Health-related Quality of Life among Type 2 Diabetes Patients in Southern Province of Saudi Arabia using WHOQOL-BREF: A Cross-section Study

Abstract

Background: Quality of life has become a more important health outcome with advancements in medical therapies and disease management, leading to better lives for people in general, particularly those living with chronic diseases. Diabetes has a direct impact on the physical, psychological, and social aspects of personal health. This study aimed to determine health-related quality of life (HRQOL) and its predictors in patients with type 2 diabetes. Methods: A cross-sectional study was carried out on 420 patients with type 2 diabetes who presented to primary healthcare centers in Samtah Town, Saudi Arabia, from March 2017 to February 2018. The HRQOL of the study participants was determined using the World Health Organization Quality of Life-BREF. Multi-level linear regression was employed to ascertain the factors associated with HRQOL among patients with type 2 diabetes. Results: Female sex was significantly associated with higher HbA1c, anxiety, depression, and stress scores and a lower HRQL in the physical, psychological, and environmental health subscales than males (P<0.001). All subscales of HRQOL were significantly lower in the > 50 years age group. When compared to those with low levels of education (illiterate, primary, or elementary school), patients with secondary and bachelor’s degrees had significantly higher HRQOL in all subscales (P<0.001). In addition, there were significant differences in glycemic control and HRQL with a longer duration of diabetes, the presence of one or more diabetes complications, and the presence of comorbid hypertension (P<0.001). However, no significant differences in the Depression Anxiety and Stress Scale (DASS) index were observed with a longer duration of diabetes and the presence of comorbid hypertension. Patients with diabetes on combined therapy and healthy diet and exercise showed significantly higher HRQOL on physical functioning (P<0.001). Conclusion: Type 2 diabetes was significantly associated with impaired health-related quality of life and mental health among study participants. Females appeared to have worse quality of life and mental health than males. Age, duration of diabetes, comorbid hypertension, diabetes complications, and level of education were significantly associated with lower HRQOL and mental health scores. Healthy diet and exercise, when combined with hypoglycemic and insulin therapy, were found to improve HRQOL and mental health among patients with diabetes. Scales based on a broad definition of health, such as the WHOQOL-BREF, are appropriate for use in primary care settings and can enhance patient management and care.

Predicting Factors of Health-Related Quality of Life Among Adults With Type 2 Diabetes: A Systematic Review

“…Our research showed that patients with complications had a greater chance of experiencing diminished HRQoL ( Alshayban & Joseph, 2020 ; Barua et al, 2021 ; Chantzaras & Yfantopoulos, 2022 ; Gebremariam et al, 2022 ; Gebremedhin et al, 2019 ; Hamady et al, 2022 ; Kalayou Haftu et al, 2022 ; Kang et al, 2021 ; Khunkaew et al, 2019 ; Nguyen et al, 2018 ; Sari et al, 2021 ; Tran Kien et al, 2021 ; Wonde et al, 2022 ; Wong et al, 2013 ; Zare et al, 2020 ; Zyoud et al, 2015 ). Patients suffering from renal disorders ( Shamshirgaran et al, 2016 ), hypertension, chronic kidney diseases ( Wan et al, 2016 ), and macrovascular complications ( Bourdel-Marchasson et al, 2013 ) had the lowest HRQoL scores overall.…”

“…In 18 primary studies, gender was determined as a significant predictor of HRQoL. Females were shown to have significantly poorer HRQoL and the most statistically significant in the physical and psychological domain ( Al Hayek et al, 2014 ; Alsayed Hassan et al, 2022 ; Alshayban & Joseph, 2020 ; Barua et al, 2021 ; Bourdel-Marchasson et al, 2013 ; Chantzaras & Yfantopoulos, 2022 ; Chew et al, 2015 ; Gebremedhin et al, 2019 ; Hamady et al, 2022 ; Natarajan & Mokoboto-Zwane, 2022 ; Nguyen et al, 2018 ; Saleh et al, 2015 ; Shamshirgaran et al, 2016 ; Tran Kien et al, 2021 ; Wan et al, 2016 ; Wonde et al, 2022 ; Zare et al, 2020 ) in particular, on the dimensions of physical functioning, emotional role, energy, emotion, social functioning, and pain ( Al Hayek et al, 2014 ).…”

“…Nine initial studies ( Alsayed Hassan et al, 2022 ; Arifin et al, 2019 ; Barua et al, 2021 ; Chantzaras & Yfantopoulos, 2022 ; Hamady et al, 2022 ; Natarajan & Mokoboto-Zwane, 2022 ; Saleh et al, 2015 ; Sari et al, 2021 ; Tran Kien et al, 2021 ) examined how education level affected the HRQoL of T2DM patients. Poor HRQoL was more prevalent among those with lower levels of education ( B = −0.617) ( Natarajan & Mokoboto-Zwane, 2022 ), while those who have a higher education have higher HRQoL (OR = 3.013) ( Barua et al, 2021 ).…”

“…HRQoL was predicted by insulin treatment among those with T2DM. It was measured in seven studies; worse HRQoL was correlated with insulin therapy and the use of both insulin therapy and oral medications ( Al Hayek et al, 2014 ; Gebremariam et al, 2022 ; Hamady et al, 2022 ; Khunkaew et al, 2019 ; Tran Kien et al, 2021 ; Wan et al, 2016 ; Wong et al, 2013 ). People who took fewer prescriptions had a greater HRQoL than those who took more than five different medications ( Nguyen et al, 2018 ).…”

“…Diabetes distress was one of the factors that predicted HRQoL ( Chew et al, 2015 ; Hamady et al, 2022 ; Jannoo et al, 2017 ; Mishra et al, 2015 ; Onu et al, 2022 ; Sari et al, 2021 ). Patients with higher levels of emotional distress related to diabetes were found to have worse HRQoL ( Jannoo et al, 2017 ).…”