Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Sampling
2.2. Procedure and Measurements
2.3. Statistical Analysis
2.4. Ethics Approval and Consent to Participate
3. Results
3.1. Characteristics of the Participants
3.2. Diabetes-Related Variables and QOL
3.3. Determinants of Quality of Life
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
- Matthews, D. What is diabetes? In Diabetes—A Handbook for the Primary Healthcare Team, 2nd ed.; McDowell, J., Matthews, D.M., Brown, F.J., Eds.; Elsevier: Oxford, UK, 2007. [Google Scholar]
- International Diabetes Federation. IDF Diabetes Atlas Diabetes Facts and Figures. Available online: http://www.idf.org/about-diabetes/facts-figures (accessed on 24 June 2019).
- NHMS, I. The First National Health and Morbidity Survey (NHMS I) 1986; Institute for Public Health: Kuala Lumpur, Malaysia, 1986. [Google Scholar]
- NHMS. National Health and Morbidity Survey (NMHS 2015): Non-Communicable Diseases, Risk Factors and Other Health Problems; Institute for Public Health: Kuala Lumpur, Malaysia, 2015. [Google Scholar]
- UK Prospective Diabetes Study Group. Tight blood pressure control and risk of macrovascular and microvascular complications in type 2 diabetes. BMJ 1998, 317, 703–713. [Google Scholar] [CrossRef]
- Odegard, P.S.; Capoccia, K. Medication taking and diabetes: A systematic review of the literature. Diabetes Educ. 2007, 33, 1014–1029. [Google Scholar] [CrossRef] [PubMed]
- Rubin, R.R. Adherence to pharmacologic therapy in patients with type 2 diabetes mellitus. Am. J. Med. 2005, 118, 27–34. [Google Scholar] [CrossRef] [PubMed]
- Asche, C.; LaFleur, J.; Conner, C. A review of diabetes treatment adherence and the association with clinical and economic outcomes. Clin. Ther. 2011, 33, 74–109. [Google Scholar] [CrossRef] [PubMed]
- Martínez, Y.V.; Prado-Aguilar, C.A.; Rascón-Pacheco, R.A.; Valdivia-Martínez, J.J. Quality of life associated with treatment adherence in patients with type 2 diabetes: A cross-sectional study. BMC Health Serv. Res. 2008, 8, 164. [Google Scholar] [CrossRef] [PubMed]
- Piette, J.D.; Wagner, T.H.; Potter, M.B.; Schillinger, D. Health insurance status, cost-related medication underuse, and outcomes among diabetes patients in three systems of care. Med. Care 2004, 42, 102–109. [Google Scholar] [CrossRef] [PubMed]
- Chew, B.H.; Hassan, N.H.; Sherina, M.S. Determinants of medication adherence among adults with type 2 diabetes mellitus in three Malaysian public health clinics: A cross-sectional study. Patient Prefer. Adherence 2015, 9, 639–648. [Google Scholar] [CrossRef] [PubMed]
- Chew, B.H. Medication adherence on quality of life among adults with type 2 diabetes mellitus: An exploratory analysis on the EDDMQoL study. Qual. Life Res. 2015, 24, 2723–2731. [Google Scholar] [CrossRef]
- Snoek, F.J.; Skinner, T.C. Psychological aspects of diabetes management. Medicine 2006, 34, 61–62. [Google Scholar] [CrossRef]
- Lin, E.H.; Von Korff, M.; Alonso, J.; Angermeyer, M.C.; Anthony, J.; Bromet, E.; Bruffaerts, R.; Gasquet, I.; de Girolamo, G.; Gureje, O.; et al. Mental disorders among persons with diabetes--results from the World Mental Health Surveys. J. Psychosom Res. 2008, 65, 571–580. [Google Scholar] [CrossRef]
- Leal, J.; Gray, A.M.; Clarke, P.M. Development of life-expectancy tables for people with type 2 diabetes. Eur. Heart J. 2009, 30, 834–839. [Google Scholar] [CrossRef] [PubMed]
- Rubin, R.R.; Peyrot, M. Quality of life and diabetes. Diabetes Metab. Res. Rev. 1999, 15, 205–218. [Google Scholar] [CrossRef]
- De Visser, C.L.; Bilo, H.J.G.; Groenier, K.H.; De Visser, W.; Meyboom-De Jong, B. The influence of cardiovascular disease on quality of life in type 2 diabetics. Qual. Life Res. 2002, 11, 249–261. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- UK Prospective Diabetes Study Group. Quality of life in type 2 diabetic patients is affected by complications but not by intensive policies to improve blood glucose or blood pressure control (UKPDS 37). Diabetes Care 1999, 22, 1125–1136. [Google Scholar]
- Goh, S.G.; Rusli, B.N.; Khalid, B.A. Diabetes quality of life perception in a multiethnic population. Qual. Life Res. 2015, 24, 1677–1686. [Google Scholar] [CrossRef] [PubMed]
- Egede, L.E.; Hernandez-Tejada, M.A. Effect of comorbid depression on quality of life in adults with Type 2 diabetes. Expert Rev. Pharm. Outcomes Res. 2013, 13, 83–91. [Google Scholar] [CrossRef]
- Eren, I.; Erdi, Ö.; Şahin, M. The effect of depression on quality of life of patients with type II diabetes mellitus. Depress. Anxiety 2008, 25, 98–106. [Google Scholar] [CrossRef] [PubMed]
- Goh, S.G.; Rusli, B.N.; Khalid, B.A. Development and validation of the Asian Diabetes Quality of Life (AsianDQOL) Questionnaire. Diabetes Res. Clin. Pract. 2015, 108, 489–498. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chang, H.Y.; Weiner, J.P.; Richards, T.M.; Bleich, S.N.; Segal, J.B. Validating the adapted Diabetes Complications Severity Index in claims data. Am. J. Manag. Care 2012, 18, 721–726. [Google Scholar]
- Chung, W.W.; Chua, S.S.; Lai, P.S.M.; Morisky, D.E. The Malaysian Medication Adherence Scale (MALMAS): Concurrent validity using a clinical measure among people with type 2 diabetes in Malaysia. PLoS ONE 2015, 10, e0124275. [Google Scholar] [CrossRef]
- Lovibond, P.F.; Lovibond, S.H. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav. Res. Ther. 1995, 33, 335–343. [Google Scholar] [CrossRef]
- Davies, G.; Caputi, P.; Skarvelis, M.; Ronan, N. The depression anxiety and stress scales: Reference data from a large psychiatric outpatient sample. Aust. J. Psychol. 2015, 67, 97–104. [Google Scholar] [CrossRef]
- Musa, R.; Fadzil, M.A.; Zain, Z. Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN J. Psychiatr. 2007, 8, 82–89. [Google Scholar]
- Green, S.B. How many subjects does it take to do a regression analysis. Multivar. Behav. Res. 1991, 26, 499–510. [Google Scholar] [CrossRef] [PubMed]
- Craig, C.L.; Marshall, A.L.; Sjostrom, M.; Bauman, A.E.; Booth, M.L.; Ainsworth, B.E.; Barbara, E.; Pratt, M.; Ekelund, U.; Yngve, A.; et al. International physical activity questionnaire: 12-country reliability and validity. Med. Sci. Sports Exerc. 2003, 35, 1381–1395. [Google Scholar] [CrossRef] [PubMed]
- Chew, B.H.; Mohd-Sidik, S.; Shariff-Ghazali, S. Negative effects of diabetes-related distress on health-related quality of life: An evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia. Health Qual. Life Outcomes 2015, 13, 187. [Google Scholar] [CrossRef] [PubMed]
- Glasgow, R.E.; Ruggiero, L.; Eakin, E.G.; Dryfoos, J.; Chobanian, L. Quality of life and associated characteristics in large national sample of adults with diabetes. Diabetes Care 1997, 20, 562–567. [Google Scholar] [CrossRef] [PubMed]
- Didarloo, A.; Alizadeh, M. Health-related quality of life and its determinants among women with diabetes mellitus: A cross-sectional analysis. Nurs. Midwifery Stud. 2016, 5, e28937. [Google Scholar] [PubMed]
- Mosaku, K.; Kolawole, B.; Mume, C.; Ikem, R. Depression, anxiety and quality of life among diabetic patients: A comparative study. JAMA 2008, 100, 73–78. [Google Scholar] [CrossRef]
- Kohen, D.; Burgess, A.P.; Catalan, J.; Lant, A. The role of anxiety and depression in quality of life and symptom reporting in people with diabetes mellitus. Qual. Life Res. 1998, 7, 197–204. [Google Scholar] [CrossRef]
- Dos Santos, M.A.B.; Ceretta, L.B.; Réus, G.Z.; Abelaira, H.M.; Jornada, L.K.; Schwalm, M.T.; Neotti, M.V.; Tomazzi, C.D.; Gulbis, K.G.; Ceretta, R.A.; et al. Anxiety disorders are associated with quality of life impairment in patients with insulin-dependent type 2 diabetes: A case-control study. Braz. J. Psychiatry 2014, 36, 298–304. [Google Scholar] [CrossRef] [PubMed]
- Coffey, J.T.; Brandle, M.; Zhou, H.; Marriott, D.; Burke, R.; Tabaei, B.P.; Engelgau, M.M.; Kaplan, R.M.; Herman, W.H. Valuing health-related quality of life in diabetes. Diabetes Care 2002, 25, 2238–2243. [Google Scholar] [CrossRef]
- Alcubierre, N.; Rubinat, E.; Traveset, A.; Martinez-Alonso, M.; Hernandez, M.; Jurjo, C.; Muricio, D. A prospective cross-sectional study on quality of life and treatment satisfaction in type 2 diabetic patients with retinopathy without other major late diabetic complications. Health Qual. Life Outcomes 2014, 12, 131. [Google Scholar] [CrossRef] [PubMed]
- Shim, Y.T.; Lee, J.; Toh, M.P.H.S.; Tang, W.E.; Ko, Y. Health-related quality of life and glycaemic. control in patients with Type 2 diabetes mellitus in Singapore. Diabet. Med. 2012, 29, 241–248. [Google Scholar] [CrossRef] [PubMed]
- Sufiza Ahmad, N.; Ramli, A.; Islahudin, F.; Paraidathathu, T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer. Adherence 2013, 7, 525–530. [Google Scholar] [Green Version]
- Aminde, L.N.; Tindong, M.; Ngwasiri, C.A.; Aminde, J.A.; Njim, T.; Fondong, A.A.; Fondong, A.A.; Takah, N.F. Adherence to antidiabetic medication and factors associated with non-adherence among patients with type-2 diabetes mellitus in two regional hospitals in Cameroon. BMC Endocr. Disord. 2019, 19, 35. [Google Scholar] [CrossRef]
- Alfian, S.D.; Sukandar, H.; Lestari, K.; Abdulah, R. Medication adherence contributes to an improved quality of life in type 2 diabetes mellitus patients: A cross-sectional study. Diabetes Ther. 2016, 7, 755–764. [Google Scholar] [CrossRef]
- Gonzalez, J.S.; Shreck, E.; Psaros, C.; Safren, S.A. Distress and type 2 diabetes-treatment adherence: A mediating role for perceived control. Health Psychol. 2015, 34, 505–513. [Google Scholar] [CrossRef]
- Hernandez-Tejada, M.A.; Lynch, C.P.; Strom, J.L.; Egede, L.E. Effect of perceived control on quality of life in indigent adults with type 2 diabetes. Diabetes Educ. 2012, 38, 256–262. [Google Scholar] [CrossRef]
Demography | Age (years) | Mean (SD) | 59.4 (8.8) |
Sex | Male | 76 (50.7) | |
Female | 74 (49.3) | ||
Ethnicity | Malay | 95 (63.3) | |
Chinese | 15 (10.0) | ||
Indian | 40 (26.7) | ||
Education level | Primary | 30 (20.0) | |
Secondary | 72 (48.0) | ||
Tertiary | 48 (32.0) | ||
Occupation | Employed | 68 (45.3) | |
Unemployed/retired | 82 (54.7) | ||
Monthly household income (MYR) | <3000 | 63 (44.0) | |
3000–4999 | 46 (30.7) | ||
≥5000 | 38 (25.3) | ||
Clinical | Body Mass Index (kg/m2) | Mean (SD) | 28.1 (4.9) |
Physical activity | Inactive | 110 (73.3) | |
Active | 40 (26.7) | ||
Systolic blood pressure (mmHg) | Mean (SD) | 139 (16) | |
Diastolic blood pressure (mmHg) | Mean (SD) | 76 (10) | |
Glycated hemoglobin, HbA1c (%) | Mean (SD) | 8.0 (1.8) | |
Duration of diabetes (years) | Mean (SD) | 9.4 (6.0) | |
Diabetes medication | OHAs | 101 (67.3) | |
OHA + Insulin | 49 (32.7) | ||
Hypoglycemia | Never | 129 (86.0) | |
At least once a month | 21 (14.0) | ||
Medication adherence | Nonadherent | 43 (28.7) | |
Complication | Retinopathy | Cataract | 17 (11.3) |
Proliferative | 25 (16.7) | ||
Background | 13 (8.7) | ||
None | 98 (65.3) | ||
Nephropathy | 57 (38.0) | ||
Neuropathy | 92 (61.3) | ||
Stroke/TIA | 2 (1.3) | ||
Cardiovascular Disease | Atherosclerosis | 17 (11.3) | |
Angina Pectoris | 1 (0.7) | ||
Myocardial Infarction | 1 (0.7) | ||
None | 132 (88.0) | ||
aDCSI score | Mean (SD) | 1.6 (1.4) | |
0 | 34 (22.7) | ||
1 | 46 (30.7) | ||
2–3 | 52 (34.7) | ||
≥4 | 18 (12.0) | ||
Psychosocial well-being | Depression | 18 (12.0) | |
Anxiety | 36 (24.0) | ||
Stress | 12 (8.0) |
Variables | QOL Scores Mean (SD) | Mean Difference (95% CI) | p |
---|---|---|---|
Age (years) | |||
<50 a | 88.6 (11.80) | 0.582 | |
50–59 | 88.56 (7.65) | −0.09 (5.53, −5.71) | |
60–69 | 90.57 (7.65) | 1.92 (7.55, −3.71) | |
>70 | 89.41 (5.03) | 0.76 (7.90, −6.37) | |
Ethnicity | |||
Malay a | 89.86 (8.07) | 0.655 | |
Indian | 88.48 (8.41) | −0.73 (4.71, −6.17) | |
Chinese | 89.13 (7.23) | −0.14 (2.30, −5.08) | |
Gender b | |||
Male | 88.8 (8.76) | −1.23 (-3.83, 1.38) | 0.354 |
Female | 90.04 (7.28) | ||
Education Level | |||
Primary a | 89.63 (4.51) | 0.894 | |
Secondary | 89.10 (8.42) | −0.54 (3.73, 4.80) | |
Tertiary | 89.77 (9.27) | 0.14 (4.71, −4.43) | |
Monthly Household Income (MYR) | |||
≤1000 a | 84.29 (7.30) | 0.469 | |
1001–2000 | 88.22 (8.91) | 3.93 (14.33, −6.47) | |
2001–3000 | 89.36 (7.65) | 5.08 (15.03, −4.88) | |
3001–4000 | 89.36 (7.12) | 5.08 (15.53, −5.37) | |
4001–5000 | 90.00 (7.75) | 5.71 (16.06, −4.63) | |
>5000 | 89.42 (8.06) | 6.53 (15.44, −3.38) | |
Diabetes duration (years) | |||
< 5 a | 89.57 (8.18) | 0.100 | |
5–10 | 91.23 (6.48) | 1.67 (5.72, −2.39) | |
>10 | 87.86 (8.88) | −1.70 (2.15, −5.56) | |
Type of treatment b | |||
OHAs | 90.46 (8.17) | 3.23 (0.46, 5.99) | 0.022 * |
OHAs and insulin | 87.23 (7.53) | ||
HbA1c | |||
<6.5 a | 93.39 (4.50) | 0.021 * | |
6.5–7.5 | 90.17 (8.31) | −3.22 (2.05, −8.49) | |
7.6–8.5 | 87.5 (7.76) | −5.89 (−0.20, −11.5) | |
>8.5 | 87.82 (8.05) | −5.56 (−0.08, −11.05) | |
Physical activity b | |||
Active | 91.6 (6.01) | 2.97 (5.88, 0.061) | 0.045 * |
Inactive | 88.6 (8.57) | ||
Retinopathy b | |||
Yes | 87.46 (7.74) | −3.00 (−5.70, −0.30) | 0.030 * |
No | 90.46 (8.34) | ||
Nephropathy b | |||
Yes | 88.82(8.57) | −0.96 (−3.64, 1.72) | 0.481 |
No | 89.78 (7.95) | ||
Neuropathy b | |||
Yes | 88.29 (8.74) | −2.91 (−5.55, −0.27) | 0.031 * |
No | 91.20 (6.51) | ||
Macrovascular Complications b | |||
Yes | 86.9(8.47) | −2.91 (−6.72, 0.90) | 0.134 |
No | 83.7 (10.76) | ||
Hypoglycemia b | |||
Never | 90.3 (7.16) | −6.63 (−1.61, −11.66) | 0.012 * |
At least once/month | 86.3 (7.88) | ||
aDCSI categories | |||
0 | 92.26 (6.03) | 0.001 ** | |
1 | 87.15 (8.61) | −5.11 (−9.60, −0.62) | |
2–3 | 91.88(6.08) | −0.04 (−4.76, 4.00) | |
4 | 82.72 (9.76) | −9.54 (−15.33, −3.76) | |
Depression b | |||
Yes | 84.06 (9.64) | 6.10 (2.20, 9.99) | 0.002 * |
No | 90.15 (7.57) | ||
Anxiety b | |||
Yes | 85.6 (7.77) | 5.04 (2.11, 7.99) | 0.001 ** |
No | 90.6 (7.80) | ||
Stress b | |||
Yes | 84.0 (10.18) | 5.93 (1.40, 10.47) | 0.011 * |
No | 89.9 (7.68) | ||
Medication adherence b | |||
Yes | 90.6(6.89) | 4.17 (0.87,7.47) | 0.014 * |
No | 86.4, (9.90) |
Factors | n (%) | c0R (95% CI) | p | aOR (95%CI) | p | |
---|---|---|---|---|---|---|
Poor-Moderate QOL | Good-Excellent QOL | |||||
Hba1c | ||||||
≤6.5% | 1 (3.2) | 30 (96.8) | 15.19 (2.00, 115.47) | 0.009 * | 20.78 (2.45, 175.94) | 0.005 * |
>6.5% | 40 (33.6) | 79 (66.4) | 1.00 | 1.00 | ||
Depression | ||||||
Yes | 7 (38.9) | 11 (61.1) | 1.83 (0.66, 5.11) | 0.246 | 0.63 (0.13, 3.10) | 0.568 |
No | 34 (25.8) | 98 (74.2) | 1.00 | 1.00 | ||
Stress | ||||||
Yes | 5 (38.5) | 8 (61.5) | 1.75 (0.54, 5.71) | 0.351 | ||
No | 36 (26.3) | 101 (73.7) | 1.00 | |||
Anxiety | ||||||
Yes | 16 (44.4) | 20 (55.6) | 2.85 (1.29,6.30) | 0.01 * | 5.73 (1.77, 18.52) | 0.004 * |
No | 25 (21.9) | 89 (78.1) | 1.00 | 1.00 | ||
Medication Adherence | ||||||
Yes | 22 (20.6) | 85 (79.4) | 3.06 (1.43, 6.56) | 0.004 * | 3.35 (1.30, 8.66) | 0.012 * |
No | 19 (44.2) | 24 (55.8) | 1.00 | 1.00 | ||
aDCSI | ||||||
0 | 4 (11.8) | 30 (88.2) | 9.38 (2.32, 37.92) | 0.002 * | 7.78 (1.54, 39.15) | 0.013 * |
1 | 19 (41.3) | 27 (58.7) | 1.78 (0.59, 5.33) | 0.306 | 1.51 (0.41, 5.52) | 0.536 |
2–3 | 8 (44.4) | 10 (55.6) | 6.88 (2.08, 22.75) | 0.002 * | 8.23 (2.06, 32.84) | 0.003 * |
≥4 | 10 (55.6) | 8(44.4) | 1.00 | 1.00 |
Model | -2loglikelihood | Deviance | Model Significance a | Change in β b | |
---|---|---|---|---|---|
1 | Full model | 126.788 | 49.176 | p < 0.05 | - |
2 | Full model + HbA1c*MA | 126.049 | 0.739 | p > 0.05 | 595.22% |
3 | Full model + Depression*MA | 125.556 | 1.232 | p > 0.05 | 24.52% |
4 | Full model + Anxiety*MA | 125.758 | 1.030 | p > 0.05 | 62.92% |
5 | Full model + aDCSI*MA | 124.857 | 1.931 | p > 0.05 | 0: 85.57% 1: 310.49% 2–3: 31.02% |
© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
Share and Cite
Dhillon, H.; Nordin, R.B.; Ramadas, A. Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus. Int. J. Environ. Res. Public Health 2019, 16, 3561. https://doi.org/10.3390/ijerph16193561
Dhillon H, Nordin RB, Ramadas A. Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus. International Journal of Environmental Research and Public Health. 2019; 16(19):3561. https://doi.org/10.3390/ijerph16193561
Chicago/Turabian StyleDhillon, Hardesh, Rusli Bin Nordin, and Amutha Ramadas. 2019. "Quality of Life and Associated Factors among Primary Care Asian Patients with Type 2 Diabetes Mellitus" International Journal of Environmental Research and Public Health 16, no. 19: 3561. https://doi.org/10.3390/ijerph16193561