Health-related quality of life in type 1 and type 2 diabetic patients in a Portuguese central public hospital

Insulin therapy in type 2 diabetes: Insights into clinical efficacy, patient-reported outcomes, and adherence challenges

Insulin therapy plays a crucial role in the management of type 2 diabetes as the disease progresses. Over the past century, insulin formulations have undergone significant modifications and bioengineering, resulting in a diverse range of available insulin products. These products show distinct pharmacokinetic and pharmacodynamic profiles. Consequently, various insulin regimens have em-erged for the management of type 2 diabetes, including premixed formulations and combinations of basal and bolus insulins. The utilization of different insulin regimens yields disparate clinical outcomes, adverse events, and, notably, patient-reported outcomes (PROs). PROs provide valuable insights from the patient's perspective, serving as a valuable mine of information for enhancing healthcare and informing clinical decisions. Adherence to insulin therapy, a critical patient-reported outcome, significantly affects clinical outcomes and is influenced by multiple factors. This review provides insights into the clinical effectiveness of various insulin preparations, PROs, and factors impacting insulin therapy adherence, with the aim of enhancing healthcare practices and informing clinical decisions for individuals with type 2 diabetes.

Perceptions and correlates of distress due to the COVID-19 pandemic and stress management strategies among people with diabetes: a mixed methods study

Background

Greater risk of adverse health outcomes and public health measures have increased distress among people with diabetes during the coronavirus-2019 (COVID-19) pandemic. The objectives of this study were to explore how the experiences of people with diabetes during the COVID-19 pandemic differ according to sociodemographic characteristics and identify diabetes-related psychosocial correlates of COVID distress.

Methods

Patients with type 1 or 2 diabetes were recruited from clinics and community health centres in Toronto, Ontario, as well as patient networks. Participants were interviewed to explore the experiences of people with diabetes with varied sociodemographic and clinical identities, with respect to wellness (physical, emotional, social, financial, occupational), level of stress and management strategies. Multiple linear regression was used to assess the relationships between diabetes distress, diabetes self-efficacy and resilient coping with COVID distress.

Results

Interviews revealed that specific aspects of psychosocial wellness affected by the pandemic, and stress and illness management strategies utilized by people with diabetes differed based on socioeconomic status, gender, type of diabetes and race. Resilient coping (β=−0.0517; 95% confidence interval [CI], −0.0918 to −0.0116; p=0.012), diabetes distress (β=0.0260; 95% CI, 0.0149 to 0.0371; p<0.0001) and diabetes self-efficacy (β=−0.0184; 95% CI, −0.0316 to −0.0052; p=0.007) were significantly associated with COVID distress.

Conclusions

Certain subgroups of people with diabetes have experienced a disproportionate amount of COVID distress. Assessing correlates of COVID distress among people with diabetes will help inform interventions such as diabetes self-management education to address the psychosocial distress caused by the pandemic.

Quality of Life among Diabetics: A Cross-Sectional Study in a Tertiary Care Center of Rohtak, Haryana

Introduction:

The most severe health threats dominating the low- and middle-income countries are no longer the dreaded communicable diseases; but, they are everyday diseases due to changes in lifestyle, which are the noncommunicable diseases. Quality of life (QOL) is defined by the World Health Organization as an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards, and concerns. QOL assessment in health system is a multidimensional construct that can be measured by evaluating objective levels of health status filtered by the subjective perceptions and expectations of the individual.

Aim and Objective:

To assess the QOL among diabetics attending the endocrine outpatient department (OPD) in a tertiary care hospital of Haryana.

Materials and Methods:

A hospital-based cross-sectional study was conducted at endocrinology OPD of Pt. B. D. Sharma PGIMS Rohtak, Haryana from May 2014 to April 2015. Five hundred diabetics (Type 1 and 2) were recruited for the study. Patients registered on the day of interview were selected using systematic random sampling. A predesigned, pretested, semi-structured schedule which included sociodemographic variables of the study participants along with information about family history of diabetes was filled by interviewing the study subjects in their vernacular language individually. Generic instrument, SF-36 v2 was used to assess the QOL.

Results:

The mean age of the study participants was 50.41 ± 9.1 years. The mean disease duration was 6.12 ± 5.55 years. Majority of our respondents belonged to Hindu religion (97.4%). The mean scores for the bodily pain domain (79.52 ± 28.15) and social functioning domain (76.47 ± 26.10) of QOL were the highest.

Conclusion:

The mean scores for the bodily pain domain and social functioning domain of QOL were the highest. Assess the QOL in patients with diabetes by measuring the multiple domains involving physical, psychological and social aspects.

The Relationship Between Family Support and Quality of Life Improvement of Patients with Diabetes Mellitus in Semarang

Introduction: Diabetes mellitus (DM) is known as the silent killer, where sufferers often do not realize its signs and symptoms and are frequently diagnosed during another health complication. To maintain quality of life, the family is required to provide support, therefore, this study aims to determine the relationship between family and the patient through observational analytic research.Methods: 120 people with DM make up the research sample using an accidental sampling technique, and data analysis was carried out using the Spearman rank test. The results found that 62 respondents (51.7%) agreed to their families providing good support, and 102 (85%) were satisfied with their quality of life.Results: The Spearman test resulted in a P value of 0,000 and R of 0.334. This means the higher the support provided by the family, the greater the increase in quality of life.Conclusion: The suggestions proposed from this study is for health workers to advocate and encourage family in the planning management of DM sufferers in order to improve their quality of life.

Health profile and medication adherence of diabetic patients in the Portuguese population

AIMS

To understand the psychological and behavioural impact of type 2 diabetes in the Portuguese Primary Care setting.

METHODS

Observational, cross-sectional study of a convenience sample of portuguese people diagnosed with type 2 diabetes mellitus. The Diabetes Health Profile (DHP-18) and the Four Item Morisky Medication Adherence Scale (MMAS-4) were applied, as well as socio-demographic and disease-related questions.

RESULTS

In a n=110 patient sample, lower education level showed a negative impact on the Psychological Distress dimension (p=0,013). In the Barriers to activity dimension, significant differences were found between different age groups (p=0,033) - a better health profile was observed in the 40-59 years group and also between gender (p=0,039) - greater impact in female subjects. Disinhibited Eating dimension wasn't associated with any of the studied variables. However, all the groups showed worse results in this domain. No associations were found between DHP and medication adherence. Worse medication adherence is more common when there is a prevailing notion of lack of control of diabetes.

DISCUSSION AND CONCLUSION

Using DHP, a larger negative impact related to type 2 diabetes mellitus is found in those with lower educational level, female and younger (20-39 years) or older (60-79 years) subjects. Broader information strategies aimed at improving the quality of life of diabetic patients is necessary, particularly those related to nutrition.

Evaluating the Direct and Indirect Effects of SF-36 Domains Score on Two Main Factors in Diabetic Patients with Path Analysis: Health-Related Quality of Life Study

Background and aims: Diabetes mellitus (DM) patients have a lower quality of life. This study aimed to examine the direct and indirect effect of eight domains score of the SF-36 questionnaire on two main factors, i.e., overall physical health (GH_M) and overall mental health (MH_M), in DM patients. To the best of our knowledge, this issue has been rarely studied so far.

Material and method: A total of 1037 DM patients filled out the Persian version of the SF-36 questionnaire. The path analysis was used in this study.

Results: In this research, only social functioning (SF) domain has significantly lower the men compared to women (P=0.06). Physical functioning (PF), bodily pain (BP), general health (GH) and vitality (VT) have a negative significant direct effect on the GH_M factor. GH domain also has a positive indirect and total effect on MH_M factor, and other domains have no significant total effect on MH_M factor.

Conclusion: It is better that physicians, focus on regulating physical activity and reducing body pain in diabetes patients, which have the most direct impact on HRQoL, to achieve a more effective outcome in improving quality of life in this patient.

Predictors of Health-Related Quality of Life Among Patients with Type II Diabetes Mellitus Who Are Insulin Users: A Multidimensional Model

BACKGROUND

Diabetes Mellitus is a progressive, chronic and multifactorial endocrine disorder characterized by elevated serum glucose levels. It has a direct effect to social and health related quality of life.

OBJECTIVE

This study aimed to determine the health-related quality of life among patients with type II diabetes mellitus (T2DM) using insulin therapy.

METHODS

Cross-sectional observational study design was used to collect data from Malaysian patients with T2DM. Subjective and objective assessments were made either by using several questionnaires or each patient's specific medication profile registered to care sites. Study participants were recruited from both public hospitals and community health clinics located in Kuala Lumpur, Malaysia.

RESULTS

A total of 430 patients with T2DM were recruited in this study with a response rate of 94.7%. The oral antidiabetic medication (OAM) group consisted of 63.0% of the study population and the rest (37.0%) were Insulin users. The body mass index and glycosylated hemoglobin patterns were significantly different between groups (P < 0.011 and P < 0.001). Insulin users showed high percentages of healthy body mass index index (44.7%) compared with OAM users (35.8%) and controlled glycemic index (glycosylated hemoglobin ≤7.5%) was significantly (P = 0.001) better among the insulin-user group compared with the OAM group. The Euro Quality of Life-5 dimension domain analysis indicated significant differences with domains of usual work (P < 0.047), pain and discomfort (P < 0.041), and anxiety and depression (P < 0.001) among insulin users versus OAM users. We also observed a significant difference between the groups regarding diet, monitoring, and disease-specific knowledge. The mean (SD) adherence score showed that insulin users were significantly (P < 0.001) more adherent (6.09 [2.98]) than OAM were nonadherent (4.19 [4.68]).

CONCLUSIONS

This study suggests the valuable effect of insulin therapy among patients with T2DM compared with OAMs on health-related quality of life, medication adherence, and health state. Insulin users reported they had better diabetes-related knowledge and treatment adherence characteristics than noninsulin users.

Metabolic factors that affect health-related quality of life in type 2 diabetes patients: a multivariate regression analysis

PURPOSE

In the past few decades, an increase in the life span of the population has caused more people to experience chronic diseases, such as type 2 diabetes. Since chronic diseases influence the whole life of patients and do not have a specific remedy, improving their health-related quality of life (HRQoL) becomes more important. The aim of the present study was to investigate the metabolic variables that influenced HRQoL questionnaire scores most significantly among patients with type 2 diabetes.

PATIENTS AND METHODS

The population of this cross-sectional study included 163 patients with type 2 diabetes and 214 healthy people who were asked to complete the HRQoL questionnaire, and their metabolic blood variables were recorded simultaneously. The effects of metabolic variables and some other demographic ones on two main scales of HRQoL, Mental Component Summary (MCS) and Physical Component Summary (PCS), were evaluated using multivariate regression.

RESULTS

Multivariate regression analysis showed that PCS score was most negatively influenced by cigarette smoking (P=0.009, β-15.761), maximum blood pressure (P=0.008, β=-0.108), minimum blood pressure (P=0.009, β=-0.039), low-density lipoprotein cholesterol (P=0.008, β=-0.721), cholesterol (P=0.006, β=-0.648), HbA1c (P=0.004, β=-0.878), FBS (p=0.006, β=-0.769), and body mass index (BMI) (P=0.034, β=-0.287). The MCS score was influenced positively by smoking cigarettes (P=0.041, β=13.032), gender (P=0.018, β=15.633), and BMI (P=0.048, β=-0.088). Men had a higher MCS score compared to women.

CONCLUSION

The HRQoL questionnaire (as a concept of health) score could be improved by controlling the variation of some metabolic variables in patients with type 2 diabetes. Some metabolic variables could be the main causes of a decrease in physical and mental HRQoL among patients with type 2 diabetes.

Profile and predictors of health related quality of life among type II diabetes mellitus patients in Quetta city, Pakistan

Background

This study aims to assess the profile and predictors of Health-Related Quality of Life (HRQoL) in Type II Diabetes Mellitus (T2DM) patients in Quetta, Pakistan.

Methods

The study was designed as a questionnaire based, cross sectional analysis. 300 Type II diabetic patients attending public and private hospitals were targeted for data collection. In addition to demographic and disease related information, Euroqol Quality of Life was used to measure HRQoL. Moreover, Drug Attitude Inventory and Michigan Diabetes Knowledge Test were used to assess medication adherence and diabetes related knowledge respectively. Treatment satisfaction was assessed by patient’s experience towards health care professionals and available facilities. Descriptive statistics were used to elaborate patients’ demographic and disease related characteristics. Binary logistic regression was used to predict factors independently associated with HRQoL. SPSS v. 20 was used for data analysis and p < 0.05 was taken as significant.

Results

Patients in the current study reported poor HRQoL with a mean score of 0.48 ± 0.36. Age, duration of disease, number of prescribed drugs, medication adherence and treatment satisfaction were significantly associated (p < 0.05) with HRQoL in the cross tabulation analysis. The significant variables were entered into the model that showed significant goodness of fit with highly significant Omnibus Test of Model Coefficient (Chi-square = 12.983, p = 0.030, df = 4). Medication adherence was reported as a significant predictor of HRQoL with an increase of one adherence score was associated with improvement of HRQoL by a factor of 1.75 provided other variables remain constant.

Conclusion

The study presents a model that is associated with HRQoL with patient with T2DM, where medication adherence shaped as a predictor of HRQoL. Healthcare professionals should pay special attention on patients’ medication taking behavior and should put their efforts in explaining the benefits of the medication adherence to the patients.