Mental health issues decrease diabetes-specific quality of life independent of glycaemic control and complications: findings from Australia’s living with diabetes cohort study

Abstract

BackgroundWhile factors associated with health-related quality of life for people with chronic diseases including diabetes are well researched, far fewer studies have investigated measures of disease-specific quality of life. The purpose of this study is to assess the impact of complications and comorbidities on diabetes-specific quality of life in a large population-based cohort of type 2 diabetic patients.MethodsThe Living with Diabetes Study recruited participants from the National Diabetes Services Scheme in Australia. Data were collected via a mailed self-report questionnaire. Diabetes-specific quality of life was measured using the Audit of Diabetes-Dependent Quality of Life (ADDQoL) questionnaire. The analyses are for 3609 patients with type 2 diabetes. Regression models with adjustment for control variables investigated the association of complications and comorbidities with diabetes-specific quality of life. Next, the most parsimonious model for diabetes-specific quality of life after controlling for important covariates was examined.ResultsThe expected associations with better diabetes-specific quality of life were evident, such as increased income, not on insulin, better glycaemic control and older age. However, being single and having been diagnosed with cancer were also associated with better ADDQoL. Additionally, poorer diabetes-specific quality of life was strongly sensitive to the presence of diabetes complications and mental health conditions such as depression, anxiety and schizophrenia. These relationships persisted after adjustment for gender, age, duration of diabetes, treatment regimen, sampling region and other treatment and socio-demographic variables.ConclusionsA greater appreciation of the complexities of diabetes-specific quality of life can help tailor disease management and self-care messages given to patients. Attention to mental health issues may be as important as focusing on glycaemic control and complications. Therefore clinicians’ ability to identify and mange mental health issues and/or refer patients is critical to improving patients’ diabetes-specific quality of life.

Health status and quality of life in patients with diabetes in Switzerland

“…Regarding characteristics associated with physical functioning (PCS) and QoL, the finding that the lowest income was associated with both lower PCS and QoL is consistent with other studies [29,34], while our finding that gender was not a significant factor is in contrast to previous studies [9]. Older individuals were more likely to report higher QoL scores than younger individuals, although older individuals tended to report lower PCS.…”

“…The low QoL score for sex life reported in our population has also been reported in other studies using the ADDQoL [23,29]. Lower sex life scores were correlated with by being a man, diagnosed for more than 10 years, and suffering from cerebrovascular complications and neuropathy.…”

“…Dietary freedom was reported as the most impacted life domain in our study, as well as in many studies using the ADDQoL in a range of countries in Europe [19][20][21][22][23][24][25], Asia [26][27][28], and Australia [29]. Diabetes requires dietary restrictions as well as constant monitoring of food intake, exercise and glucose levels to decrease the risk of developing complications and thus increase the likelihood of better health and QoL in the future.…”

“…Regarding the global diabetes-related QoL as expressed by the overall ADDQoL score, the mean score in our population was among the least negative in the published literature using the same instrument (e.g. [19,29,31]) with most studies reporting worse scores (e.g. [8,32,33]).…”

Gastric bypass significantly improves quality of life in morbidly obese patients with type 2 diabetes

“…Furthermore, obese diabetic patients exploring bariatric surgery are well aware of the unparalleled impact of RYGB on diabetes, and the expectation that a long-term disability might be remitted could also influence quality of life perception post-operatively. The complications of T2DM have been shown to impact the HRQOL of diabetic patients [32]. Our prospective study was not designed to assess the complications of T2DM their rate of remission after RYGB.…”