Jump to content

Diabetes and Health-Related Quality of Life

Original Editor - Ally Youssouf Top Contributors - Olufemi Oyewole, Vidya Acharya, Mila Andreew, Uchechukwu Chukwuemeka, Ally Youssouf, Lucinda hampton, Kim Jackson, Lauren Lopez, Ewa Jaraczewska, Mary Akinwola, Aminat Abolade, Mohamed A Hassanin and Amanda Ager


Introduction

Improved Quality of life (QOL) has been regarded as a key goal of healthcare interventions for Diabetes (DM) management programs.

DM is a significant and growing healthcare challenge primarily because of increased physical inactivity, consumption of unhealthy diets, obesity and sedentary lifestyles. DM is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation. DM and its complications have contributed tremendously to the burden of mortality and disability worldwide.[1]

Diabetes often leads to the development of physical disabilities that, in turn, can harm a patient's quality of life (QOL). Literature suggests that people with diabetes have lower QOL in general, and that depression among people with type 2 diabetes (T2DM) further reduces the QOL.[2] Research has further established that depression in type I diabetes patients was more than 3 times higher than the normal range and 2 times higher in type 2 diabetes patients. [3]

The importance of optimising health-related QOL (HRQOL) has increasingly been recognised, not only because it represents an important goal for health care on its own but also because of the associations between poor HRQOL and adverse outcomes in people with type 2 diabetes, including poor response to therapy, disease progression, and even mortality.[4]

Global Burden of Type 2 Diabetes

T2DM is a global public health crisis that threatens the economies of all nations, particularly developing countries. In 2019, it was estimated that about 85-95% of all people living with diabetes in developing countries suffer from T2DM[5][6]. Diabetes mellitus (DM) and related complications have reached epidemic levels. According to the International Diabetes Federation (IDF) 2025 report[7]:

  • Globally, 589 million adults (those ranging from 20 to 79) have diabetes, accounting for 11.1% or 1 in 9 adults.
  • Approximately 252 million individuals, or more than 4 out of 10, do not know they have diabetes.
  • By 2050, the number of adults with diabetes is expected to reach 853 million, or 13% of the population.
  • T2DM is most commons and accounts for 90% of all diabetes globally.
  • In 2025, there will be approximately 9.50 million type 1 diabetics worldwide.
  • There is a higher risk of cardiovascular diseases, including a 72% higher risk of heart attack, a 52% higher risk of stroke, and an 84% higher risk of heart failure.
  • By 2050, Africa is expected to have the fastest growth rate, at 142%.
  • The prevalence and incidence of DM are increasing worldwide, and a rapid progression has been reported in middle- and low-income countries.[1]

This growing global number significantly impacts the quality of life of those affected with diabetes, creating substantial physical, psychological, and social burdens.

Quality of Life

Quality of life (QOL) is a multidimensional concept that measures a person’s well-being. As stated by the World Health Organisation (WHO), QOL can be defined as the "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."[8] The discussion and use of QOL as a measurable outcome in health has increased in recent decades as healthcare has shifted from a disease-focused biomedical model to a more holistic, well-being-focused biopsychosocial model. QOL has also become more important with improvements in medical treatments and disease management, leading to longer lives for people, particularly those living with chronic diseases. Examples of QOL assessments are the WHOQOL-BREF and WHOQOL-100.

[9]

Diabetes and HRQoL

T2DM is a complex and serious chronic disease that imposes a significant burden on patients and society in terms of morbidity and premature mortality [10]. In the long term, diabetic patients have to face many complications. HRQoL is a crucial outcome for individuals with T2DM and is used to assess the impact of the disease and its treatment on patients and healthcare costs. The disease itself can hurt the quality of life.

QoL studies have been recognised as an essential health outcome of all medical interventions and have become a core issue in diabetes care. They provide clinicians with important information to support clinical decision-making, taking both biomedical and psychosocial into consideration.

Persons with T2DM report lower HRQoL than the general population[11]. The leading causes of health-related quality of life (HRQoL) diminution are:

  1. Diabetes-related complications
  2. Episodes and fear of hypoglycaemia
  3. Change in lifestyle[12].

Several factors have been identified as predictors of HRQoL and diabetes-related quality of life in T2DM, including the following:

  • older age,
  • female sex,
  • depressive symptoms,
  • number of diabetic complications,
  • presence of comorbidities, and
  • insulin use [13].

Even after controlling for other variables, recent research indicates that individuals with diabetes and prediabetes had worse HRQoL than those with normal glucose levels [14]. This suggests that quality of life is impacted by glucose dysregulation prior to a formal diagnosis. The interconnectedness of HRQoL impacts in diabetes is further revealed by network analysis, highlighting the necessity of management approaches that take into account a variety of interrelated aspects [15].  

Physical Health Domain

The physical health domain assesses the impact of the disease on the

Research findings: Diabetes had a greater impact on the HRQoL of

  • Females and older patients (50 years and more)[17]
  • Those with a low level of education, sedentary work, and long duration of diabetes [18].
  • Foot problems, most frequently reported foot problems were pain and problems due to badly fitting footwear[19]
  • Those with peripheral neuropathy also had lower HRQol [20].

Beyond the effects of diabetes alone, comorbidities linked to type 2 diabetes can significantly decrease HRQoL. HRQoL is significantly impaired in people with type 2 diabetes who acquire severe liver fibrosis, according to research. These impacts are shown in a variety of health domains [21] This emphasises how crucial it is to monitor and treat hepatic problems in diabetic people to maintain their quality of life.


Impact on Cognitive Function

Both type 1 and type 2 diabetes are associated with mild to moderate decrements in cognitive function.

  • T2DM is usually diagnosed at an older age and is commonly associated with obesity, insulin resistance, hypertension and dyslipidemia, all of which can hurt the brain.
  • The underlying mechanism and the risk factors that may lead to the development of more severe cognitive dysfunction, like dementia in some but not all people with diabetes, are not well understood.

More studies are needed to understand the impact of mild to moderate decrements in cognitive function in the daily lives of people with diabetes.

  • A mild to moderate degree of cognitive impairment likely does not cause clinically significant problems in the day-to-day activities of most people with diabetes. However, it may present problems during more stressful and challenging situations.
  • People at the extremes of age are more likely to be at increased risk of developing a clinically significant decline in cognitive function[22].

Psychological Health Domain

Type 2 diabetes is frequently accompanied by depression, anxiety, and diabetic distress, all of which considerably lower HRQoL and frequently interfere with self-management [23]. Particularly for rural people with limited access to healthcare, social support can mitigate these impacts and improve results [24]. In clinical practice, it is important to highlight regular checks for diabetes distress, anxiety, and depression and encourage increased social support through community programs, family education, and peer groups.

Social Health Domain

The social domain assesses personal relationships, social support and sexual activity[16].

  • Social relationships were one of the main areas affected by people living with T2DM.

People value their relationships with themselves and with others. When an individual is no longer able to physically, emotionally, or sexually relate to self and others, quality of life is often negatively affected[25].

Social support lowers distress and enhances HRQoL in addition to helping with everyday diabetes care. Robust support networks assist patients in overcoming obstacles, with particularly noteworthy advantages for rural individuals who encounter healthcare obstacles. In addition to encouraging therapies like peer groups, family education, and community programs, clinicians should assess their patients' support systems [24].  

Measurement of HRQoL

There is are array of instruments (outcome measures) to assess HRQoL in type 2 diabetes. These outcome measures can be generic or diabetes-specific. Most of these outcome measures are patient-reported outcomes. Outcome measures that assessed functional status and psychological well-being have been identified in the literature as a subset of generic outcome measures in type 2 diabetes[26].

  • Generic HRQoL measures: They are generic preference-based measures that provide valuable health status information of patients with diabetes and allow comparisons with the general population and chronic health diseases[26][27][1]. See Table 1 below for examples of generic measures used in type 2 diabetes.
  • Psychological HRQoL measures: These assess functional status and psychological well-being (anxiety and depression) of the patient with type 2 diabetes[26]. See the table for types (Table 1).
  • Diabetes-specific HRQoL measures: These assess a specific aspect of diabetes, such as the presence of diabetes symptoms, attitudes, worries, self-care, treatment satisfaction, adherence to the diabetic regimen, locus of control, and social and family support[26]. See Table 1 for types of diabetes-specific measures.

Selecting Appropriate HRQoL Measures

Finding ideal tools to measure HRQoL in routine data collection among patients with diabetes could be tasking due to numerous such measures. Selection of suitable outcome measure is based on several factors that have been stated in the literature. However, it has been recommended to use the Appraisal of Diabetes Scale in combination with the SF-12 in clinical settings[28][2]. Also, Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Care Profile (DCP) and WBQ were promising diabetes-specific tools because of their good internal reliability, external and construct validity[29]. The outcome measures are summarised in the table below.

HRQoL measures used in type 2 diabetic populations

[26][30]
Generic quality of life questionnaires Psychological measures Diabetes-specific scales
Short Form 6D (SF-6D) Affect Balance Scale (ABS) Diabetes Quality of Life (DQOL)
Short Form 12 (SF-12) Center for Epidemiologic Studies-Depression (CES-D) Scale Diabetes-39 (D-39)
Short Form 20 (SF-20) Zung Self-Rating Depression Scale (ZSDS) ATT39 Scale
Short Form 36 (SF-36) Symptom Check-List 90-Revised (SCL-90-R) Problem Areas in Diabetes Survey (PAID)
Sickness Impact Profile (SIP) Hospital Anxiety and Depression Scale (HADS) Diabetes Care Profile (DCP)
Dartmouth COOP/WONCA Chart Beck Depression Inventory (BDI) Diabetes Health Profile (DHP)
Nottingham Health Profile (NHP) Profile of Mood State (POMS) Diabetes Impact Measurement Scales (DIMS)
Quality of Well-Being Scale (QWB)   Diabetes Health Status Questionnaire (DHS)
EuroQol (EQ-5D)   Perceived Control scales
Well-Being Questionnaire (WBQ)   Diabetes Treatment Satisfaction Questionnaire (DTSQ)
World Health Organization Quality of Life Questionnaire (WHOQOL)   Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ)
WHO-5 Index for QoL   The Diabetes Activities Questionnaire (TDAQ)
  Diabetes Fear of Injecting and Self-testing Questionnaire (D-FISQ)
  DSC-Type 2
  Audit of Diabetes-Dependent Quality of Life (ADDQoL)
  Appraisal of Diabetes Scale (ADS)
  Diabetes Distress Scale (DDS)
  Diabetes-Specific Quality of Life Scale (DSQoLS)
  Elderly Diabetes Burden Scale (EDBS)
  Insulin Delivery System Rating Questionnaire (IDSRQ)
  Quality of Life with Diabetes Questionnaire (LQD)
  Questionnaire on Stress in Diabetic patients-Revised (QSD-R)
  Well-being Enquiry for Diabetics (WED)

Innovative analytical techniques have been used in recent studies to gain a deeper understanding of HRQoL in diabetic populations. In order to assess HRQoL among populations with diabetes, prediabetes, and normal glycaemic management, propensity score matching has been used. This has made it possible to estimate the effects of diabetes on quality of life more precisely [14]. Also, to capture the multidimensional nature of quality of life determinants, network analytic approaches have been used to map the intricate interactions between factors impacting HRQoL, going beyond conventional linear models [15].

These methodological developments supplement conventional outcome measurements and give researchers and physicians a more complex picture of how diabetes impacts patients' lives in a variety of interrelated dimensions.

Role of Physiotherapy

The ultimate aim of diabetes care is to improve the quality of life of individuals [1]. Physical complications of diabetes can manifest as muscle weakness, pain, loss of balance, and lower limb dysfunction, all of which ultimately influence the health-related quality of life (HRQoL) of individuals [2]. Physiotherapists serve as essential members of the interdisciplinary diabetes care team, contributing to prevention, treatment, and ongoing management strategies.

Incorporating individualised physical activity programmes and patient education into diabetes management enables clinicians to prevent and control complications [31][4]. For individuals experiencing physical complications of diabetes, physiotherapists utilise evidence-based interventions including:

Exercise Therapy:

Structured exercise programming plays a fundamental role in diabetes management. Current evidence supports multiple exercise modalities with distinct physiological benefits, such as those seen with:

Aerobic Exercise: Improves cardiovascular fitness and metabolic function in individuals with diabetes. Research demonstrates improvements in insulin sensitivity, blood lipid profiles, and endothelial function through regular aerobic training [32] [33].

Resistance Training: Strengthens skeletal muscle and enhances metabolic control. Meta-analyses indicate that resistance exercise produces meaningful reductions in HbA1c levels and fasting blood glucose, with improvements in muscle mass, bone density, and insulin sensitivity [34]. Recent evidence suggests resistance training may offer comparable or superior glycaemic benefits to aerobic exercise alone for certain patient populations [35].

High-Intensity Interval Training (HIIT): Network meta-analyses examining multiple exercise types identify HIIT as producing the greatest HbA1c reductions amongst exercise modalities, with mean improvements ranging from 0.44% to 0.73% depending on baseline glycaemic control [36][37].

Combined Training: Concurrent aerobic and resistance training programmes demonstrate synergistic effects on cardiorespiratory fitness, metabolic health, and cardiovascular function [38]. A 2024 study identified optimal weekly physical activity doses of approximately 1,100 MET-minutes per week, with HbA1c reductions varying based on initial glycaemic status; from 1.02% reduction in severely uncontrolled diabetes to 0.24% in prediabetes [39].

Through developing individualised exercise regimens, physiotherapists help improve muscle strength, balance, and functional mobility, positively affecting the physical aspects of HRQoL in individuals with diabetes [31].

Behavioural Change Strategies:

Physiotherapists employ evidence-based behavioural techniques to facilitate long-term lifestyle modifications, such as:

Motivational Interviewing: This person-centred communication approach strengthens patient motivation and supports autonomous decision-making for health behaviour changes [32] [40]. The American Diabetes Association recognises motivational interviewing as an evidence-based strategy for diabetes self-management education [41]. Research demonstrates that motivational interviewing improves HbA1c, self-management behaviours, self-efficacy, and quality of life outcomes in adults with diabetes [42][43].

Goal-Setting and Problem-Solving: Behavioural interventions incorporating structured goal-setting, social support networks, and systematic problem-solving techniques have demonstrated improvements in glycaemic control [44].

Diabetes Self-Management Education: Educational sessions addressing blood glucose monitoring, nutrition, physical activity, and medication adherence form the foundation for sustained behavioural change, with family and social support playing crucial roles in habit formation [45].

Digital Health and Telerehabilitation:

Technological advances have expanded physiotherapy service delivery options to:

Remote Monitoring and Intervention: Telehealth-based physiotherapy interventions utilising video conferencing and telecommunication platforms provide accessible alternatives to traditional in-person care [46]. Systematic reviews indicate that motivational interviewing delivered via telehealth improves HbA1c, blood pressure control, diabetes self-efficacy, and physical activity levels [47].

Mobile Applications: Smartphone-based interventions incorporating motivational interviewing principles show promise for supporting diabetes self-management, though evidence suggests hybrid models combining automated technology with human coaching may optimise outcomes [48].

Wearable Technology: Integrating activity trackers and continuous glucose monitors into structured exercise programmes enables real-time feedback and personalised adjustment of physical activity prescriptions [49].

Through these comprehensive, evidence-based approaches, physiotherapists address the multifaceted needs of individuals with diabetes, optimising both physical function and metabolic control whilst supporting sustainable behavioural changes that enhance quality of life.

Role of Occupational Therapy

The role of occupational therapy in diabetes care is to improve treatment adherence, diabetes self-management abilities, and health-related quality of life.[50] Occupational therapists use activity-based treatments and psychosocial interventions that target multiple levels of influence, such as individual capacity, family, organisation, and community. Intervention sessions are held in participants’ homes or community locations. They also use text messaging to provide information and reminders.[51]

Occupational therapists facilitate self-management by making patients responsible for their nutrition, physical activities, insulin therapy, and glucose monitoring and also assist with psychosocial adaptations to chronic illness[50]. The intervention places a strong emphasis on developing habits and routines. Because habits depend on contextual cues, therapists help by assisting patients to modify cues if the original cue does not work (e.g., if setting an alarm does not help in remembering to take medicine, utilising a visual cue of placing evening medication on the nightstand may help).[51]

Resilient, Empowered, Active Living with Diabetes Program

The REAL Diabetes program (Resilient, Empowered, Active Living with Diabetes), an occupational therapy intervention focusing on the lifestyle-related activities, habits, and goals of ethnically diverse young adults with low socioeconomic status having type 1 or type 2 diabetes showed significant improvement in blood glucose control, diabetes-related quality of life, and blood glucose monitoring habits [52][51]. The program [50] provides a set of possible treatment options from which OT can select activities relevant to the patient's needs instead of fixed therapies that the patient needs to complete. The intervention comprises the following 7 modules:

  1. Assessment and goal setting
  2. Basic self-management knowledge and skills
  3. Self-advocacy in health care and community settings
  4. Establishment and maintenance of health-promoting habits and routines
  5. Seeking and receiving social support
  6. Enhancing emotional well-being
  7. Self-reflection and strategies to maintain long-term health.

First, the therapist carries out the initial assessment. Next, the occupational therapist offers personalised interventions based on the information from other modules and the patient's individual goals and personal factors (like readiness to change, personal preferences, and their prescribed diabetes management regimen).[50]Thus, the occupational therapist provides education, support patient in changing their behaviours and habits, plan ADLs in a systematic manner, and develop skills to self-manage diabetes, all of which contribute to improving quality of life.[53] .

Outcome Measures

The following tools can be used by occupational therapists in patients with diabetes to identify and prioritise activities, coping strategies, and emotional well-being: [54]

  • Canadian occupational performance measure (COPM): It helps assess an individual’s perceived occupational performance in self-care, productivity, and leisure.
  • Diabetes Empowerment scale (DES) and its short form (DES-SF): measures diabetes-related psychosocial self-efficacy
  • World Health Organisation-five well-being index (WHO-5): is a psychometric evaluation of emotional well-being, depression, and quality of life
  • Brief COPE: measures strategies for coping with stress-effective approach coping (active coping, acceptance, positive reframing, planning, use of emotional or instrumental support) and ineffective avoidant coping (denial, self-distraction, substance use, behavioural disengagement, venting and self-blame)

Conclusion

People with diabetes have a worse quality of life than those without diabetes, specifically in physical functioning and well-being.

Better control of blood sugar levels typically leads to an improved quality of life. Certain psychosocial characteristics, including health-related beliefs, social support, coping style, and personality, have a significant impact on quality of life, either directly or by mitigating the negative effects of diabetes.[55]. Also, physiotherapists play a significant role in managing the physical complications of diabetes to improve quality of life.

Different measures can be utilised to manage the quality of life change because of T2DM, which needs a strategic health policy.

References

  1. ↑ 1.0 1.1 1.2 Alshayban D, Joseph R. Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: a cross-sectional study. PLoS One. 2020 Jan 10;15(1):e0227573.
  2. ↑ 2.0 2.1 Mishra SR, Sharma A, Bhandari PM, Bhochhibhoya S, Thapa K. Depression and health-related quality of life among patients with type 2 diabetes mellitus: a cross-sectional study in Nepal. PloS one. 2015;10(11):e0141385.
  3. ↑ Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012;142 Suppl:S8-21. doi: 10.1016/S0165-0327(12)70004-6.
  4. ↑ 4.0 4.1 Landman GW, Van Hateren KJ, Kleefstra N, Groenier KH, Gans RO, Bilo HJ. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes care. 2010;33(11):2378-82.
  5. ↑ Fekadu G, Bula K, Bayisa G, Turi E, Tolossa T, Kasaye HK. Challenges And Factors Associated With Poor Glycemic Control Among Type 2 Diabetes Mellitus Patients At Nekemte Referral Hospital, Western Ethiopia. J Multidiscip Healthc. 2019;12:963-974.
  6. ↑ Guariguata L, Whiting D, Weil C, Unwin N. The International Diabetes Federation diabetes atlas methodology for estimating global and national prevalence of diabetes in adults. Diabetes Res Clin Pract. 2011;94(3):322-32. doi: 10.1016/j.diabres.2011.10.040.
  7. ↑ International Diabetes Federation. IDF Diabetes Atlas, 11th edition, 2025 global factsheet [Internet]. Brussels: International Diabetes Federation; 2025. Available from: https://diabetesatlas.org/media/uploads/sites/3/2025/04/IDF_Atlas_11th_Edition_2025_Global-Factsheet.pdf [Assessed 2025 Dec 21]
  8. ↑ Kuyken W, Orley J, Power M, Herrman H, Schofield H, Murphy B, et al. The world health organisation quality of life assessment (WHOQOL) - position paper from the world health organisation. Social Science & Medicine. 1995 Jan 1;41(10):1403–9.
  9. ↑ OECD. Quality of life: What matters to you? Available from: http://www.youtube.com/watch?v=yYNjXRVFnTc[last accessed 28/11/2025]
  10. ↑ Roglic G, N Unwin. Mortality Attributable to Diabetes: estimates for the year 2010. Diabetes Res Clin Pract. 2010;87(1):15-9. DOI:10.1016/j.diabres.2009.10.006.
  11. ↑ Ribu L, Hanestad BR, Moum T, Birkeland K, Rustoen T. A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a non-diabetes group from the general population. Qual Life Res. 2007; 16:179–189
  12. ↑ Akinci F, Yildirim A, Gözü H, Sargın H, Orbay E, Sargin M. Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey. Diabetes Research and Clinical Practice. 2008; 79:117–123
  13. ↑ Wexler DJ, Grant R, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, et al. Correlates of health-related quality of life in type diabetes. Diabetologia. 2006: 49(7):1489–1497
  14. ↑ 14.0 14.1 Li M, Liu N, Jiang G, Zeng H, Guo J, Wu D, et al. Health-related quality of life in populations with diabetes, prediabetes, and normal glycemic levels in Guangzhou, China: a cross-sectional study. Front Endocrinol (Lausanne). 2025;16:1518204. doi: 10.3389/fendo.2025.1518204.
  15. ↑ 15.0 15.1 Lu C, Li L, Qiao K, Qiao Z, Xiang Y, Zhou J, et al. Exploring Factors Influencing the Quality of Life in Diabetes: A Network Analysis-based Study. Frontiers in Psychiatry. 2024; 15: 1431772.
  16. ↑ 16.0 16.1 Skevington SM. Advancing cross-cultural research on quality of life. Observations are drawn from WHOQOL development. World Health Organisation Quality of Life Assessment. Quality of life Research. 2002; 11(2):135-144.
  17. ↑ Werfalli M, Kassanjee R, Kalula S, Kowal P, Phaswana-Mafuya N, Levitt NS. Diabetes in South African older adults: prevalence and impact on quality of life and functional disability - as assessed using SAGE Wave 1 data. Glob Health Action. 2018;11(1):1449924.
  18. ↑ Ronak N, Hussein, Saadia A, Khtheer, Tariq S, AlHadithi.Impact of diabetes on physical and psychological aspects of quality of life of diabetic in Erbil city. Iraq 2010; 4(2):4959.
  19. ↑ Sundaram M, Kavookjian J, Patrick JH, Miller LA, Madhavan SS, Scott VG. Quality of life, health status and clinical outcomes in Type 2 diabetes patients. Qual Life Res. 2007; 16(2):165–177.
  20. ↑ Smide B, Lukwale J, Msoka A, Wikblad K. Self-reported health and glycaemic control in Tanzanian and Swedish people with diabetes. Journal of Advanced Nursing. 2002; 37(2):182-191.
  21. ↑ Michel M, Funuyet-Salas J, Doll M, Alqahtani SA, Armandi A, Labenz C, et al. Impairment of health-related quality of life among people with type 2 diabetes and advanced liver fibrosis. Sci Rep. 2024;14(1):21650. doi: 10.1038/s41598-024-72105-8.
  22. ↑ Moheet A, Mangia S, Seaquist ER. Impact of diabetes on cognitive function and brain structure. Annals of the New York Academy of Sciences. 2015 Sep;1353:60. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837888/ (accessed 23.9.2021)
  23. ↑ Alwhaibi M. Depression, anxiety, and health-related quality of life in adults with type 2 diabetes. J Clin Med. 2024;13(20):6028. doi:10.3390/jcm13206028
  24. ↑ 24.0 24.1 Mahato S, Wen S, Misra R. The moderating role of social support in the association between diabetes distress and health-related quality of life in rural adults with type 2 diabetes. Med Res Arch. 2025;13(9). doi:10.18103/mra.v13i9.6918
  25. ↑ Biraguma J, Rhoda A. Peripheral neuropathy and quality of life of adults living with HIV/AIDS in the Rulindo district of Rwanda. SAHARA J. 2012;9(2):88-94. doi: 10.1080/17290376.2012.683582.
  26. ↑ 26.0 26.1 26.2 26.3 26.4 Luscombe FA. Health-Related Quality of Life Measurement in Type 2 Diabetes. Value in health. 2000; 3 (Suppl.1): S15-28
  27. ↑ Mulhern B, Meadows K. The construct validity and responsiveness of the EQ-5D, SF-6D and Diabetes Health Profile-18 in type 2 diabetes. Health and Quality of Life Outcomes 2014, 12:42.
  28. ↑ Nair R, Kachan P. Outcome tools for diabetes-specific quality of life. Can Fam Physician. 2017; 63:e310-5
  29. ↑ Levterova BA, Dimitrova DD, Levterov GE, Dragova EA. Instruments for disease-specific quality-of-life measurement in patients with type 2 diabetes mellitus--a systematic review. Folia Med (Plovdiv). 2013; 55(1):83-92.
  30. ↑ El Achhab Y, Nejjari C, Chikri M, Lyoussi B. Disease-specific health-related quality of life instruments among adults diabetic: A systematic review. Diabetes Research and Clinical Practice. 2008; 80(2):171–184
  31. ↑ 31.0 31.1 Jahantigh Akbari N, Hosseinifar M, Naimi SS, Mikaili S, Rahbar S. The efficacy of physiotherapy interventions in mitigating the symptoms and complications of diabetic peripheral neuropathy: A systematic review. J Diabetes Metab Disord. 2020;19(2):1995-2004. doi: 10.1007/s40200-020-00652-8.
  32. ↑ 32.0 32.1 Bohn B, Herbst A, Pfeifer M, Krakow D, Zimny S, Kopp F, et al. Impact of Physical Activity on Glycemic Control and Prevalence of Cardiovascular Risk Factors in Adults With Type 1 Diabetes: A Cross-sectional Multicenter Study of 18,028 Patients. Diabetes Care. 2015;38(8):1536-43. doi: 10.2337/dc15-0030.
  33. ↑ Janssen SM, Connelly DM, Gillis H. Physiotherapists' Perspectives on Type 2 Diabetes Management and as a Primary Condition for Referral to Physiotherapy Services: A Qualitative Descriptive Study. Physiother Can. 2024;76(3):282-294. doi: 10.3138/ptc-2022-0022.
  34. ↑ Su W, Tao M, Ma L, Tang K, Xiong F, Dai X, et al. Dose-response relationships of resistance training in type 2 diabetes mellitus: a meta-analysis of randomised controlled trials. Front Endocrinol (Lausanne). 2023;14:1224161.
  35. ↑ Janssen SM, Connelly DM, Gillis H. Educators' perspectives on the teaching and learning of type 2 diabetes content in physiotherapy programmes across Canada. Physiother Can. 2024;76(1):46-54.
  36. ↑ Garcia SP, Cureau FV, Iorra FQ, Bottino LG, Monteiro LERC, Leivas G, et al. Effects of exercise training and physical activity advice on HbA1c in people with type 2 diabetes: a network meta-analysis of randomised controlled trials. Diabetes Res Clin Pract. 2025;221:112027.
  37. ↑ Yan R, Chen L, Lin G, Shi Y, Huang W, Mai Y, et al. Comparative effectiveness of different exercise modality on glycaemic control and lipid profile for prediabetes: systematic review and network meta-analysis. Front Endocrinol (Lausanne). 2025;16:1518871. doi: 10.3389/fendo.2025.1518871.
  38. ↑ De Cock D, Schreurs L, Steenackers N, Pazmino S, Cools W, Eykerman L, et al. The effect of physical activity on glycaemic control in people with type 1 diabetes mellitus: A systematic literature review and meta-analysis. Diabet Med. 2024;41(10):e15415. doi: 10.1111/dme.15415.
  39. ↑ Gallardo-Gómez D, Salazar-Martínez E, Alfonso-Rosa RM, Ramos-Munell J, Del Pozo-Cruz J, Del Pozo Cruz B, et al. Optimal Dose and Type of Physical Activity to Improve Glycemic Control in People Diagnosed With Type 2 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care. 2024;47(2):295-303. doi: 10.2337/dc23-0800.
  40. ↑ Miller WR, Rollnick S. Motivational interviewing: helping people change and grow. 4rd ed. New York: Guilford Press; 2023.
  41. ↑ Beck J, Greenwood DA, Blanton L, Bollinger ST, Butcher MK, Condon JE, et al. 2017 National Standards for Diabetes Self-Management Education and Support. Diabetes Educ. 2017;43(5):449-464. doi: 10.1177/0145721717722968.
  42. ↑ Kaya Meral D, Kutlu FY. Effects of motivational interviewing intervention on self-management and HbA1c in type 2 diabetes patients. MAS J Appl Sci. 2024;9(1):100-110.
  43. ↑ Palacio A, Garay D, Langer B, Taylor J, Wood BA, Tamariz L. Motivational Interviewing Improves Medication Adherence: a Systematic Review and Meta-analysis. J Gen Intern Med. 2016;31(8):929-40. doi: 10.1007/s11606-016-3685-3.
  44. ↑ Song Y, Song HJ, Han HR, Park SY, Nam S, Kim MT. Unmet needs for social support and effects on diabetes self-care activities in Korean Americans with type 2 diabetes. Diabetes Educ. 2012;38(1):77-85. doi: 10.1177/0145721711432456.
  45. ↑ ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2023. Diabetes Care. 2023;46(Supple 1):S68-S96. doi: 10.2337/dc23-S005.
  46. ↑ Man SS, Wen H, Chiu KT, Wang F, Chan HS. Effectiveness of Telephysiotherapy in Improving Older Adults' Physical and Psychological Outcomes: A Systematic Review and Meta-Analysis. Healthcare (Basel). 2024;12(17):1775. doi: 10.3390/healthcare12171775.
  47. ↑ McDaniel CC, Kavookjian J, Whitley HP. Telehealth delivery of motivational interviewing for diabetes management: A systematic review of randomized controlled trials. Patient Educ Couns. 2022;105(4):805-820. doi: 10.1016/j.pec.2021.07.036.
  48. ↑ Yoon S, Tang H, Tan CM, Phang JK, Kwan YH, Low LL. Acceptability of Mobile App-Based Motivational Interviewing and Preferences for App Features to Support Self-Management in Patients With Type 2 Diabetes: Qualitative Study. JMIR Diabetes. 2024;9:e48310. doi: 10.2196/48310.
  49. ↑ Vilafranca-Cartagena M, Bonet-Augè A, Colillas-Malet E, Puiggrós-Binefa A, Tort-Nasarre G. Physical Activity Interventions in People with Diabetes: A Systematic Review of The Qualitative Evidence. Healthcare (Basel). 2024;12(14):1373. doi: 10.3390/healthcare12141373.
  50. ↑ 50.0 50.1 50.2 50.3 Shen X, Shen X. The Role of Occupational Therapy in Secondary Prevention of Diabetes. Int J Endocrinol. 2019;2019:3424727. doi: 10.1155/2019/3424727.
  51. ↑ 51.0 51.1 51.2 Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, et al. Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomised controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemporary clinical trials. 2017;54:8-17.
  52. ↑ Pyatak EA, Carandang K, Vigen CL, Blanchard J, Diaz J, Concha-Chavez A, Sequeira PA, et al. Occupational therapy intervention improves glycemic control and quality of life among young adults with diabetes: The Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) randomized controlled trial. Diabetes care. 2018; 41(4):696-704.
  53. ↑ Christopherson K, Janssen M, Merchlewicz N. Occupational Therapy Interventions for People with Type 2 Diabetes in Rural Communities.
  54. ↑ Bahadır Ağce Z, Ekici G. Person-centred, occupation-based intervention program supported with problem-solving therapy for type 2 diabetes: a randomized controlled trial. Health and Quality of Life Outcomes. 2020 Dec;18(1):1-4.
  55. ↑ Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205-218.
Retrieved from "https://www.physio-pedia.com/w/index.php?title=Diabetes_and_Health-Related_Quality_of_Life&oldid=374415"