Assessment of health-related quality of life (HRQoL) of patients with type 2 diabetes in Turkey

Abstract

We measured the health-related quality of life (HRQoL) in a sample of 376 type 2 diabetes patients in Turkey using the Diabetes Quality of Life (DQOL) instrument and examined which patient socio-demographic and diabetes-related clinical characteristics are associated with better quality of life (QoL). The influence of patient socio-demographic and clinical characteristics on QoL was examined using independent sample t-tests and one-way analysis of variance. Diabetes significantly affected the HRQoL of patients included in this study. The mean score of the total DQOL measure was higher among patients who were less than 40 years of age, male, married, had less than 8 years of education, lived with their family and had no family history of diabetes (p < 0.05). Similarly, patients with less than 5 years of disease duration, no complications or prior hospitalization, receive insulin, and with HbA₁c < 7 reported significantly better overall HRQoL (p < 0.05). Patients with BMI < 24 had higher levels of satisfaction with diabetes than those with BMI ≥ 24 (p < 0.05). Diabetes-related HRQoL information is clearly of supreme importance to family physicians and policy makers to identify and implement appropriate interventions for achieving better management of diabetes and ultimately improving the QoL of diabetes patients.

Introduction

Diabetes is a complex and a serious chronic disease associated with several potentially preventable complications such as blindness, amputation, neuropathy, nephropathy, and cardiovascular disease. The prevalence of diabetes is dramatically rising worldwide; 171 million people suffered from diabetes in 2000, and it is expected that this figure will more than double to 366 million by 2030 [1]. Diabetes-related morbidity and premature mortality impose a sizeable burden on individuals with this disease and on society, representing a major public health concern [2], [3]. According to the International Diabetes Federation (IDF), diabetes represents the fourth leading cause of global death by disease [4]. While the prevalence of diabetes is much higher in developed countries than in developing countries, the greatest impact of increased prevalence of diabetes will be felt in developing countries by 2025 [4], [5]. Diabetes is expected to reach epidemic proportions in many regions throughout the world as life spans extend and societies adopt increasingly urban and modern lifestyles [6], [7]. The highest rate of diabetes prevalence is in the Eastern Mediterranean and Middle East (9.2%) followed by North America (8.4%)[8]. In addition to more than 25 million years of life lost each year due to diabetes-related mortality, an estimated 23 million years of life are lost due to disability and reduced quality of life caused by the preventable complications of diabetes [9].

There is increasing recognition among clinicians and researchers that the impact of chronic illnesses and their treatments must be assessed in terms of their quality of life (QoL) in addition to more traditional measures of clinical outcomes—morbidity and mortality [10], [11], [12], [13]. People with diabetes have a worse QoL than people with no chronic illness, but a better QoL than people with most other serious chronic diseases [14], [15]. The duration and type of diabetes are not consistently associated with QoL. Intensive treatment is shown to improve glycemic control which is associated with better quality of life [16]. Diabetes complications are the most important disease-specific determinants of QoL [17]. Recent studies establish that better diabetes QoL is associated with higher levels of social support, self-efficacy, physical activity, education, income, and with the absence of complications and co-morbid psychiatric disorders [10], [11]. It is also documented that diabetes QoL and treatment satisfaction improved after good glycemic control and greater perceived flexibility in leisure time activities and diet [13], [18].

Diabetes and impaired glucose tolerance (IGT) are moderately common in Turkey. The prevalence of diabetes in the Turkish population is 7.2% (previously undiagnosed, 2.3%) and 6.7% for IGT [19]. The findings of this first largest population-based study conducted in Turkey indicate that obese and hypertensive individuals and those with familial diabetes and lower education are at increased risk for diabetes. The need for increasing public awareness and the value of lifestyle modification toward traditional Mediterranean nutrition, increased physical activity, and weight reduction are emphasized by the researchers. A more recent population-based prospective study provides a higher diabetes prevalence rate of 11.0% of the population aged 35 years or higher [20] and concludes that abdominal obesity and age represent the two important predictors of diabetes in Turkey. While several other studies documented the prevalence of diabetes and obesity for both adult and adolescents in major Turkish cities [21], [22], [23], [24], [25], [26], [27] there is a wide variation in reported diabetes prevalence rates and, unfortunately, diabetes awareness is still considered poor in Turkey [19]. More importantly, only a limited number of studies have been conducted in Turkey to document the QoL of diabetes patients. One of these studies focused on assessment of the psychological well-being of only 100 patients with type 2 diabetes using the Turkish version of the Well-being Questionnaire (WBQ-22) [28]. The other study examined the influence of a specific diabetes education program on the well-being of 255 patients with type 2 diabetes [29].

To the best of the authors’ knowledge, this is the first study documenting the overall HRQoL of patients with type 2 diabetes in Turkey using a larger sample size and widely recognized diabetes-specific quality of life assessment tool (DQOL). The purpose of this study, therefore, was to measure HRQoL in Turkish patients with type 2 diabetes and examine which patient socio-demographic and diabetes-related clinical characteristics are associated with better quality of life.

Identifying the key determinants of HRQoL and assessing their effect levels play a key role in helping to concentrate clinical and health policy efforts on these areas and formulating effective intervention strategies to improve management of diabetes and ultimately improving the QoL of diabetes patients. This study enhances the growing literature on diabetes-related QoL and provides clinicians and policy makers in Turkey and other developed nations with additional insights into determinants of HRQoL for diabetes patients.