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ORIGINAL ARTICLE
Year : 2020  |  Volume : 13  |  Issue : 4  |  Page : 311-314  

Quality of life of patients with type 2 diabetes mellitus: A cross-sectional study


1 Department of Physiotherapy, Tilak Maharashtra Vidyapeeth, Pune, Maharashtra, India
2 PT School and Center, Seth GS Medical College and KEM Hospital, Mumbai, Maharashtra, India
3 Department of Medicine, Smt. Kashibai Navle Medical College, Pune, Maharashtra, India

Date of Submission23-Dec-2019
Date of Decision23-Dec-2019
Date of Acceptance27-Jan-2020
Date of Web Publication20-Jul-2020

Correspondence Address:
Ujwal L Yeole
Tilak Maharashtra Vidyapeeth, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/mjdrdypu.mjdrdypu_353_19

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  Abstract 


Background: Diabetes mellitus, a chronic noncommunicable disease, is associated with long-term damage of multiple organ system with its long-term complications and significantly impacts upon the quality of life (QoL) of affected patients. Methods: A survey was carried out on 245 patients during thirty sessions of diabetes outpatient department at multispecialty hospitals, among which 228 patients agreed for the participation. A final survey was carried on 200 patients, whereas 28 patients did not fit into the criteria. Further evaluation was carried out using the World Health Organization QoL-BREF questionnaire in Hindi, English, and Marathi versions. The mean score and total score of domains were calculated to check the QoL of the patients. Results: Almost 72% of the participants mentioned good QoL in physical domain with 18% mentioning average QoL. Around 35% mentioned excellent QoL in psychological domain with 46% mentioning good QoL. Around 55% mentioned good QoL in social domain. Majority of participants mentioned good (23%) to excellent (71%) QoL in environmental domain. The physical domain demonstrated a mean score of 66.6 ± 9.303 (min 44, max 94). The psychological domain demonstrated the mean score of 70.9, ±15.558, (min 5, max 94). The social domain demonstrated the mean score of 75.96, ±15.245, (min 31, max 100). The environmental domain demonstrated the mean score of 82.19, ±13.211, (min 31, max 100). Conclusion: Overall patients mentioned average-to-good QoL in physical, psychological, and social domain, and a majority of patients had good QoL in environmental domain.

Keywords: Diabetes-related factors, quality of life, type 2 diabetes mellitus


How to cite this article:
Yeole UL, Jiandani MP, Kunjir SR, Bhat SM. Quality of life of patients with type 2 diabetes mellitus: A cross-sectional study. Med J DY Patil Vidyapeeth 2020;13:311-4

How to cite this URL:
Yeole UL, Jiandani MP, Kunjir SR, Bhat SM. Quality of life of patients with type 2 diabetes mellitus: A cross-sectional study. Med J DY Patil Vidyapeeth [serial online] 2020 [cited 2020 Dec 1];13:311-4. Available from: https://www.mjdrdypv.org/text.asp?2020/13/4/311/290179




  Introduction Top


Diabetes mellitus (DM) is associated with long-term damage of multiple organ systems with increased age-adjusted mortality rates. DM, a chronic noncommunicable disease, carries with its long-term complications and significantly impacts on the quality of life (QoL) of the affected patients. Diabetic patients have to take hypoglycemic medications for prolonged periods and also exert strict dietary norms to maintain healthy blood sugar level.[1]

Diabetes is a demanding disease and naturally, the life of every person with diabetes is unique. The life experience of diabetes has been mentioned to be “Diabetes Overwhelmus” (i.e., poor QoL) since so many people feel overwhelmed by the continuous burden of their disease and its management.[1]

The association between well-being and glycemic control has been assessed in various studies. Some studies also showed a positive effect on health-related QoL (HRQoL) with improved glycemic control, whereas others showed a neutral or negative effect on HRQoL. It is not known whether impaired glycemic control leads to lower QoL or lower QoL leads to impaired glycemic control.[2]

They have to adhere to the advice for exercises on a daily basis to lose the weight so that blood sugar levels are under control, thereby preventing complications. QoL is a very important factor that is positively related to treatment adherence, and a good QoL motivates the patient to manage the disease and achieve health and happiness in the long terms.[3]

The World Health Organization (WHO) defined QoL as 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. Therefore, person's physical health definition of QoL includes psychological state, level of person's independence, social life, and personal beliefs. In spite of diabetes, people should aim to carry out their daily activities without difficulty.[4]

Currently, India is considered the “Diabetes Capital” of the world. This is because the largest number of people with diabetes lives in this country. The International Diabetes Federation estimated that the number of diabetics in India has doubled between 1995 and 2005, and by 2025, it would reach a figure of about 70 million. India plays a unique role in the diabetes picture of the world. Compared to any other ethnic groups, Asian Indians have a higher propensity to insulin resistance, DM, and coronary artery disease.[5]

The WHO also stated that health was defined not only by the absence of disease and infirmity but also by the presence of physical, mental, and social well-being.[5] Adults are increasingly prone to negative feelings, regarding themselves as burdens to their descendants. Some people, after retirement, tend to feel lost and shunted sideways by the society. The change in the quantity and structure of the adults leads to changes in disease pattern, including changes of QOL.[6]

For this reason, diabetes care and management requires continuous and committed efforts from the diabetic person. This incorporates such factors as home blood glucose monitoring, meal plan, regular exercise, and good compliance of medication. The overall goal for the treatment of all diabetes is to prevent acute and chronic complications, while preserving a good QoL for the patients.[7]

Besides, the trouble of taking oral antidiabetic agents several times a day, the fear of subcutaneous injection of insulin, and incidents of hypoglycemia might depress diabetic patients and further reduce HRQoL. Diabetes can impact your QOL in many ways.[2]

Physical symptoms like fatigue or the neuropathic pain are one of them. It also includes mental symptoms such as depression due to impaired health or fear of future complications affecting the QoL. These emotional and social burdens may be compounded by the acute physical distress of hypoglycemia or hyperglycemia and by the chronic physical distress of diabetes related.[1]

Some demographic variables are associated with QoL in people with diabetes, just as they are in the general population. Men usually tend to have better QoL than women. Younger people generally report better QoL than older people. According to some demographic variables, it is said that the more educated or has good income generally have better QoL than those with less of either.[2]

Quality-of-life research in diabetes will begin to realize its potential when a design, implement, and evaluate interventions that influence factors that affect QoL. Among these factors, coping skills may be the critical one. People with diabetes, who are not active or effective copers, may benefit from interventions that are designed to enhance their coping skills. A sedentary lifestyle is considered to be a risk factor for type 2 diabetes leading to poor QoL. Exercise is a key treatment for people living with diabetes.[2]


  Methods Top


This study was carried out as a part of the screening phase of a research project registered under (CTRI/2018/01/011193) approved by the institutional ethical committee with the approval number: (IEC II/338/18).

An exploratory cross-sectional survey was carried out on diabetic patients visiting medicine outpatient departments at affiliated hospitals in Pune to determine the QoL in patients with Type 2 DM. Patients visiting diabetic clinics were approached (total 245) among which 228 agreed for participation in the survey.

The patients within the age of 35–60 years, both males and females, and patients diagnosed with Type 2 diabetes for more than 1 year were included in the study, and patients with Type 1 and gestational diabetes were excluded from the study. A total of 28 patients did not fit in the criteria so were excluded. A final survey was carried out on 200 diabetic individuals. The patients who agreed for participation in the survey were further interviewed using WHOQOL-BREF questionnaire in Hindi, English, and Marathi by a trained interviewer.

Before participation, patients were instructed and explained about the aims, objectives, and method of study, and informed consent was obtained from the participants.

The WHOQOL-BREF questionnaire is categorized into physical, psychological, social, and environmental domains. The physical domain includes the factors such as the activity of daily living, dependency on medicinal substances, energy and fatigue, pain and discomfort, sleep, rest, and work capacity. The psychological domain includes factors based on bodily appearance, positive and negative feelings, personal beliefs, and it also incorporated thinking memory and concentration. The social domain includes factors such as social relationships which describe about personal relationships, social support, and sexual activities, and the environmental domain includes factors such as financial resources, freedom, physical safety, health and social care, participation in leisure activities, and about the physical environment. Accordingly, patients were interviewed and the results were formulated.

Data management and statistical analysis

The collected data was tabulated and analysed using Microsoft Excel 2010 and Instat [DATASETI. ISD] Software.


  Results Top


A total of 200 patients with the mean age of 55 years (84 males and 116 females) interviewed for the QoL in patients with type 2 diabetes. The mean body mass index (BMI) observed in males was 26 ± 5.66 kg/m2 and as compared to females was 26.6 ± 5.26 kg/m2. The mean duration of diabetes of the males was 9.88 ± 9.56 years and that of females was 7.077 ± 6.31 years. The mean hemoglobin A1c (HbA1c) of the male patients was 7.35% ± 1.047% and those of the female patients was 6.98% ± 1.37%. [Figure 1], [Figure 2], [Figure 3], [Figure 4], show the variations of haemoglobin A1c with physical, psychological, social and environmental domains.
Figure 1: Variation in hemoglobin A1c with physical domain

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Figure 2: Variation in hemoglobin A1c with psychological domain

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Figure 3: Variations in hemoglobin A1c with social domain

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Figure 4: Variations in hemoglobin A1c with environmental domain

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  Discussion Top


The current study demonstrated the QoL of patients diagnosed with type 2 diabetes and attending follow-up clinic. Diabetes is considered to be the most common noncommunicable disease globally. For many years, exercise, along with diet and medication, has been considered equally important for diabetes therapy.

Exercise training results in a variety of physiological and metabolic adaptations in both nondiabetic and diabetic individuals. The role of exercise has long been recognized in the treatment regimen of type 2 diabetic patients, and aerobic endurance exercise has traditionally been advocated as the most suitable exercise mode.[3]

To evaluate QoL and glycemic control in patients, the average (random) Blood Sugar Levels (BSL) of the females included in our study were 176 with a standard deviation of 42.2, whereas in males, it was 207 with a standard deviation of 61.5, and the HbA1c values of males were higher (i.e., 7.35) than females (i.e., 6.98).

The physical domain [Figure 1] in this study demonstrates the mean score of 66.6 ± 9.303 which showed the minimum QoL score in diabetic patient, whereas the environmental domain [Figure 4] demonstrated the mean score of 82.19 ± 13.211, which is the maximum QoL scores, whereas in the psychological domain [Figure 2] and the social domain [Figure 3] demonstrated good QOL with the score of 70.9 ± 15.55 and 75.96 ± 15.24, respectively.

The current study showed that physical domain in this study had a minimum score of 44 and maximum score of 94. The minimum and the maximum scores in the psychological domain were 5 and 94, respectively. The social domain showed minimum score of 31 and the maximum score of 100. The environmental domain also showed similar maximum and minimum scores.

In our study, [Table 1] represents, domain wise 72% had good physical QoL, 46% had good psychological QoL, 55% had good social QoL, and 71% had excellent environmental QoL. In a study done by Manjunath et al., it was stated that domain wise 63% had good physical QoL, 69% had good psychological QoL, 27% had good social QoL, and 85% had good environmental QoL.
Table 1: Quality of life measured in according to domains

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Manjunath et al. also stated that patient-reported outcomes such as QoL need to be incorporated into the assessment of diabetes and its follow-up. While treating patients with diabetes in the clinic, this should be taken into consideration that it might not be easy to modify clinical outcomes with good services and support, but it might be much more effective in bringing a change in QoL. Thus, QoL measurements should become a routine part of the clinical management of diabetic patients.[6]

Pibernik-Okanović et al. in their study indicated that introducing insulin therapy in patients with type 2 DM and sustained elevated HbA1c levels might positively affect their QOL. Improvement of glycemic control by the addition of insulin therapy may increase HRQoL because of a reduction in hyperglycemic symptoms and an associated reduction in morbidity. Furthermore, overtreatment and episodes of hypoglycemia and other side effects can also impact the QoL.[8]

People with higher HbA1c generally had lower HRQoL which showed negative associations between blood pressure, blood lipid, and HRQoL. Impaired HRQoL was found in people with higher BMI. Smokers had worse HRQoL than their nonsmoker counterparts. In general, patients who were under diet treatment had better HRQoL than patients on drug or insulin therapies.[3]

Redekop WK and Redekop studies showed that there was no sign of association between QoL and duration. The duration of diabetes was not associated with QoL, but our study stated longer duration of diabetes was associated with poor QoL in males than females.[1],[9]

Hence, due to the lack of literature, the study will help to improve the condition of such patients and also improve QoL.


  Conclusion Top


Overall participants mentioned average-to-good QoL in physical, psychological, and social domain, and a majority of participants had good QoL in environmental domain.

Acknowledgment

The authors would like to acknowledge Dr Shreepad Bhat, Diabetologist at Affiliated Hospital for his kind support through conducting this survey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Rubin RR. Diabetes and quality of life. Diabetes Spectrum;13: 2000-21.  Back to cited text no. 1
    
2.
Javanbakht M, Abolhasani F, Mashayekhi A, Baradaran HR, Jahangiri noudeh Y. Health related quality of life in patients with type 2 diabetes mellitus in Iran: a national survey. PLoS One 2012;7:e44526.  Back to cited text no. 2
    
3.
Kiadaliri AA, Najafi B, Mirmalek-Sani M. Quality of life in people with diabetes: a systematic review of studies in Iran. J Diabetes Metab Disord 2013;12:54.  Back to cited text no. 3
    
4.
Harsimran S, Clare B. Quality of life in diabetes. Int J Diabetes Dev Ctries 2006;26:7-10.  Back to cited text no. 4
    
5.
Manjunath K, Christopher P, Gopichandran V, Rakesh PS, George K, Prasad JH. Quality of life of a patient with type 2 diabetes: A cross-sectional study in rural South India. J Family Med Prim Care 2014;3:396-9.  Back to cited text no. 5
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6.
Singh RK, Pattanshetty S, Nair S. Quality of life among type 2 diabetes patients in Udupi taluk: A cross-sectional study. Int J Med Sci Public Health 2016;5:1846-50.  Back to cited text no. 6
    
7.
Rana AK, Wahlin A, Lundborg CS, Kabir ZN. Impact of health education on health-related quality of life among elderly persons: Results from a community-based intervention study in rural Bangladesh. Health Promot Int 2009;24:36-45.  Back to cited text no. 7
    
8.
Pibernik-Okanović M, Szabo S, Metelko Z. Quality of life following a change in therapy for diabetes mellitus. Pharmacoeconomics 1998;14:201-7.  Back to cited text no. 8
    
9.
Redekop WK, Koopmanschap MA, Stolk RP, Rutten GE, Wolffenbuttel BH, Niessen LW. Health-related quality of life and treatment satisfaction in dutch patients with type 2 diabetes. Diabetes Care 2002;25:458-63.  Back to cited text no. 9
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]



 

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