Home Print this page Email this page Small font size Default font size Increase font size
Users Online: 1489
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents 
ORIGINAL ARTICLE
Year : 2021  |  Volume : 10  |  Issue : 8  |  Page : 3040-3046  

Quality of life among type II diabetic patients attending the primary health centers of King Saud Medical City in Riyadh, Saudi Arabia


1 Academy of Family Medicine, King Saud Medical City, Riyadh, Saudi Arabia
2 Head Department of Family and Community Medicine, King Saud Medical City, Riyadh, Saudi Arabia
3 Epidemiology Specialist, Ministry of Health, Saudi Arabia

Date of Submission24-Jan-2021
Date of Decision17-Feb-2021
Date of Acceptance04-Apr-2021
Date of Web Publication27-Aug-2021

Correspondence Address:
Dr. Saleh Alsuwayt
Academy of Family Medicine, King Saud Medical City, P.O. Box: 13322, Riyadh
Saudi Arabia
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jfmpc.jfmpc_175_21

Rights and Permissions
  Abstract 


Background/Aim: Type 2 diabetic patients (T2DM) have lower quality of life (QoL) compared to the general population. This study was conducted to determine QoL of T2DM patients and analyze factors that affect patients' QoL. Methods: We conducted this cross-sectional study in January to February of 2019 at several primary care health centers (PCHC) in Riyadh, Saudi Arabia. All adult T2DM patients were invited to participate in the study. We used the EQ-5D-3L and EQ VAS tools to determine the patients' health state and their self-rated overall health. Results: A total of 274 T2DM patients were surveyed, 149 (54.4%) were males. The mean age was 59.7 ± 10.4 years. Of the five EQ-5D-5L domains, self-care had the highest proportion that reported no problem (n = 183, 66.8%). The mobility domain had the highest proportion of reported severe problems (n = 37, 13.5%) and extreme problems (n = 7, 2.6%). Nineteen (6.9%) patients reported with a full state of health. The mean EQVAS was 65.9 ± 22.1, with only 24.1% reported as between 81–100%. Females, patients above 75 years old, those who are in the low socioeconomic income, unemployed, widow had lower EQ VAS. Conclusion: Males, with higher socioeconomic status, employed, married and younger patients experience better QoL compared to their counterparts. The overall health related QoL among our diabetic patients is low. These findings suggest improvement of health-related QoL, and more efforts should be invested in patient education particularly among patients who are in the low socioeconomic status, the elderly, females and the unemployed.

Keywords: Primary care clinics, quality of life, type 2 diabetes


How to cite this article:
Alsuwayt S, Almesned M, Alhajri S, Alomari N, Alhadlaq R, Alotaibi A. Quality of life among type II diabetic patients attending the primary health centers of King Saud Medical City in Riyadh, Saudi Arabia. J Family Med Prim Care 2021;10:3040-6

How to cite this URL:
Alsuwayt S, Almesned M, Alhajri S, Alomari N, Alhadlaq R, Alotaibi A. Quality of life among type II diabetic patients attending the primary health centers of King Saud Medical City in Riyadh, Saudi Arabia. J Family Med Prim Care [serial online] 2021 [cited 2021 Sep 27];10:3040-6. Available from: https://www.jfmpc.com/text.asp?2021/10/8/3040/324673




  Introduction Top


Diabetes mellitus (DM) is one of the most common metabolic disorders in the world and the prevalence of diabetes in adults. The 2010 world prevalence of diabetes among adults aged 20 – 79 years old is 6.4% (approximately 285 million adults) and is projected to increase to 7.7% (approximately 439 million adults) by 2030.[1],[2] The International Diabetes Federation (IDF) has produced estimates of diabetes prevalence since the year 2000 and has demonstrated a large and increasing burden, with significant regional variability.[3],[4],[5]

In the United States of America, the prevalence of DM increased by 75% from 1988 – 1994 to 2005 – 2010.[6] Many other countries have reported an increase in the prevalence of DM including 12.4% in the United Kingdom,[7] and 5.5% in France.[8] In the Middle East and North African region (MENA), the current prevalence was reported at 9.2% which translates to 34 million people.[9] In the Gulf area, the estimated prevalence was projected at 23.1% in the United Arab Emirates, 7.5% in Yemen, and 27.1% in Saudi Arabia by the year 2035.[2]

The rapid urbanization has driven rapid transitions in lifestyle thereby increasing the risk factors for obesity, hypertension, and type 2 diabetes (T2DM).[10] The burden of the increasing prevalence of T2DM significantly affects the allocation of resources, health-promoting policies, and the prevention of the disease.[11] In Saudi Arabia alone, patients with diabetes have medical healthcare expenditures that are ten times higher ($3,686 vs. $380) than patients without diabetes.[12]

The health-related quality of life (HRQoL) scale measures a person's physical, cognitive, social, emotional, psychological, role, and spiritual status.[13],[14] It measures the acceptable outcome or efficacy of self-care among adults with Type II diabetes mellitus and was shown to correlate with quality of life (QoL).[15],[16] Studies have shown that T2DM patients rated HRQoL lower than the general population.[16] The EQ-5D-3L index score (which defines a respondent's health status according to five dimensions: mobility, self-care, usual activities, pain/discomfort, and anxiety/depression was lower for older people with T2DM and was positively associated with mobility, pain/discomfort, and anxiety and depression.[17] Among Saudi patients with T2DM, the HRQoL on the role-emotional aspect with a mean score of 28.3%, lower than the physical health domains, and was significantly associated to a low level of education.[18] In Saudi Arabia, male patients and those with high monthly income, those T2DM patients who have no diabetes-related complications, and those with random blood glucose level of <200 mg/dl were found to have higher HRQoL index scores.[19] The predicted quality-adjusted life years (QALYs) was shown to be a composite measure of diabetes risk control and estimate the lifetime health outcomes of patients with T2DM and can be used in clinical practice, trials, economic evaluation, and health policy formulation.[20],[21]

This study was conducted to determine the HRQoL of T2DM patients in our institution and analyze factors that affect patients' QoL. Through this, medical practitioners and health experts will gain more insight on the common issues faced by T2DM patients and help in the disease management of the patients, as well as allow policy makers to review, formulate and implement guidelines and management protocols to improve QoL and reduce morbidity and mortality.


  Methods Top


We conducted this cross-sectional study in January to February of 2019 at the primary care health centers (PCHC) of King Saud Medical City in Riyadh, Saudi Arabia. All adult patients diagnosed with T2DM who were attending the PCHC aged 18 years old and above were invited to participate in the study. Patients younger than 18 years old, pregnant, those with mental and/or physical disability, and those with critical or advanced complications were excluded from the study. Sample size was calculated using the formula Z1/22 P (1-p)/d2 with 5% type 1 error, 80% power and 95% confidence level. The calculated sample size was 274 patients.

Verbal consent was secured from each patient. Consenting patients were asked to answer the questionnaire. The questionnaire included questions on demographics which included age, gender, nationality, marital status, level of education, job, monthly income, moral and social support, problem with access to health center and satisfaction with the service of the moral and social support, problem with access to health center and satisfaction with the service of the PCHC [Supplementary data 1].

The EQ-5D-3L descriptive system which comprises the five dimensions including; ability to move, personal care, typical activities, pain and discomfort, and anxiety and depression was used to describe how good or bad the patient's health state.[22]

The EQVAS (EQ Visual Analog Scales) was used to indicate the overall health on the day of the questionnaire completion. Patients were also asked to self-rate their health status using a scale (from 0-100). The mean EQVAS was calculated and presented as a mean and standard deviation.[22]

Collected data were analyzed using the Statistical Program for Social Sciences (SPSS) version 23.0 (SPSS Inc, IBM, Armonk, New York, USA). Descriptive characteristics are reported as numbers and percentages for categorical variables and as mean and standard deviation for continuous variables. Chi-square test was used to compare proportions between two categorical groups, independent t-test was used to compare between two means, and one-way analysis of variation (ANOVA) was used to compare between 3 or more means. Pearson correlation was used to determine correlation between variables. A P value of ≤0.05 was considered statistically significant.

Ethical approval was obtained from the Research Ethics Committee of KSMC and the Institutional Review Board (IRB), with approval number H1RI-08-Apr19-05. (Approved in 30 April, 2019).


  Results Top


A total of 274 T2DM patients were surveyed, 149 (54.4%) males and 125 (45.6%) females. The mean age was 59.7 ± 10.4 years (range: 35 to 85 years old). Majority (n = 264, 96.4%) were Saudi nationals. Two hundred and sixteen (78.8%) patients have moral and social support from family and friends. Majority of the patients (n = 238, 87.2%) have no problems accessing the health center, and 173 (63.2%) were satisfied (excellent to very excellent) with the service of the PCHC. [Table 1] shows the demographic profile of the surveyed patients.

[Table 2] shows the frequencies and proportions reported by dimension and level of the EQ-5D-5L. Of the five domains, self-care has the highest proportion that reported no problem (n = 183, 66.8%) and slight problem (n = 60, 21.9%) followed by anxiety and depression domain with 137 (50.0%) no problem and 92 (33.6%) slight problems. On the other hand, the mobility domain has the highest proportion of reported severe problems (n = 37, 13.5%) and extreme problems (n = 7, 2.6%). There were only 19 (6.9%) patients who reported with a full state of health.
Table 1: Demographic profile of the 274 surveyed T2DM patients

Click here to view
Table 2: EQ-5D-5L frequencies and proportions reported by dimension and level

Click here to view


Females showed to have a significantly higher mean overall EQ-5D-5L compared to males (p < 0.001). Mean EQ-5D-5L proportionately and significantly increased with increasing age and was highest at age group above 75 years old (p < 0.001). Widows had significantly higher mean EQ 5D-5L compared to other marital status (p < 0.001). Mean EQ-5D-5L was significantly higher among the low level of educated patients (p < 0.001). The unemployed posted significantly higher EQ-5D-5L compared to those patients who were employed (p < 0.001). Patients who had a net monthly household income of <5,000 SAR had significantly higher mean EQ-5D-5L compared to others (p = 0.025). However, there were no significant differences in the mean EQ-5D-5L among patients with and without moral and social support, among patients who have/do not have problems accessing health center, and their satisfaction with the services offered by the PCHC (p = 0.457, P = 0.997, and P = 0.081, respectively) [Table 3].
Table 3: Study sample characteristics, EQ-5D-5L according to sociodemographic variables

Click here to view


The mean EQVAS was 65.9 ± 22.1 (range: 0-100). A large proportion of patients self-rated EQVAS as 41 – 60 (n = 89, 32.5%), 61 – 80 (n = 85, 31.0%) and 81 – 100 (n = 66, 24.1%) [Figure 1]. Male patients reported a significantly higher mean EQVAS compared to females (68.63 ± 22.15 versus 62.64 ± 21.58, P = 0.025). Younger patients had significantly higher mean EQVAS compared to their older counterparts (p < 0.001). Married patients had significantly higher mean EQVAS compared to the others (p < 0.002). A higher level of education (Bachelor's degree and above) posted higher mean EQVAS (p < 0.001). Patients who were employed had significantly higher mean EQVAS compared to those who were not employed (p < 0.001). Patients who had a monthly net income of more than 15000 a month posted a higher mean EQVAS (p = 0.029), as well as those who were satisfied with the services offered by the PCHC (p = 0.001). There were no significant differences in the mean EQVAS among patients who have/who do not have moral and social support (p = 0.077), and among patients who have/who do not have problems accessing the health center (p = 0.945) [Table 4].
Figure 1: EQ = 5D-5L frequency distribution

Click here to view
Table 4: Study sample characteristics, EQVAS according to sociodemographic variables

Click here to view


EQ-5D-5L have significant positive correlation with the female gender (r = 0.260, P < 0.001), older age beyond 65 years old (r = 0.465, P < 0.001), divorced/separated/widowed (r = 0.373, P < 0.001), educational level below bachelor's degree (r = 0.483, P < 0.001), unemployed (r = 0.370, P < 0.001), and negatively correlated with income level less than 10,000 SAR per month (r = -0.168, P = 0.005). On the other hand the EQVAS was significantly negatively correlated with the female gender (r = -0.136, P = 0.025), older age beyond 65 years old (r = -0.323, P < 0.001), divorced/separated/widowed (r = -0.229, P < 0.001), educational level below bachelor's degree (r = -0.311, P < 0.001), unemployment (r = -0.323, P < 0.001), and satisfaction (r = -0.238, P < 0.001), but was positively correlated with income level of less than 10,000 SAR per month (r = 0.179, P = 0.003).


  Discussion Top


An essential component of managing patients with T2DM is substantiating a high QoL. It has been said that “patients who feel good about their life despite having diabetes, they have more energy to take good care of themselves, feel better day-to-day” and stay healthier.[22] For this reason, the EQ-5D-5L and the EQ VAS has been developed and used for patients to self-assess their QoL amidst the never-ending demands of the disease.

This study showed that majority of our patients reported lesser problems when it comes to self-care and anxiety/depression. Our result is similar (although lower in percentage) to the study among German general population which reported 93.0% without problems with self-care.[23] This translates to the fact that patients know their disease and were aware of the possible complications that may ensue. On the other hand, our patients reported problems on mobility (13.5% severe and 2.6% extreme). This is very true among older patients and patients who have concomitant complications including peripheral neuropathy, stroke, on insulin treatment, nephropathy and arthritis as described by Bruce et al.[24] in 2005. Among diabetic patients, their risk of mobility impairment increases by 6% a year (by increasing age) and from 40% to 222% increased risk in mobility impairment depending on the concomitant complication.[23] Furthermore, an increased risk in mobility impairment was shown to be significantly associated with non-adherence to lifestyle modification and non-adherence to self-care practices.[25] This implies that patients who practice self-care are those patients that have a high QoL, very good self-care behavior, and thus less risk for complications. The 19 patients who reported full state of health were majority males, married, with income of >10,000 SAR a month, with good moral support structure and without problems accessing the PCHC.

This study also showed that females experience more problems compared to males. One probable reason is that females report greater burden and restriction in their social interactions and less leisure time flexibility as well as their difficulty with dietary adherence as explained by Misra and Lager.[26] Older patients, particularly those age group above 75 years old experience more problems and burdens of the disease because of the development and increasing prevalence of concomitant complications. Reports showed that older adults report 14 or more unhealthy days compared to their younger counterparts.[27] Married individuals will most likely receive more moral and physical support from family. Although in our study we found out that having moral support or not, will not significantly affect the QoL. However among widows, the compounded issues not just the disease but the psychological and social aspects may further add to the burden which explains why widows experience more problems and have lower QoL.[28] Similar to the previous studies, low socioeconomic status (<5,000 SAR monthly income) and diabetics with a high school education or less had a negative impact on the QoL.[29],[30],[31]

Another highlight of this study is that only one in four (24.1%) of our patients perceive their health status as very good to excellent based on their EQ VAS results. Male patients, younger patients, married, those with higher level of education and income level perceived their health status very good to excellent. This is in agreement to previous studies that showed similar results.[32],[33],[34],[35]

This study supports the validity, reliability and responsiveness of the EQ-5D-5L and the EQ VAS in modeling health outcomes for health practitioners and health institutions management of Type 2 diabetics. This study showed that patients perception of their health state and the dimensions that were most affected by the condition correlated well with their overall health (whether good or bad). Although there were more patients who perceived their health as having problems particularly on mobility with only 19 patients coming up with perfect health perception, the overall EQ VAS showed more patients who perceived their health as good to excellent. One limitation is, we were not able to repeatedly measure the QoL over time to enable examination of the QoL as the disease progress. Moreover, we were not able to establish causality because of the observational design of the study. Another limitation of the study is that the questionnaire was conducted in such a limited time that the participants might have answered the questionnaire without sufficient understanding of the questions particularly the poorly-educated and the elderly patients. However, we were able to deduce and identify health-related dimensions that affect the QoL among our patients despite the limitations.

Key points

  • The mobility domain has the highest proportion of reported severe and extreme problems
  • Females have a higher mean overall EQ-5D-5L compared to males, whereas males have a higher mean EQVAS compared to females
  • Mean EQ-5D-5L proportionately increase with increasing age and was highest at age group above 75 years old
  • Younger patients, married, and those employed have a higher mean EQVAS as well as were more satisfied with the services offered by the PCHC
  • Males, with higher socioeconomic status, employed, married and younger patients experience better QoL compared to their counterparts.



  Conclusion Top


This study indicates a significant effect of T2DM on the QoL of diabetic patients. Males, with higher socioeconomic status, employed, married and younger patients experience better QoL compared to their counterparts. The overall health related QoL among our diabetic patients is low. These findings suggest improvement of health-related QoL and health outcomes of diabetic patients, and more efforts should be invested in patient education particularly among patients who are in the low socioeconomic status, the elderly, females and the unemployed.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

[Supplementary data 1]: The used questionnaire in study

Peace be upon you. We thank you for your cooperation with us in the success of this study aimed at diabetes patients and study the quality of life of the patient, which will help to improve and develop the therapeutic steps of the patient .. Wishing you a speedy recovery ..

Personal Information:









 
  References Top

1.
Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract 2010;87:4-14.  Back to cited text no. 1
    
2.
Guariguata L, Whiting DR, Hambleton I, Beagley J, Linnenkamp U, Shaw JE. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 2014;103:137-49.  Back to cited text no. 2
    
3.
Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: Global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 2011;94:311-21.  Back to cited text no. 3
    
4.
Atlas D. International diabetes federation. Press Release, Cape Town, South Africa, 4; 2006.  Back to cited text no. 4
    
5.
Atlas ID. Brussels, Belgium: International Diabetes Federation; 2013. International Diabetes Federation (IDF); 2017.  Back to cited text no. 5
    
6.
Cheng YJ, Imperatore G, Geiss LS, Wang J, Saydah SH, Cowie CC, et al. Secular changes in the age-specific prevalence of diabetes among US adults: 1988–2010. Diabetes Care 2013;36:2690-6.  Back to cited text no. 6
    
7.
Holden SE, Barnett AH, Peters JR, Jenkins-Jones S, Poole CD, Morgan CL, et al. The incidence of type 2 diabetes in the United Kingdom from 1991 to 2010. Diabetes Obes Metab 2013;15:844-52.  Back to cited text no. 7
    
8.
Eschwege E, Basdevant A, Crine A, Moisan C, Charles MA. Type 2 diabetes mellitus in France in 2012: Results from the ObEpi survey. Diabetes Metab 2015;41:55-61.  Back to cited text no. 8
    
9.
Majeed A, El-Sayed AA, Khoja T, Alshamsan R, Millett C, Rawaf S. Diabetes in the Middle-East and North Africa: An update. Diabetes Res Clin Pract 2014;103:218-22.  Back to cited text no. 9
    
10.
Hu FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care 2011;34:1249-57.  Back to cited text no. 10
    
11.
Schofield D, Cunich MM, Shrestha RN, Passey ME, Veerman L, Callander EJ, et al. The economic impact of diabetes through lost labour force participation on individuals and government: Evidence from a microsimulation model. BMC Public Health 2014;14:220.  Back to cited text no. 11
    
12.
Alhowaish AK. Economic costs of diabetes in Saudi Arabia. J Family Community Med 2013;20:1-7.  Back to cited text no. 12
    
13.
Sakamaki H, Ikeda S, Ikegami N, Uchigata Y, Iwamoto Y, Origasa H, et al. Measurement of HRQL using EQ-5D in patients with type 2 diabetes mellitus in Japan. Value Health 2006;9:47-53.  Back to cited text no. 13
    
14.
Sparring V, Nyström L, Wahlström R, Jonsson PM, Östman J, Burström K. Diabetes duration and health-related quality of life in individuals with onset of diabetes in the age group 15—34 years–A Swedish population-based study using EQ-5D. BMC Public Health 2013;13:377.  Back to cited text no. 14
    
15.
Fu AZ, Qiu Y, Radican L, Luo N. Marginal differences in health-related quality of life of diabetic patients with and without macrovascular comorbid conditions in the United States. Qual Life Res 2011;20:825-32.  Back to cited text no. 15
    
16.
Lee WJ, Song KH, Noh JH, Choi YJ, Jo MW. Health-related quality of life using the EuroQol 5D questionnaire in Korean patients with type 2 diabetes. J Korean Med Sci 2012;27:255-60.  Back to cited text no. 16
    
17.
Zhuang Y, Ma QH, Pan CW, Lu J. Health-related quality of life in older Chinese patients with diabetes. PLoS One 2020;15:e0229652.  Back to cited text no. 17
    
18.
Almogbel E. Assessment of health-related quality of life among Saudi patients with type 2 diabetes mellitus in Qassim region—Saudi Arabia. Age 2020;234:68-8.  Back to cited text no. 18
    
19.
Alshayban D, Joseph R. Health-related quality of life among patients with type 2 diabetes mellitus in Eastern Province, Saudi Arabia: A cross-sectional study. PLoS One 2020;15:e0227573.  Back to cited text no. 19
    
20.
Schmittdiel J, Vijan S, Fireman B, Lafata JE, Oestreicher N, Selby JV. Predicted quality-adjusted life years as a composite measure of the clinical value of diabetes risk factor control. Med Care 2007;45:315-21.  Back to cited text no. 20
    
21.
Clarke PM, Gray AM, Briggs A, Farmer AJ, Fenn P, Stevens RJ, et al.; UK Prospective Diabetes Study (UKPDS) Group. A model to estimate the lifetime health outcomes of patients with type 2 diabetes: The United Kingdom Prospective Diabetes Study (UKPDS) Outcomes Model (UKPDS no. 68). Diabetologia 2004;47:1747-59.  Back to cited text no. 21
    
22.
Al-Taie N, Maftei D, Kautzky-Willer A, Krebs, M, Stingl H. Assessing the quality of life among patients with diabetes in Austria and the correlation between glycemic control and the quality of life. Prim Care Diabetes 2020;14:133-8.  Back to cited text no. 22
    
23.
Huber MB, Felix J, Vogelmann M, Leidl R. Health-related quality of life of the general German population in 2015: Results from the EQ-5D-5L. Int J Environ Res Public Health 2017;14:426.  Back to cited text no. 23
    
24.
Bruce DG, Davis WA, Davis TM. Longitudinal predictors of reduced mobility and physical disability in patients with type 2 diabetes: The Fremantle Diabetes Study. Diabetes Care 2005;28:2441-7.  Back to cited text no. 24
    
25.
Saleh F, Mumu SJ, Ara F, Hafez MA, Ali L. Non-adherence to self-care practices & medication and health related quality of life among patients with type 2 diabetes: A cross-sectional study. BMC Public Health 2014;14:431.  Back to cited text no. 25
    
26.
Misra R, Lager J. Ethnic and gender differences in psychosocial factors, glycemic control, and quality of life among adult type 2 diabetic patients. J Diabetes Complications 2009;23:54-64.  Back to cited text no. 26
    
27.
American Diabetes Association. 5. Facilitating behavior change and well-being to improve health outcomes: Standards of Medical Care in Diabetes—2020. Diabetes Care 2020;43(Suppl 1):S48-65.  Back to cited text no. 27
    
28.
Imiyama I, Plotnikoff RC, Courneya KS, Johnson JA. Determinants of quality of life in adults with type 1 and type 2 diabetes. Health Qual Life Outcomes 2011;9:115.  Back to cited text no. 28
    
29.
Speight J, Holmes-Truscott E, Hendrieckx C, Skovlund S, Cooke DJ. Assessing the impact of diabetes on quality of life: What have the past 25 years taught us? Diabet Med 2020;37:483-92.  Back to cited text no. 29
    
30.
Wubben DP, Porterfield D. Health-related quality of life among North Carolina adults with diabetes mellitus. N C Med J 2005;66:179-85.  Back to cited text no. 30
    
31.
Alhayek AA, Robert AA, Al Saeed A, Alzaid AA, Al Sabaan FS. Factors associated with health-related quality of life among Saudi patients with type 2 diabetes mellitus: A cross-sectional survey. Diabetes Metab J 2014;38:220-9.  Back to cited text no. 31
    
32.
Quah JH, Luo N, Ng WY, How CH, Tay EG. Health-related quality of life is associated with diabetic complications, but not with short-term diabetic control in primary care. Ann Acad Med Singap 2011;40:276-86.  Back to cited text no. 32
    
33.
Bradley C, Eschwège E, de Pablos-Velasco P, Parhofer KG, Simon D, Vandenberghe H, et al. Predictors of quality of life and other patient-reported outcomes in the PANORAMA multinational study of people with type 2 diabetes. Diabetes Care 2018;41:267-76.  Back to cited text no. 33
    
34.
Knowles SR, Apputhurai P, O'Brien CL, Ski CF, Thompson DR, Castle DJ. Exploring the relationships between illness perceptions, self-efficacy, coping strategies, psychological distress and quality of life in a cohort of adults with diabetes mellitus. Psychol Health Med 2020;25:214-28.  Back to cited text no. 34
    
35.
Javabakht M, Abolhasani F, Mashayekhi A, Baradaran HR, Jahangiri Noudeh Y. Health related quality of life in patients with type 2 diabetes mellitus in Iran: A national survey. PLoS One 2012;7:e44526.  Back to cited text no. 35
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

Top
   
 
  Search
 
Similar in PUBMED
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
   Abstract
  Introduction
  Methods
  Results
  Discussion
  Conclusion
   References
   Article Figures
   Article Tables

 Article Access Statistics
    Viewed302    
    Printed0    
    Emailed0    
    PDF Downloaded29    
    Comments [Add]    

Recommend this journal