The quality of life in patients with diabetes mellitus type 2

Abstract

Background/Aim. Through its various activities, World Health Organization (WHO) contributed to increasing the understanding of the concept of quality of life. People with diabetes have a lower quality of life than people without chronic illnesses. The aim of this study was to examine the differences in the quality of life, related to health, in patients with diabetes mellitus (DM) type 2 by age, gender and type of therapy. Methods. We performed a cross-sectional study at the outpatient department of the Clinical Center in Novi Sad and the Health Center Ruma - General Practice. The group consisted of 90 patients with DM type 2, 41 men and 49 women. The age of respondents was from 40 to 80 years and they were classifed into four groups according to the ten-year age intervals. We applied WHO Quality of life questinnaire - BREF 100 composed of four domains: physical health, psychological health, social relationships and environment. The general questionnaire asks questions about socio-demographic data, duration of diabetes, the last value of blood glucose and glycosylated hemoglobin, training for self-control and its implementation, informing patients about their disease, therapy and its impact on daily activities and the presence of comorbidity. In statistical analysis the following tests were used: Student?s t-test, Ftest, ANOVA (one way). Results. The average duration of DM type 2 was 11.2 ? 9.2 years. Most of the patients (76%) were trained to self-control and 91% received enough information about their disease. Oral hypoglycemic preparations were used by 49%, insulin by 21%, and oral drugs and insulin by 29% patients while 1% were on a special regime of a diet therapy. Daily activities were performed without difficulties by over 29%, with some difficulties by 41% and 30% of patients who could not perform daily activities. The patients with DM type 2 had significantly lower scors in all 4 domains of quality of life (physical health, psychological health, social relations, environment). The biggest influence was on physical domains (51.31). Education level had an impact on physical and psychological domains. Comorbidity was found in 83% of the respondents. The most common were: arterial hypertension (63%), chronic cardiovascular disease (46%), neuropathy (23%), impaired vision 24%, elevated blood lipids (39%) and amputation of toes or feet (2.2%). The average value HbA1C in the group with comorbidity was 8.47% and in the group without comorbidity 6.46%. The subjects with comorbidity had low quality of life assessment in relation to the group without comorbidity: the domain of physical health (45.64 vs 79.66), psychological health (50.3 vs 76.86), social relations (52.97 vs 75.46) and environment (52.7 vs 75.06). Conclusion. Diabetes mellitus type 2 has negative influence on the quality of life. It contributes to the presence of comorbidity. The occurrence of comorbidity was associated with higher glucosylated HbA1C values. There was no difference in the assessment of quality of life regarding gender, age, or the type of therapy used. The quality of life was assessed as low in patients with comorbidity. However, certain personality characteristics play a decisive role in self-evaluation.Uvod/Cilj. Svetska zdravstvena organizacija (SZO) svojom delatnoscu doprinela je porastu razumevanja koncepta kvaliteta zivota. Kvalitet zivota je bolesnikova percepcija uticaja bolesti i odgovarajuce terapije na njegovu fizicku i radnu sposobnost, psiholosko stanje, socijalnu komunikaciju i somatsko zdravlje. Osobe sa dijabetesom imaju losiji kvalitet zivota od ljudi bez hronicnih bolesti. Cilj istrazivanja bio je da se ispitaju razlike u kvalitetu zivota povezanog sa zdravljem kod obolelih od dijabetesa melitusa (DM) tipa 2 prema starosnim grupama, polu i vrsti primenjene terapije. Metode. Sprovedena je studija preseka u Dijabetoloskoj dnevnoj bolnici Klinickog centra Vojvodine u Novom Sadu i Domu Zdravlja Ruma - Sluzba opste medicine. Bilo je ukljuceno 90 bolesnika sa DM tipa 2. Ispitanici su bili starosti od 40 do 80 godina, podeljeni u cetiri grupe prema desetogodisnjim starosnim intervalima. Koriscen je upitnik za procenu kvaliteta zivota SZO (WHOQOL - BREF), koji se sastoji od cetiri domena: fizicko zdravlje, psiholosko zdravlje, socijalne relacije i zivotno okruzenje. Opsti upitnik je sadrzao pitanja o socijalnodemografskim podacima, duzini trajanja DM, poslednjoj vrednosti glikemije naste i glikoziliranog (HbA1C) hemoglobina, obucenost i za samokontrolu glikemije i njeno sprovodjenje, informisanosti bolesnika o svojoj bolesti, terapiji i njenom uticaju na svakodnevne aktivnosti, kao i o prisustvu komorbiditeta. Rezultati. Prosecna duzina trajanja DM tip 2 bila je 11,2 ? 9,2 godine. Vecina bolesnika (76%) bili su obuceni za samokontrolu, a 91% dobilo je dovoljno informacija o svojoj bolesti. Oralne hipoglikemijske preparate koristilo je 49%, insulin 21%, oralnu terapiju i insulin 29%, a 1% ispitanika bilo je na terapiji dijetetskim rezimom ishrane. Bez teskoce svakodnevne aktivnosti obavljalo je njih 29%, nesto teze 41%, a 30% nije moglo da obavlja svakodnevne aktivnosti. Nasi ispitanici dali su nizu ocenu kvaliteta zivota, a najnizi nivo bio je u oblasti fizickog zdravlja (51,31). Najnizi nivo kvaliteta zivota bio je kod osoba sa nizom strucnom spremom u oblasti mentalnog zdravlja, socijalnih relacija i zivotnih uslova (p < 0,01; p < 0,05; p < 0,05) redom. Komorbiditet je imalo 83% ispitanika i oni su imali nizi kvalitet zivota u odnosu na grupu bez komorbiditeta. Najcesci komorbiditeti bili su: arterijska hipertenzija kod 63%, hronicne kardiovaskularne bolesti kod 46%, neuropatija kod 23%, ostecenje vida kod 24%, povisene masnoce u krvi kod 39% i amputacije prstiju ili stopala kod 2,2% obolelih od DM. Prosecna vrednost HbA1C u grupi sa komorbiditetom bila je 8,47%, a u grupi bez komorbiditeta 6,46% i ova razlika bila je statisticki znacajna (t = 12,37; p < 0,01). Nije bilo statisticki znacajne razlike u oceni kvaliteta zivota prema starosti, polu obolelih, kao ni prema vrsti primenjene terapije. Zakljucak. DM tipa 2 ima negativan uticaj na kvalitet zivota. Losija ocena kvaliteta zivota bila je u grupi bolesnika sa komorbiditetima. Kod bolesnika sa DM uocen je pad radne sposobnosti i sposobnosti za obavljanje svakodnevnih aktivnosti.