Quality of Life and Diabetic Complications Among Type 2 Diabetes Patients Across Healthcare Levels in Bandung, Indonesia

Abstract

Purpose: To analyze differences in quality of life (QoL) among patients with Type 2 Diabetes Mellitus (T2DM) across three levels of healthcare facilities in Bandung, Indonesia, and to identify factors associated with poor QoL. Methods: This cross-sectional analytical study involved 369 adult T2DM patients from primary, secondary, and tertiary healthcare facilities in Bandung, Indonesia. The participants were enrolled in the National Health Insurance program and had available data on blood glucose levels, diabetes-related complications, and treatments. Quality of life was assessed using the Indonesian version of the Asian Diabetes Quality of Life (ADQOL) questionnaire. Results: Significant differences in patient characteristics were observed across the three healthcare levels. The highest proportion of patients experiencing multiple complications was found in secondary and tertiary care settings (62.5% and 63.3%, respectively). Patients attending secondary healthcare facilities had the worst quality of life (40.2%), followed by those in tertiary and primary care (33.0% and 26.8%, respectively). Although QoL revealed variability across healthcare levels, it was not statistically significant. Multivariate analysis revealed that complications were significantly associated with poor QoL (one complication: AOR = 4.118, 95% CI: 1.567–10.827). Conclusion: While patient characteristics varied among healthcare facility levels, they did not independently associate with quality of life. Instead, diabetes complications are significantly associated with quality of life for T2DM patients in Bandung, Indonesia. Although this study limited by its cross-sectional design, this finding highlights the need for screening and early management of complications across all levels of healthcare to improve patient QoL.