Diabetes and Health-Related Quality of Life: Difference between revisions

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<div class="editorbox"> '''Original Editor '''- [[User:User Name|Ally Youssouf]] '''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}</div>
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==Type 2 Diabetes==
[[Diabetes Mellitus Type 2|Diabetes]] is a chronic disease with considerable impact on health status and [[Quality of Life|quality of life]] and it is considered an urgent public health issue because it has a pandemic potential<ref>Boyle JP, Honeycutt A, Narayan KM. Projection of diabetes burden through 2050. Diabetes Care. 2001; 24:1936-40</ref>. The World Health Organization (WHO) suggested a subdivision into four main groups of diabetes; Type I diabetes, Type II diabetes, gestational diabetes and other specific types (heterogenic group) <ref>Sleire L. Diabetes a neglected disease in sub –Sahara Africa: A Comparative study between Rwanda and Norway [dissertation]. Norway: University of Oslo. 2011</ref>. Type 2 diabetes is a global public health crisis that threatens the economies of all nations, particularly developing countries. Fueled by rapid urbanization, nutrition, and an increasingly sedentary lifestyle, the epidemic has grown in parallel with the worldwide rise in obesity<ref name=":1">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 Dec;94(3):322-32. doi: 10.1016/j.diabres.2011.10.040.
</ref>.


===The Global Burden of Type 2 Diabetes===
==Introduction==
Once a disease of the west, type 2 diabetes has now spread to every country in the world. Once “a disease of affluence” it is now increasingly common among the poor. Once an adult-onset disease, almost unheard of in children, the rising rate of childhood obesity rendered it more common in the pediatric population. Diabetes is increasing most rapidly in developing countries, where industrialization and urbanization have led to the adoption of a western lifestyle. The world prevalence of diabetes in 2010 among adults (aged 20-79 years) was estimated at 6.4% affecting 285 million adults. By 2030 it is expected to increase to 7.7% and affecting 438 million adults with two-third of all diabetes cases occurring in low-to middle-income countries<ref name=":1" />.
[[File:Diabetes-528678 960 720.jpg|right|frameless|449x449px]]
Improved [[Quality of Life|Quality of life (QOL)]] has been regarded as a key goal of healthcare interventions for  Diabetes (DM) management programs.


===Etiology and Pathogenesis of Type 2 Diabetes===
DM is a significant and growing healthcare challenge primarily because of increased [[Physical Inactivity|physical inactivity]], consumption of unhealthy diets, [[obesity]] and sedentary lifestyles. DM is a major cause of blindness, [[Chronic Kidney Disease|kidney failure]], [[Myocardial Infarction|heart attacks]], [[stroke]] and lower limb amputation. DM and its complications have contributed tremendously to the burden of mortality and disability worldwide.<ref name=":5">Alshayban D, Joseph R. [https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0227573#sec013 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. Available:https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0227573#sec013 (accessed 22.9.2021)</ref>
Type II diabetes is characterized by insulin resistance in peripheral tissues but may range from predominantly insulin resistance with relative insulin deficiency, to a predominantly secretory defect with or without insulin deficiency. Insulin resistance is an impaired response to the physiologic effects of insulin, and diabetes is only one of the manifestations of the insulin resistance syndrome commonly associated with type II diabetes. Other manifestations of this syndrome include [[obesity]], nephropathy, hypertension, dyslipidemia, ovarian hyperandrogenism and non-alcoholic fatty liver disease<ref>Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ.Type 2 diabetes in children and adolescents. Pediatric diabetes. 2009;10( Suppl 12):17-32.</ref>.


=== Contributing Factors of Type 2 Diabetes ===
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 ([[Diabetes Mellitus Type 2|T2DM]]) further reduced the QOL.<ref>Mishra SR, Sharma A, Bhandari PM, Bhochhibhoya S, Thapa K. [https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141385#sec014 Depression and health-related quality of life among patients with type 2 diabetes mellitus: a cross-sectional study in Nepal]. PloS one. 2015 Nov 23;10(11):e0141385.Available: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141385#sec014<nowiki/>(accessed 22.9.2021)</ref> Researches have further established that [[depression]] in type I diabetes patient was more than 3 times higher than normal range and 2 times higher in type 2 diabetes patients. <ref>Roy T, Lloyd CE. Epidemiology of depression and diabetes: a systematic review. J Affect Disord. 2012 Oct;142 Suppl:S8-21. doi: 10.1016/S0165-0327(12)70004-6. PMID: 23062861.</ref>
Type 2 diabetes is increasing most quickly in developing countries where: rapid uncontrolled urbanization and major changes in lifestyle towards western diets, increased food quantity with reduced quality, low levels of exercise, smoking and increased alcohol availability as well as increased life expectancy could be driving this epidemic <ref>Phillips DI, Barker DJ, Hales CN, Hirst S, Osmond C.Thinness at birth and insulin resistance in adult life. Diabetologia. 1994;37(2):150-154</ref>. Risk factors for [[Diabetes Mellitus Type 2|type 2 diabetes mellitus]] include old age, increased body mass index (BMI) and a certain body fat distribution, weight gain in adulthood, ethnicity, family history of diabetes, low birth weight, sedentary lifestyle, higher systolic blood pressure, impaired glucose tolerance, impaired fasting glucose, and history of [[gestational diabetes]]. It is estimated that about 85-95% of all people living with diabetes in developing countries suffer from type 2 diabetes<ref>Gerstein C, Mann J, Yi Q, Zinman B. Albuminuria and Risk of Cardiovascular Events, Death, and Heart Failure in Diabetic and Non diabetic Individuals. JAMA 2001; 286:421-426</ref>.


==Quality of Life Dimensions==
The importance of optimizing health-related QOL (HRQOL) has increasingly been recognized, 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.<ref>Landman GW, Van Hateren KJ, Kleefstra N, Groenier KH, Gans RO, Bilo HJ. [https://care.diabetesjournals.org/content/33/11/2378 Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18)]. Diabetes care. 2010 Nov 1;33(11):2378-82. Available:https://care.diabetesjournals.org/content/33/11/2378 (accessed 22.9.2021)</ref>
Quality of life is a complex and multidimensional concept that is difficult to define and measure<ref>Casado A. Measurement of quality of life of HIV individuals future directions. Indian Journal of Medical Research. 2005; 112:282-284</ref>. The subjective dimension of quality of life has been defined as the individual’s ability to perform and enjoy social roles, work roles, family roles, and community roles and shows how good a life each individual feels he or she has, incorporated also personal satisfaction with life, meaning of life, well- being and happiness. The objective dimension means how one’s life is perceived by the outside world, their described quality of life in material terms” related to income, possessions and career success<ref>Søren V, Joav M, Niels JA. Quality of Life Theory I. The IQOL Theory: An  Integrative Theory of the Global Quality of Life Concept. The Scientific World Journal  2003; 3:1030-1040.</ref>.


===Diabetes and Health Related Quality of Life===
== Global Burden of Type 2 Diabetes ==
Diabetes is not a single disease but a heterogeneous group of syndromes characterized by an elevation of blood glucose which may affect the patient physically, mentally and emotionally. The patients’ perception of how diabetes may affect their physical, psychological and social functioning is related to diabetes-specific health-related quality of life.Type II diabetes mellitus is a complex and serious chronic disease that imposes a significant burden on patients and society in a term of morbidity and premature mortality <ref>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. </ref>. In the long term, diabetic patients have to face many complications. In addition to diabetes-related complications, episodes and fear of hypoglycemia and change in lifestyle are the main cause of health-related quality of life (HRQoL) diminution<ref>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</ref>.
[[Diabetes Mellitus Type 2|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<ref>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. Published 2019 Nov 22. doi:10.2147/[https://pubmed.ncbi.nlm.nih.gov/31819470/ JMDH.S232691]</ref><ref name=":1">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 Dec;94(3):322-32. doi: 10.1016/j.diabres.2011.10.040.
</ref>. Diabetes mellitus (DM) and related complications have reached epidemic levels. According to the International Diabetes Federation (IDF) 2021 report:


In recent years QoL has been recognized as an important health outcome of all medical interventions and has become a core issue in diabetes care. QoL studies may provide clinicians with important information to support clinical decision making, taking both biomedical and psychosocial into Consideration. However, persons with type 2 diabetes report lower HRQoL than the general population<ref>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</ref>.  
* 10.5 percent of adults aged 20–79 years (537 million adults) had DM globally in 2021
* Of the above, 90% had type 2 diabetes mellitus (T2DM).
* The prevalence and incidence of DM are increasing worldwide, and a rapid progression has been reported in middle- and low-income countries.<ref name=":5" />
* The IDF predicts a 46 percent increase in the DM population between 2022 and 2045 on a world level. The highest tendency is reported on the African continent, with a 134 percent increase. <ref name=":6">Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF [https://pubmed.ncbi.nlm.nih.gov/34879977/ Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045]. ''Diabetes Research and Clinical Practice'', ''183'', 109119. <nowiki>https://doi.org/10.1016/j.diabres.2021.109119</nowiki></ref>
* Furthermore, estimates have established that 240 million people are currently living with undiagnosed diabetes worldwide.<ref name=":6" />


HRQoL is an important outcome for persons with type II diabetes, as it has been used to evaluate the impact of the disease and its treatment on individuals and health care costs. The disease itself can have a negative impact on the quality of life. Several factors have been identified as predictors of HRQoL and diabetes-related quality of life in type 2 diabetes, including older age, female sex, depressive symptoms, number of diabetic complications, presence of comorbidities, and insulin use <ref>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</ref>. HRQoL provides a multidimensional perspective that encompasses a patient's physical, emotional, and social functioning<ref>International Diabetes Federation. Epidemiology and morbidity. 2009.</ref>. Generally, patients with more than one co-morbid condition report the poorest level of HRQoL, but some chronic conditions, like cancer, cardiovascular and pulmonary diseases, and diabetes mellitus, are more strongly associated with poor HRQoL than others  <ref>Egede LE. Disease-focused or integrated treatment: diabetes and depression. Med Clin North Am. 2006 90(4):627–646.</ref>. However, less is known as regards differences in HRQoL in different regions of the world.
==Quality of Life ==
[https://www.physio-pedia.com/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.''"<ref>Willem Kuyken, John Orley, Mick Power, Helen Herrman, Hilary Schofield, B. Murphy, Željko Metelko, Silvija Szabo, Mirjana Pibernik-Okanović, N. Quemada, A. Caria, S. Rajkumar, S. Kumar, Shekhar Saxena, Dan Bar-On, M. Amir, M. Tazaki, A. Noji, G. Vanheck, . . . G. Burkovsky. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. ''Social Science &Amp; Medicine'', ''41''(10), 1403–1409. <nowiki>https://doi.org/10.1016/0277-9536(95)00112-k</nowiki></ref> The discussion and use of QOL as a measurable [[Outcome Measures|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|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 Disease|chronic diseases]]. Examples of QOL assessments are the [[WHOQOL-BREF]] and [[WHOQOL-100]]. 
{{#ev:youtube|yYNjXRVFnTc}}<ref>"Quality of life: What matters to you?"YouTube, uploaded by OECD, 31 May 2016,www.youtube.com/watch?v=yYNjXRVFnTc</ref>
 
== Diabetes and HRQoL ==
T2DM is a complex and serious [[Chronic Disease|chronic disease]] that imposes a significant burden on patients and society in a term of morbidity and premature mortality <ref>Roglic G, N Unwin. [https://pubmed.ncbi.nlm.nih.gov/19914728/ 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. </ref>. In the long term, diabetic patients have to face many complications. HRQoL is an important outcome for persons with T2DM and is used to evaluate the impact of the disease and its treatment on individuals and healthcare costs. The disease itself can have a negative impact on the quality of life.
 
QoL studies have been recognized 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 Considerations for Traumatic Brain Injury|psychosocial]] into consideration. 
 
Persons with T2DM report lower HRQoL than the general population<ref>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</ref>. The leading causes of health-related quality of life (HRQoL) diminution are:
 
# Diabetes-related complications
# Episodes and fear of [[hypoglycemia]]
# Change in lifestyle<ref>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</ref>.
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 <ref>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</ref>.


====Physical Health Domain====
====Physical Health Domain====
The physical health domain assesses the impact of the disease on the activity of daily living, dependence on medical substances, a lack of energy and initiative, restricted mobility and the capacity to work<ref name=":4">Skevington SM. Advancing cross-cultural research on quality of life . Observations drawn from WHOQOL development. World Health Organisation Quality of Life Assessment. Quality of life Research. 2002; 11(2):135-144.</ref>. Physical health gives an individual the ability to perform and adapt to the environment. Physical health is estimated by an individual’s perceptions of energy and fatigue, pain and discomfort, and sleep and rest. The physical health domain has shown a positive relationship with the overall quality of life when one’s physical status was reported as high, perceptions were physical health and quality of life was more positive <ref>Sousa KH, Holzemer WL, Henry WL, Slaughter R. Dimensions of health related quality of life in persons living with HIV disease, Journal of Advanced Nursing. 1999; 29(1):178-187.</ref>. Based on the study conducted in Iraq in 2010 which reported that Diabetes had a greater impact on the QoL of females and older patients (50 years and more) than on the QoL of males and the young. Older diabetics (50 years and more) were affected more physically than psychologically. Factors that decrease physical and psychological domains of QoL were gender (being female), aged 60 years and more, low level of education, sedentary type of work and long duration of diabetes. Therefore, changes in HRQoL should be considered in the management of all people with diabetes in all health care settings <ref>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.</ref>.
The physical health domain assesses the impact of the disease on the  


In a follow-up study on Self-Care, [[Diabetic Neuropathy|Foot Problems]] and Health in Tanzanian Diabetic Patients and Comparisons with Matched Swedish Diabetic patients it was founded that more Tanzanian than Swedish patients experienced foot problems. The most frequently reported foot problem in Tanzanian patients was pain, whereas Swedish patients mostly experienced problems due to badly fitting footwear. Tanzanians with peripheral neuropathy (PN) reported significantly poorer health than those free from late foot complications, whereas those with [[Peripheral Arterial Disease|peripheral vascular disease]] (PVD) had health scorings equal to those without any late foot complications<ref>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.</ref>. The relation between PN, peripheral vascular disease (PVD) and self-perceived health in Tanzanian patients Tanzanians with PN had lower scores, indicating poorer health, in all eight health domains in comparison with those free from foot complications. Significantly lower scores were found in the health domains of physical functioning, and role functioning. Thus, PN could be an influencing factor in patients’ perceived health <ref>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.</ref>.
* [[Activities of Daily Living|activities of daily living]]
* dependence on [[Pharmacological Management of Diabetes Mellitus|medical substances]]
* a lack of energy and initiative, 
* restricted mobility 
* capacity to work<ref name=":4">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.</ref>.
[[File:Diabetic foot.jpg|thumb]]
Research findings: Diabetes had a greater impact on the HRQoL of 


====Psychological Domain====
* Females and older patients (50 years and more)<ref>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. doi:10.1080/[https://pubmed.ncbi.nlm.nih.gov/29699475/ 16549716.2018.1449924]</ref>
The psychological domain accesses the patient’s own thoughts about body image and appearance, negative feelings, self-esteem and personal beliefs<ref name=":4" />. Psychological well being is the focus of intense research attention and is relevant to the experience of the individual<ref name=":4" />. It is a person's evaluative reaction to his or her life; either in terms of life satisfaction (cognitive evaluations) or effects (ongoing emotional reaction). Psychological well being has been found to be a source of resilience against stress and becoming ill<ref name=":4" />. The impact of diabetes on quality of life and general quality of life was different between males and females<ref>Santiprabhob J, Kiattisakthavee P, Likitmaskul S,Chaichanwattanakul K, Wekawanich J,et al.Glycemic control, quality of life and self-care behavior among adolescents with type 1 diabetes who attended a diabetes camp. 2005: 43: 172-184.</ref>. Similarly Miksch A et al <ref>Miksch A, Hermann K, Trieschmann J, Roelz A, Heiderhoff M, Laux G, et al. Gender specific  differences in quality of life of patients with type 2 diabetes with or without participating in DMP. Gesundheitswesen. 2008;  70(4): 250-255.</ref> found gender-specific differences within the quality of life of patients with diabetes.  
* Those with a low level of education, sedentary work, and long duration of diabetes <ref>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.</ref>.
* [[Foot Pain|Foot problems]], most frequently reported foot problems were pain and problems due to badly fitting footwear<ref>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.</ref>
* Those with [[Neuropathic Pain|peripheral neuropathy]] also had lower HRQol <ref>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.</ref>.
 
 
====Impact on Cognitive Function====
[[File:Cognition.png|right|frameless]]
Both type 1 and type 2 diabetes are associated with mild to moderate decrements in [[Cognitive Impairments|cognitive function]]. 
 
* T2DM is usually diagnosed at an older age and is commonly associated with obesity, [[Insulin Resistance|insulin]] resistance, [[hypertension]] and dyslipidemia, all of which can have a negative impact on 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.
 
* 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 clinically significant decline in cognitive function<ref>Moheet A, Mangia S, Seaquist ER. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4837888/ 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)</ref>.


====Social Health Domain====
====Social Health Domain====
According to Skevington<ref name=":4" />. social domain assesses personal relationship, social support and sexual activity. Social relationships were one of the main area affected in people living with type 2 diabetes. People value their relationship with self 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<ref name=":0">Biraguma J. Peripheral neuropathy and quality of life of adults living with HIV/AIDS in Rulindo district in Rwanda: A cross-sectional study [dissertation]. South Africa:University of the Western Cape. 2009</ref>. The study conducted at Turkey in urban primary healthcare in 2012 has concluded that female participants reported a better sex life than did males; younger participants’ social life was better than that of older participants (≥ 51 years); divorced, widowed and single participants’ social life was better than that of those who were married; and participants without complication had better family relationships, sex life, sport/ leisure, and travel opportunities than those with complications<ref name=":2">Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205-218.</ref>.
The social domain assesses personal relationships, social support and sexual activity<ref name=":4" />.  
 
* 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<ref name=":0">Biraguma J. Peripheral neuropathy and quality of life of adults living with HIV/AIDS in Rulindo district in Rwanda: A cross-sectional study [dissertation]. South Africa: University of the Western Cape. 2009</ref>.


==Measurement of HRQoL==
==Measurement of HRQoL==
There are arrays of instruments (outcome measures) to assess HRQoL in type 2 diabetes. These [[Outcome Measures|outcome measures]] can be generic or diabetes-specific measures. 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 sub-set of generic outcome measures in type 2 diabetes<ref name=":3">Luscombe FA. Health-Related Quality of Life Measurement in Type 2 Diabetes. Value in health. 2000; 3 (Suppl.1): S15-28</ref>.
There are arrays of instruments (outcome measures) to assess HRQoL in type 2 diabetes. These [[Outcome Measures|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 sub-set of generic outcome measures in type 2 diabetes<ref name=":3">Luscombe FA. Health-Related Quality of Life Measurement in Type 2 Diabetes. Value in health. 2000; 3 (Suppl.1): S15-28</ref>.
* Generic HRQoL measures: They are generic preference-based measures which provide valuable health status information of patients with diabetes and allow comparisons with the general population and chronic health diseases<ref name=":3" /><ref>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. DOI:10.1186/1477-7525-12-42.</ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304018/]. See table 1 below for examples of generic measures used in type 2 diabetes.
* 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<ref name=":3" /><ref>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. DOI:10.1186/1477-7525-12-42.</ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4304018/]. 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<ref name=":3" />. See the table for types (Table 1).
* Psychological HRQoL measures: These assess functional status and psychological well-being (anxiety and [[depression]]) of the patient with type 2 diabetes<ref name=":3" />. 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<ref name=":3" />. See the table 1 for types of diabetes-specific measures.
* 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<ref name=":3" />. See the Table 1 for types of diabetes-specific measures.


===Selecting Appropriate HRQoL 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 types of such measures. [[Guide to Selecting Outcome Measures|Selection of suitable outcome measure]] is based on several factors which had been stated in the literature. However, it has been recommended the use of Appraisal of Diabetes Scale in combination with the SF-12 in clinical settings<ref>Nair R, Kachan P. Outcome tools for diabetes-specific quality of life. Can Fam Physician. 2017; 63:e310-5</ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471097/]. Also, Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Care Profile (DCP) and WBQ were promising diabetes-specific tools because of its good internal reliability, external and construct validity<ref>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.</ref>.
Finding ideal tools to measure HRQoL in routine data collection among patients with diabetes could be tasking due to numerous such measures. [[Guide to Selecting Outcome Measures|Selection of suitable outcome measure]] is based on several factors that had 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<ref>Nair R, Kachan P. Outcome tools for diabetes-specific quality of life. Can Fam Physician. 2017; 63:e310-5</ref>[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471097/]. 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<ref>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.</ref>. The outcome measures are summarized in the table below.  


==Conclusion==
=== HRQoL measures used in type 2 diabetic populations ===
In a review of quality of life and diabetes, Rubin and Peyrot conclude that people with diabetes have worse quality of life than do those without diabetes, specifically in the areas of physical functioning and well-being. Better glucose control generally improves quality of life, and some psychosocial factors (health-related beliefs, social support, coping style, and personality) have a powerful effect on quality of life either directly or through their capacity to buffer the negative effects of diabetes<ref name=":2" />. It is clear that different measures can be utilized to manage the quality of life change because of Diabetes type 2 and this needs strategic health policy. 
{| class="wikitable"
{| class="wikitable"
|+Table 1: HRQoL measures used in type 2 diabetic populations<ref name=":3" /><ref>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</ref>[https://www.valueinhealthjournal.com/article/S1098-3015(11)70016-X/pdf?_returnURL=https%3A%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS109830151170016X%3Fshowall%3Dtrue][https://reader.elsevier.com/reader/sd/037593BACE7F3157188C0369E8B6576A42E22F0815297770FBB32D2AF3A4BBBA02EC9A62DA569EEBD4E1DEA8D57C6D6C]
|+<ref name=":3" /><ref>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</ref>
!
!
{| class="wikitable"
{| class="wikitable"
Line 58: Line 102:
|Diabetes  Quality of Life (DQOL)
|Diabetes  Quality of Life (DQOL)
|-
|-
|Short Form 12 (SF-12)
|[[12-Item Short Form Survey (SF-12)|Short Form 12 (SF-12)]]
|Center for  Epidemiologic Studies-Depression (CES-D) Scale
|Center for  Epidemiologic Studies-Depression (CES-D) Scale
|Diabetes-39 (D-39)
|Diabetes-39 (D-39)
|-
|-
|Short Form 20 (SF-20)
|[https://www.rand.org/health-care/surveys_tools/mos/20-item-short-form/survey-instrument.html Short Form 20 (SF-20)]
|Zung  Self-Rating Depression Scale (ZSDS)
|Zung  Self-Rating Depression Scale (ZSDS)
|ATT39 Scale  
|ATT39 Scale
|-
|-
|Short Form 36 (SF-36)
|[[36-Item Short Form Survey (SF-36)|Short Form 36 (SF-36)]]
|Symptom  Check-List 90-Revised (SCL-90-R)
|Symptom  Check-List 90-Revised (SCL-90-R)
|Problem Areas  in Diabetes Survey (PAID)
|Problem Areas  in Diabetes Survey (PAID)
|-
|-
|Sickness  Impact Profile (SIP)
|[[Sickness  Impact Profile (SIP)]]
|Hospital  Anxiety and Depression Scale (HADS)
|[https://www.riverviewpractice.co.uk/website/S55150/files/HADS.pdf Hospital  Anxiety and Depression Scale (HADS)]
|Diabetes Care  Profile (DCP)
|Diabetes Care  Profile (DCP)
|-
|-
Line 78: Line 122:
|Diabetes  Health Profile (DHP)
|Diabetes  Health Profile (DHP)
|-
|-
|Nottingham  Health Profile (NHP)
|[[Nottingham Health Profile|Nottingham  Health Profile (NHP)]]
|Profile of Mood State (POMS)
|Profile of Mood State (POMS)
|Diabetes  Impact Measurement Scales (DIMS)
|Diabetes  Impact Measurement Scales (DIMS)
|-
|-
|Quality of  Well-Being Scale (QWB)
|[https://www.sralab.org/rehabilitation-measures/quality-well-being-and-self-administered-version Quality of  Well-Being Scale (QWB)]
| 
| 
|Diabetes  Health Status Questionnaire (DHS)
|Diabetes  Health Status Questionnaire (DHS)
Line 94: Line 138:
|Diabetes  Treatment Satisfaction Questionnaire (DTSQ)
|Diabetes  Treatment Satisfaction Questionnaire (DTSQ)
|-
|-
|World Health  Organization Quality of Life Questionnaire (WHOQOL)
|[https://www.who.int/tools/whoqol World Health  Organization Quality of Life Questionnaire] (WHOQOL)
| 
| 
|Diabetes  Quality of Life Clinical Trial Questionnaire (DQLCTQ)
|Diabetes  Quality of Life Clinical Trial Questionnaire (DQLCTQ)
|-
|-
|WHO-5 Index for QoL
|[https://ogg.osu.edu/media/documents/MB%20Stream/who5.pdf WHO-5 Index for QoL]
| 
| 
|The Diabetes  Activities Questionnaire (TDAQ)
|The Diabetes  Activities Questionnaire (TDAQ)
Line 108: Line 152:
|
|
| 
| 
|DSC-Type 2  
|DSC-Type 2
|-
|-
|
|
Line 136: Line 180:
|
|
| 
| 
|Quality of Life with Diabetes questionnaire (LQD)
|Quality of Life with Diabetes Questionnaire (LQD)
|-
|-
|
|
Line 146: Line 190:
|Well-being Enquiry for Diabetics (WED)
|Well-being Enquiry for Diabetics (WED)
|}
|}
|}  
|}
 
== Role of Physiotherapy ==
The ultimate aim of diabetes care is to improve the quality of life of the individuals <ref>Jing, X., Chen, J., Dong, Y. ''et al.'' Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis. ''Health Qual Life Outcomes'' 2018;16, 189 . <nowiki>https://doi.org/10.1186/s12955-018-1021-</nowiki>[https://hqlo.biomedcentral.com/articles/10.1186/s12955-018-1021-9#citeas 9]</ref>. Physical complications of diabetes can be in the form of muscle weakness, pain, loss of balance and lower limb dysfunction, all of which can ultimately influence the HRQoL of individuals  <ref>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. Journal of Diabetes & Metabolic Disorders. 2020;19(2):1995–2004.</ref>. Physiotherapists play a crucial role in the management of the physical symptoms of diabetes. By incorporating individualized physical activity and patient education in the management of diabetes, complications can be prevented.
 
Likewise, for individuals with physical complications of diabetes, physiotherapists employ techniques such as:
 
* [[Therapeutic Exercise|Exercise therapy]]: Exercise therapy through physical activity plays a substantial role in managing diabetes. By developing a structured and individualized regimen, exercise can help improve the strength of weak muscles, gait pattern and balance. Hence, engaging in physical activities positively affects the physical aspect of  HRQoL of individuals with diabetes <ref>Kaur, Jaspreet and Singh ''et al.''. Physiotherapy and rehabilitation in the management of Diabetes mellitus: A Review. Indian Journal of Scientific Research.2015,6;171-181. https://www.researchgate.net/publication/303182927_Physiotherapy_and_rehabilitation_in_the_management_of_Diabetes_mellitus_A_Review</ref>.
* [[Motivational Interviewing|Motivation Interviewing]]: The physiotherapist aims to create long-term changes to the patient's lifestyle with motivational interviewing. More than just exercises, the physiotherapist tries to engage the patient's motivation in the therapeutic process to create a therapeutic alliance and enhance greater daily behaviour changes. <ref>Grant P. Motivational interviewing in diabetes care, By MP Steinberg and WR Miller: New York, NY: Guilford Press, 2015. Clin Med (Lond). 2016 Apr;16(2):205. doi: 10.7861/clinmedicine.16-2-205. PMCID: PMC4952982.</ref>
 
== 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''.<ref name=":7">Shen X, Shen X. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6681589/ The role of occupational therapy in secondary prevention of diabetes.] International Journal of Endocrinology. 2019 Jul 24;2019.</ref> Occupational therapists use activity-based treatments and psychosocial interventions that target multiple levels of influence, such as individual capacity, family, organization, and community. Intervention sessions are held in participants’ homes or community locations. They also use text messaging to provide information and reminders.<ref name=":8">Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312749/pdf/nihms843813.pdf Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults.] Contemporary clinical trials. 2017 Mar 1;54:8-17.</ref>
 
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<ref name=":7" />. 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, utilizing a visual cue of placing evening medication on the nightstand may help).<ref name=":8" />
 
=== 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 <ref>Pyatak, E.A., Carandang, K., Vigen, C.L., Blanchard, J., Diaz, J., Concha-Chavez, A., Sequeira, P.A., Wood, J.R., Whittemore, R., Spruijt-Metz, D. and Peters, A.L., 2018. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5860833/ 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'', ''41''(4), pp.696-704.</ref><ref>Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5312749/pdf/nihms843813.pdf Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults.] Contemp Clin Trials. 2017 Mar;54:8-17. </ref>. The program <ref name=":7" /> 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 7 following modules: 
 
# Assessment and goal setting
# Basic self-management knowledge and skills
# Self-advocacy in health care and community settings
# Establishment and maintenance of health-promoting habits and routines
# Seeking and receiving social support
# Enhancing emotional well-being
# 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).<ref name=":7" />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''.<ref>Christopherson K, Janssen M, Merchlewicz N. [https://commons.und.edu/cgi/viewcontent.cgi?article=1009&context=cat-papers Occupational Therapy Interventions for People with Type 2 Diabetes in Rural Communities.]</ref> .
 
=== Outcome Measures ===
The following tools can be used by occupational therapists in patients with diabetes in order to identify and prioritise activities, coping strategies, and emotional well-being: <ref>Bahadır Ağce Z, Ekici G. [https://hqlo.biomedcentral.com/articles/10.1186/s12955-020-01521-x 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.</ref> 
 
* [https://www.sralab.org/rehabilitation-measures/canadian-occupational-performance-measure 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 ([https://www.shropscommunityhealth.nhs.uk/content/doclib/13952.pdf DES-SF]): measures  diabetes-related psychosocial self-efficacy
* [https://ogg.osu.edu/media/documents/MB%20Stream/who5.pdf World Health Organisation-five well-being index] (WHO-5): is a psychometric evaluation of emotional well-being, depression, and quality of life
* [https://www.sralab.org/rehabilitation-measures/brief-coping-problems-experienced 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 glucose control generally improves quality of life, and some psychosocial factors (health-related beliefs, social support, coping style, and personality) have a powerful effect on quality of life either directly or through their capacity to buffer the negative effects of diabetes<ref name=":2">Rubin RR, Peyrot M. Quality of life and diabetes. Diabetes Metab Res Rev. 1999;15(3):205-218.</ref>. Also, physiotherapists play a significant role in managing the physical complications of diabetes to improve quality of life. 
 
It is clear that different measures can be utilized to manage the quality of life change because of T2DM, which needs strategic health policy. 


'''References'''
== References ==
<references />
<references />
[[Category:Diabetes]]
[[Category:Diabetes]]

Latest revision as of 14:32, 7 September 2023

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


Introduction[edit | edit source]

Diabetes-528678 960 720.jpg

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 reduced the QOL.[2] Researches have further established that depression in type I diabetes patient was more than 3 times higher than normal range and 2 times higher in type 2 diabetes patients. [3]

The importance of optimizing health-related QOL (HRQOL) has increasingly been recognized, 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[edit | edit source]

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) 2021 report:

  • 10.5 percent of adults aged 20–79 years (537 million adults) had DM globally in 2021
  • Of the above, 90% had type 2 diabetes mellitus (T2DM).
  • The prevalence and incidence of DM are increasing worldwide, and a rapid progression has been reported in middle- and low-income countries.[1]
  • The IDF predicts a 46 percent increase in the DM population between 2022 and 2045 on a world level. The highest tendency is reported on the African continent, with a 134 percent increase. [7]
  • Furthermore, estimates have established that 240 million people are currently living with undiagnosed diabetes worldwide.[7]

Quality of Life[edit | edit source]

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[edit | edit source]

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

QoL studies have been recognized 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 hypoglycemia
  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].

Physical Health Domain[edit | edit source]

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

Diabetic foot.jpg

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

  • Females and older patients (50 years and more)[15]
  • Those with a low level of education, sedentary work, and long duration of diabetes [16].
  • Foot problems, most frequently reported foot problems were pain and problems due to badly fitting footwear[17]
  • Those with peripheral neuropathy also had lower HRQol [18].


Impact on Cognitive Function[edit | edit source]

Cognition.png

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 have a negative impact on 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.

  • 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 clinically significant decline in cognitive function[19].

Social Health Domain[edit | edit source]

The social domain assesses personal relationships, social support and sexual activity[14].

  • 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[20].

Measurement of HRQoL[edit | edit source]

There are arrays 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 sub-set of generic outcome measures in type 2 diabetes[21].

  • 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[21][22][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[21]. 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[21]. See the Table 1 for types of diabetes-specific measures.

Selecting Appropriate HRQoL Measures[edit | edit source]

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 had 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[23][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[24]. The outcome measures are summarized in the table below.

HRQoL measures used in type 2 diabetic populations[edit | edit source]

[21][25]
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)

Role of Physiotherapy[edit | edit source]

The ultimate aim of diabetes care is to improve the quality of life of the individuals [26]. Physical complications of diabetes can be in the form of muscle weakness, pain, loss of balance and lower limb dysfunction, all of which can ultimately influence the HRQoL of individuals [27]. Physiotherapists play a crucial role in the management of the physical symptoms of diabetes. By incorporating individualized physical activity and patient education in the management of diabetes, complications can be prevented.

Likewise, for individuals with physical complications of diabetes, physiotherapists employ techniques such as:

  • Exercise therapy: Exercise therapy through physical activity plays a substantial role in managing diabetes. By developing a structured and individualized regimen, exercise can help improve the strength of weak muscles, gait pattern and balance. Hence, engaging in physical activities positively affects the physical aspect of HRQoL of individuals with diabetes [28].
  • Motivation Interviewing: The physiotherapist aims to create long-term changes to the patient's lifestyle with motivational interviewing. More than just exercises, the physiotherapist tries to engage the patient's motivation in the therapeutic process to create a therapeutic alliance and enhance greater daily behaviour changes. [29]

Role of Occupational Therapy[edit | edit source]

The role of occupational therapy in diabetes care is to improve treatment adherence, diabetes self-management abilities, and health-related quality of life.[30] Occupational therapists use activity-based treatments and psychosocial interventions that target multiple levels of influence, such as individual capacity, family, organization, and community. Intervention sessions are held in participants’ homes or community locations. They also use text messaging to provide information and reminders.[31]

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[30]. 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, utilizing a visual cue of placing evening medication on the nightstand may help).[31]

Resilient, Empowered, Active Living with Diabetes Program[edit | edit source]

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 [32][33]. The program [30] 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 7 following 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).[30]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.[34] .

Outcome Measures[edit | edit source]

The following tools can be used by occupational therapists in patients with diabetes in order to identify and prioritise activities, coping strategies, and emotional well-being: [35]

  • 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[edit | edit source]

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

Better glucose control generally improves quality of life, and some psychosocial factors (health-related beliefs, social support, coping style, and personality) have a powerful effect on quality of life either directly or through their capacity to buffer the negative effects of diabetes[36]. Also, physiotherapists play a significant role in managing the physical complications of diabetes to improve quality of life.

It is clear that different measures can be utilized to manage the quality of life change because of T2DM, which needs strategic health policy.

References[edit | edit source]

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  2. ↑ 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 Nov 23;10(11):e0141385.Available: https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0141385#sec014(accessed 22.9.2021)
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  4. ↑ 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 Nov 1;33(11):2378-82. Available:https://care.diabetesjournals.org/content/33/11/2378 (accessed 22.9.2021)
  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. Published 2019 Nov 22. doi:10.2147/JMDH.S232691
  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 Dec;94(3):322-32. doi: 10.1016/j.diabres.2011.10.040.
  7. ↑ 7.0 7.1 Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
  8. ↑ Willem Kuyken, John Orley, Mick Power, Helen Herrman, Hilary Schofield, B. Murphy, Željko Metelko, Silvija Szabo, Mirjana Pibernik-Okanović, N. Quemada, A. Caria, S. Rajkumar, S. Kumar, Shekhar Saxena, Dan Bar-On, M. Amir, M. Tazaki, A. Noji, G. Vanheck, . . . G. Burkovsky. (1995). The World Health Organization quality of life assessment (WHOQOL): Position paper from the World Health Organization. Social Science &Amp; Medicine, 41(10), 1403–1409. https://doi.org/10.1016/0277-9536(95)00112-k
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  27. ↑ 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. Journal of Diabetes & Metabolic Disorders. 2020;19(2):1995–2004.
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  31. ↑ 31.0 31.1 Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemporary clinical trials. 2017 Mar 1;54:8-17.
  32. ↑ Pyatak, E.A., Carandang, K., Vigen, C.L., Blanchard, J., Diaz, J., Concha-Chavez, A., Sequeira, P.A., Wood, J.R., Whittemore, R., Spruijt-Metz, D. and Peters, A.L., 2018. 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, 41(4), pp.696-704.
  33. ↑ Pyatak EA, Carandang K, Vigen C, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL. Resilient, Empowered, Active Living with Diabetes (REAL Diabetes) study: Methodology and baseline characteristics of a randomized controlled trial evaluating an occupation-based diabetes management intervention for young adults. Contemp Clin Trials. 2017 Mar;54:8-17.
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