Hierarchical Regression of Diabetes Self-Management and Health Related Quality of Life among Older Adults Patients with Type 2 Diabetes Mellitus.
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The global elderly population is experiencing a rising prevalence of diabetes mellitus (DM). As a chronic and noncommunicable disease, diabetes requires strict daily self-management, significantly affecting the health-related quality of life (HRQOL). We investigated the relationship between diabetes self-management behaviors and HRQOL in a population of older adults diagnosed with type 2 diabetes mellitus (T2DM). This cross-sectional study was conducted between March 2022 and August 2022 at Phramongkutklao Hospital, Bangkok, Thailand. Participants completed questionnaires measuring sociodemographic factors, we utilized the Diabetes Self-Management Questionnaire (DSMQ) and the Diabetes-39 Questionnaire (D-39) to assess self-management behaviors. Hierarchical linear regression analysis was then employed to investigate the association between diabetes self-management and HRQOL. A total of 252 participants with a mean age of 68.96 years (SD = 6.64) were included. Most participants were aged 60-69 years (57.0%), female (59.9%), married (81.0%), had an undergraduate education (56.7%), and had an income lower than or equal to 40,000 baht (76.6%). Three factors were associated with HRQOL: compliance with cardiovascular disease (β = 0.233, P < 0.001), acute pancreatitis (β = 0.132, P < 0.05), and diabetes self-management (β = -0.376, P < 0.001). Our findings from the final Model 3 analysis revealed a statistically significant positive association between cardiovascular disease (CVD) and HRQOL (standardized β = 0.233, P < 0.001). This indicates that individuals with CVD reported lower HRQOL compared to those without the condition. Similarly, a significant positive association emerged between acute pancreatitis (AP) and HRQOL (standardized β = 0.132, P < 0.05), suggesting a negative impact of this acute illness on HRQOL. Conversely, diabetes self-management demonstrated a significant negative association with HRQOL (standardized β = -0.376, P < 0.001). This implies that better self-management practices among diabetic patients were linked to improved HRQOL. These findings highlight the crucial role of understanding patient perspectives on self-management. Healthcare providers and researchers should prioritize investigating these perspectives to develop and implement interventions that deliver effective diabetes self-management education. Such targeted interventions have the potential to significantly enhance the HRQOL of patients living with diabetes.
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IDF Diabetes Atlas, 10th edn. 2021. Available from: https://www.diabetesatlas.org. Accessed September 10, 2022.
Aekplakorn W, Chariyalertsak S, Kessomboon P, Assanangkornchai S, Taneepanichskul S, Putwatana P. Prevalence of Diabetes and Relationship with Socioeconomic Status in the Thai Population: National Health Examination Survey, 2004-2014. J Diabetes. 2018:1654530.
Ong-Artborirak P, Seangpraw K, Boonyathee S, Nisarat A, Winaiprasert P. Health literacy, self-efficacy, self-care behaviors, and glycemic control among older adults with type 2 diabetes mellitus: a cross-sectional study in Thai communities. BMC Geriatrics. 2023;23:1-10.
Ageing and health. 2022. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health. Accessed November 11, 2022.
Rosengren A, Dikaiou P. Cardiovascular outcomes in type 1 and type 2 diabetes. Diabetologia. 2023;66(3):425-437.
Tantirat P, Suphanchaimat R, Rattanathumsakul T, Noree T. Projection of the Number of Elderly in Different Health States in Thailand in the Next Ten Years, 2020–2030. Int J Environ Res Public Health. 2020;17(22):8703.
Tuttle D, Griffiths J, Kaunnil A. Family Caregivers of Older Adults with Physical Disabilities in Rural Thailand. The Qualitative Report. 2023;28(2):607-622.
Sinclair A, Dunning T, Rodriguez-Mañas L. Diabetes in older people: new insights and remaining challenges. Lancet Diabetes Endocrinol. 2015;3(4):275-285.
Bellary S, Kyrou I, Brown JE, Bailey CJ. Type 2 diabetes mellitus in older adults: clinical considerations and management. Nat Rev Endocrinol. 2021;17(9):534-548.
10. Khan A, Uddin S, Srinivasan U. Comorbidity network for chronic disease: A novel approach to understand type 2 diabetes progression. Int J Med Inform. 2018;115:1-9.
Xu X, Mishra GD, Jones M. Evidence on multimorbidity from definition to intervention: An overview of systematic reviews. Ageing Res Rev. 2017;37:53-68.
Selleh PK, Anto EO, Wina IOB, Sackey B, Boateng LA, Nkansah C, et al. Quality of glycemic control in type 2 diabetes mellitus (T2DM) and its association with markers of coagulation and inhibitors of fibrinolysis: A case–control study in the Upper West Region, Ghana. Health Sci Rep. 2023;6(6):e1297.
Che M, Zhou Q, Lin W, Yang Y, Sun M, Liu X, et al. Healthy Lifestyle Score and Glycemic Control in Type 2 Diabetes Mellitus Patients: A City-Wide Survey in China. Healthcare. 2023;11(14):2037.
Hurst CP, Rakkapao N, Hay K. Impact of diabetes self-management, diabetes management self-efficacy and diabetes knowledge on glycemic control in people with Type 2 Diabetes (T2D): A multi-center study in Thailand. PLoS One. 2020;15(12): e0244692.
Teli M, Thato R, Rias YA. Predicting Factors of Health-Related Quality of Life Among Adults With Type 2 Diabetes: A Systematic Review. SAGE Open Nurs. 2023;9:23779608231185921.
Zeng Z, Wang X, Chen Y, Zhou H, Zhu W, Xiong X, et al. Health-related quality of life in Chinese individuals with type 2 diabetes mellitus: a multicenter cross-sectional study. Health Qual Life Outcomes. 2023;21(1):100.
Janke Z, Modjadji P, Madiba S, Moropeng L, Mokgalaboni K, Mphekgwana PM, et al. Self-Management of Diabetes and Associated Factors among Patients Seeking Chronic Care in Tshwane, South Africa: A Facility-Based Study. Int J Environ Res Public Health. 2023;20(10):5887.
León-Hernández R, Rodríguez-Pérez AC, Pérez-González YM, María IPdC, Raúl de L-E, Gómez-Gutiérrez T, et al. Psychosocial Factors Associated with Self-Management in Patients with Diabetes. Healthcare. 2023;11(9):1284.
Gao Y, Keshu Y, Yan X, Na X, Gao J, Ren H. Correlation between health literacy and health-related quality of life in patients with diabetic peripheral neuropathy: The mediating role of self-management. Nurs Open. 2023;10(5):3164-3177.
Alzahrani O, Fletcher JP, Hitos K. Quality of life and mental health measurements among patients with type 2 diabetes mellitus: a systematic review. Health Qual Life Outcomes. 2023;21(1):21-27.
Zeng Z, Wang X, Chen Y, Zhou H, Zhu W, Xiong X, et al. Health-related quality of life in Chinese individuals with type 2 diabetes mellitus: a multicenter cross-sectional study. Health and Quality of Life Outcomes. 2023;21:1-10.
Khunkaew S. Type 2 diabetes mellitus and diabetic foot ulcers: an exploration of the health-related quality of life, diabetes knowledge and foot self-care management in Thailand. University of Wollongong Thesis Collection 2017+. 2019.
Khunkaew S, Fernandez R, Sim J. Demographic and clinical predictors of health-related quality of life among people with type 2 diabetes mellitus living in northern Thailand: A cross-sectional study. Health Qual Life Outcomes. 2019;17(1):177.
Miracle VA. The Belmont Report: The Triple Crown of Research Ethics. Dimens Crit Care Nurs. 2016;35(4):223-228.
Thojampa S, Mawn B. Psychometric evaluation of the Thai translation of the Diabetes Self-management Questionnaire in type 2 diabetes. Int J Nurs Sci. 2017;4(3):236-238.
Schmitt A, Gahr A, Hermanns N, Kulzer B, Huber J, Haak T. The Diabetes Self-Management Questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes. 2013;11:138.
Songraksa K, Lerkiatbundit S. Development of a disease specific quality of life instrument: Thai version of the Diabetic-39. Journal of Health Science and Medical Research. 2009;27(1):35-49.
Fauzi A, Anggraini N, Fatkhurohman N. Self-management: A comprehensive approach to improve quality of life among people living with HIV in Indonesia. Belitung Nurs J. 2021;7(5):395-401.
Guyatt GH, Ferrans CE, Halyard MY, Revicki DA, Symonds TL, Varricchio CG, et al. Exploration of the value of health-related quality-of-life information from clinical research and into clinical practice. Mayo Clin Proc. 2007;82(10):1229-1239.
Lin X-J, Lin IM, Fan S-Y. Methodological issues in measuring health-related quality of life. Tzu Chi Medical Journal. 2013;25(1):8-12.
Mosenzon O, Alguwaihes A, Leon JLA, Bayram F, Darmon P, Davis TME, et al. CAPTURE: a multinational, cross-sectional study of cardiovascular disease prevalence in adults with type 2 diabetes across 13 countries. Cardiovasc Diabetol. 2021;20(1):154.
Sitlinger A, Zafar SY. Health-Related Quality of Life: The Impact on Morbidity and Mortality. Surg Oncol Clin N Am. 2018;27(4):675-684.
Arnold SV, Khunti K, Tang F, Chen H, Nicolucci A, Gomes MB, et al. Impact of micro‐ and macrovascular complications of type 2 diabetes on quality of life: Insights from the DISCOVER prospective cohort study. Endocrinol Diabetes Metab. 2022;5(2): e00321.
Pool LR, Ning H, Huffman MD, Reis JP, Lloyd-Jones DM, Allen NB. Association of cardiovascular health through early adulthood and health-related quality of life in middle age: The Coronary Artery Risk Development in Young Adults (CARDIA) Study. Prev Med. 2019;126:105772.
Wu X, Liu X, Liao W, Kang N, Shengxiang S, Tanko A, et al. The Association Between Ideal Cardiovascular Health and Health-Related Quality of Life in Adults: A Population-Based Cross-Sectional Study. Int J Public Health. 2021;66:592043.
Lertsakulbunlue S, Mungthin M, Rangsin R, Kantiwong A, Sakboonyarat B. Trends in predicted 10-year risk for cardiovascular diseases among patients with type 2 diabetes in Thailand, from 2014 to 2018. BMC Cardiovasc Disord. 2023;23(1)183.
Zhang Y, Miao H, Chia YC, Buranakitjaroen P, Siddique S, Shin J, et al. Cardiovascular risk assessment tools in Asia. J Clin Hypertens (Greenwich). 2022;24(4):369-377.
Lai SW, Muo CH, Liao KF, Sung FC, Chen PC. Risk of Acute Pancreatitis in Type 2 Diabetes and Risk Reduction on Anti-Diabetic Drugs: A Population-Based Cohort Study in Taiwan. Am J Gastroenterol. 2011;106(9):1697-1704.
Li L, Li L. Risk factors for diabetic ketoacidosis in acute pancreatitis patients with type 2 diabetes. BMC Gastroenterol. 2023;23(1):257.
Śliwińska-Mossoń M, Bil-Lula I, Marek G. The Cause and Effect Relationship of Diabetes after Acute Pancreatitis. Biomedicines. 2023;11(3):667.
Sun Y, Jin J, Zhu A, Hu H, Lu Y, Zeng Y, et al. Risk Factors for Recurrent Pancreatitis After First Episode of Acute Pancreatitis. Int J Gen Med. 2022;15:1319-1328.
Samarasekera E, Shama M, Carlisle S, Charnley R. Pancreatitis: summary of NICE guidance. BMJ. 2018;362: k3443.
Xiao AY, Tan MLY, Wu LM, Asrani VM, Windsor JA, Yadav D, et al. Global incidence and mortality of pancreatic diseases: a systematic review, meta-analysis, and meta-regression of population-based cohort studies. Lancet Gastroenterol Hepatol. 2016;1(1):45-55.
Alsayed Hassan D, Helaluddin F, Chahestani OH, Mohamed O, Islam N. Diabetes Self-Management and Health-Related Quality of Life among Primary Care Patients with Diabetes in Qatar: A Cross-Sectional Study. Healthcare. 2022;10(11):2124.
Pham TB, Nguyen TT, Truong HT, Trinh CH, Du HNT, Ngo TT, et al. Effects of Diabetic Complications on Health-Related Quality of Life Impairment in Vietnamese Patients with Type 2 Diabetes. J Diabetes Res. 2020;2020:4360804.
Gu S, Wang X, Shi L, Sun Q, Hu X, Gu Y, et al. Health-related quality of life of type 2 diabetes patients hospitalized for a diabetes-related complication. Qual Life Res. 2020;29(10):2695-2704.
Al-Khaledi M, Al-Dousari H, Al-Dhufairi S, Al-Mousawi T, Al-Azemi R, Al-Azimi F, et al. Diabetes Self-Management: A Key to Better Health-Related Quality of Life in Patients with Diabetes. Med Princ Pract. 2018;27(4):323-331.
Dereje Chala D, Leung DYP, Suen LKP. Factors predicted quality of life of people with type 2 diabetes in western Ethiopia. PLoS One. 2023;18(2):e0281716.
Volčanšek Š, Lunder M, Janež A. Health-Related Quality of Life Assessment in Older Patients with Type 1 and Type 2 Diabetes. Healthcare. 2023;11(15):2154.
Anderson N, Ozakinci G. Effectiveness of psychological interventions to improve quality of life in people with long-term conditions: rapid systematic review of randomised controlled trials. BMC Psychol. 2018;6(1):11.
Fitzpatrick R, Fletcher A, Gore S, Jones D, Spiegelhalter D, Cox D. Quality of life measures in health care. I: Applications and issues in assessment. BMJ. 1992;305(6861):1074-1077.
Phyo AZZ, Ryan J, Freak-Poli R. The role of health-related quality of life in risk prediction for developing cardiovascular disease, dementia and all-cause death among general older adults. Front Public Health. 2022;10:1014019.