by depression type interaction >0.54).

CONCLUSIONS

Non-melancholic type of depression and previously known diabetes are independently associated with lower health-related quality of life. This should be appraised in long-term treatment of diabetes and when treating non-melancholic depressive symptoms to maintain a higher health-related quality of life.

Factors affecting the quality of life in women with gestational diabetes mellitus: a path analysis model

Background

Quality of life (QoL) is the most important indicator for assessing the status of health care in chronic diseases. The present study aimed to determine the pathway determinants model of QoL in patients with gestational diabetes mellitus (GDM).

Methods

This cross-sectional study was conducted on 329 women with GM referred to health care centers in Qom, Iran during 2018. Convenience sampling methods was used. Inclusion criteria were: afflicted by GM and received pregnancy care services from health center. Several questionnaires (Knowledge, attitude, self-efficacy (SE), social support (SS), pregnancy distress, self-management(SM) and QoL) were used for data collection. Data were analyzed with SPSS-21 and Lisrel-8.8 software using statistical path analysis.

Results

The mean age of participants was 30.93 ± 5.42 years. The final path model fitted well (CFI =1, RMSEA = 0.0003) and showed that, only age variable from both direct and indirect path had an impact on QoL (B = 0.51). Among variables that directly affected the QoL, SS had the highest effect (B = 1.02) and SE (B = 0.01) had the lowest effect. In the indirect path, only the knowledge variable by affecting the SE had an impact on the QoL (B = 0.0045).

Conclusion

SS had the greatest impact on the QoL. Obviously, providing all the requirements to support patients can help them overcome problems and improve their QoL. Distress negatively affects the QoL through SM and it should be noticed in interventional studies.

Efficacy and safety of cinnamon in type 2 diabetes mellitus and pre-diabetes patients: A meta-analysis and meta-regression

INTRODUCTION

Cinnamon has been used as a dietary component and in the management of diabetes mellitus. This study systematically reviewed and synthesized evidence on the efficacy of cinnamon for the treatment of type 2 diabetes mellitus (T2DM) and pre-diabetes patients.

METHODS

Databases of Web of Sciences, the Cochrane library, PubMed, CINAHL and SCOPUS were searched. Stata version 13 (College Station, Texas 77845 USA) and RevMan var. 5.3 software were used for meta-analysis. Heterogeneity was assessed using Chi-square and I² tests.

RESULTS

Sixteen randomized controlled studies were included in the meta-analysis. Cinnamon significantly reduced fasting blood glucose (FBG) and homeostatic model assessment for insulin resistance (HOMA-IR) level compared to placebo with weighted mean difference (WMD) of -0.545 (95% CI: -0.910, -0.18) mmol/L, I² = 83.6% and -0.714(-1.388, -0.04), I² = 84.4% respectively. There was no significant change in weighted mean difference of glycosylated hemoglobin A1C (HbA1c) % and lipid profiles (mmol/L). Meta-regression did not show any factor significantly affecting the treatment response.

CONCLUSION

Cinnamon reduced FBG and HOMA-IR, level in T2DM and pre-diabetes patients compared to placebo. High heterogeneity observed among included studies warrants further clinical trials after standardization of cinnamon formulation.