Predictors of quality of life in people living with type-1 and type-2 diabetes: an Indian perspective study and systematic review

Abstract

background: this study evaluated predictors of good quality of life (QOL), in people with type-1 diabetes (t1DM) and type 2 diabetes (t2DM) using validated general health questionnaire [World Health Organization’s (WHO)-QOL-brief (brEF) questionnaire] and diabetes-specific questionnaire [Multidimensional Diabetes Questionnaire (MDQ)]. Methods: consecutive people > 18 years age, having t1DM or t2DM of > 6 months duration, without any severe co-morbid states or hospital admission in last 3 months, attending endocrinology-clinics of 3 different centers in Delhi, between August 2014 to september 2019, underwent QOL assessment. PubMed and Medline search for articles published to till November 2019 on QOL in diabetes was done for systematic review. results: Data from 2067 patients was analyzed. WHOQOL-BREF aggregate score was significantly better in t2DM compared to t1DM (3.39 ± 0.46 vs. 3.11 ± 0.63; p < 0.001). T1DM did significantly better than T2DM patients only with regards to physical health. t1DM patients’ QOL scores were worse for psychological, social relationship, and environmental domains. Analysis based on quartiles of WHO-QOL-brEF aggregate score revealed people in Quartile-4 were significantly older, had the lowest hypoglycemia, nephropathy, retinopathy, neuropathy, cAD, and peripheral artery disease. Patients with the lowest QOL (Quartile-1) had the highest blood glucose and HbA1c. step-wise linear regression revealed age, sex, diabetes type, duration, HbA1c, hypoglycemia, nephropathy, neuropathy, and coronary artery disease to be independent predictors of QOL. Every percent increase in HbA1c was associated with a 2.1% reduction in aggregate QOL score. Hypoglycemia, the presence of nephropathy, and neuropathy were associated with a 9.1%, 11.4%, and 7.8% reduction in QOL aggregate score. conclusions: Younger age, female sex, t1DM, disease duration, glycaemic control, hypoglycemia end-organ damage are important predictors of poor QOL in Indians. Insulin use and a number of medications have no impact on QOL.