Quality of Life Among Diabetes Patients in Nepal

Diabetes Mellitus is a long-lasting illness that poses a serious Health challenge worldwide. It is one of the top four health problems that don't spread from person to person. About three out of four people with Diabetes Mellitus live in countries with lower or middle income. As people get older, more of them develop prediabetes or diabetes. In Nepal, the number of people with diabetes varies a lot by region, with some places having only 2% of people affected and others having up to 10%.

This disease can lead to serious health problems affecting both large blood vessels (like heart disease and stroke) and small blood vessels (leading to issues in kidneys, nerves, and eyes). Living with diabetes doesn't just harm physical health; it can also take a toll on mental and social well-being. Many individuals with diabetes face significant challenges that can impact their overall health and happiness.

People diagnosed with Type 2 Diabetes often have a tough time managing their treatment. When diabetes is managed well, it can help reduce symptoms and prevent serious health issues that might lead to hospital visits or even death. Research has shown that older adults with type 2 diabetes may experience both physical and mental health problems. Managing diabetes is influenced by factors such as support from family, how well people stick to their treatment plans, and availability of health information.

As more people develop diabetes, we can expect to see more long-term and serious health issues in the general population. This increase will likely affect Quality Of Life, health services, and overall costs in healthcare. Treatments for diabetes, like using insulin, can improve quality of life by lowering high blood sugar but might also cause problems like low blood sugar. The mental strain of managing diabetes can complicate self-care, increasing the chances of serious health problems over time.

The World Health Organization (WHO) defines Quality of Life (QoL) as how people perceive their life based on their culture, values, goals, and concerns. It’s important for everyone on the healthcare team to recognize the significance of quality of life. Diabetes can seriously affect a person's QoL in several ways, including health, emotional state, social life, and finances. To help improve the QoL for those with diabetes, we need to focus on effective management strategies such as education, support, and healthcare access. Knowing how diabetes affects the lives of individuals is key to creating better support systems, treatment options, and enhancing overall well-being.

This study aimed to look at the quality of life for people diagnosed with type 2 diabetes at a hospital in Nepal.

#Materials and Methods

#Study Setting

A descriptive study was conducted to assess the quality of life of diabetes patients. The research took place at Universal College of Medical Sciences, a large hospital in Nepal with 750 beds. Participants included patients diagnosed with type 2 diabetes for at least six months who visited the outpatient department, agreed to participate, and were available to provide information during the study.

The sample size was calculated to involve 334 diabetes patients by taking previous findings into account that indicated 68% of patients report a good quality of life. These patients were chosen using a non-random approach, and those who came to the outpatient department were interviewed in the order they arrived.

#Research Instrument

For gathering information, a structured questionnaire was used, which had two parts. The first part collected basic information such as age, gender, marital status, education, job, family history of diabetes, how long they had diabetes, and any other health issues they might have.

The second part of the questionnaire was the WHOQOL-BREF, a 26-item survey that measures quality of life in four categories: physical health, psychological well-being, social relationships, and environment. It also included questions about how individuals view their overall quality of life and health. Each answer was scored from 1 to 5, with higher scores indicating better quality of life. Some questions were phrased in a way that required reverse scoring before analysis to ensure accuracy.

The scores were adjusted to align with WHOQOL-100 standards, with a scale of 0-100 where 100 represents the best quality of life. The WHOQOL-BREF showed high reliability, meaning it provides consistent results. The questionnaire was originally in English, translated into Nepali, and then back-translated to ensure accuracy. A small test run was done before the main study with 33 respondents to fine-tune the instrument.

#Ethical Approval

To conduct this study, approval was secured from the Institutional Review Committee of the hospital. The Medical Superintendent allowed data collection, and each patient provided written consent after the purpose of the study was explained. Confidentiality was promised, and data was monitored for completeness during collection. The researcher collected all data personally over a six-month period.

#Statistical Analysis

Reliability for the questionnaire was confirmed, showing good consistency. The analysis used software to examine the relationship between quality of life and various demographic factors, applying tests to see if the differences found were significant.

In total, 334 respondents participated in the study. More than half were aged between 41-60 years. Around 29% felt they had a good quality of life, while 22% were satisfied with their health, according to the first two questions of the WHOQOL-BREF survey.

#Socio-demographic Characteristics of Respondents

The four categories of quality of life showed how individuals perceived their well-being in each area. The highest average score was found in social relationships, followed by the environment and psychological health, with the lowest score in physical health.

Different age groups showed significant differences in quality of life scores. Older individuals scored lower in the physical and psychological categories compared to younger groups, while they also scored lower in social relationships and the environment compared to those aged 41-60.

Gender also played a role, with males generally reporting higher scores across all domains. In terms of marital status, divorced individuals tended to have lower scores in physical and environmental areas compared to singles. Education level made a difference too, as those who were literate scored higher than those who were not.

The length of time someone had diabetes also impacted scores, with those diagnosed for five years or less scoring better than those diagnosed longer. Similarly, patients using diet and oral medications for diabetes management tended to report better psychological and environmental scores than those using insulin or a combination of methods.

Comorbidities had a significant impact on quality of life scores across all four domains. Those without additional health issues scored higher compared to those with comorbidities.

#Correlation Between Domains

The reliability of the WHOQOL-BREF survey was confirmed through statistical tests, showing strong relationships between the various categories of life quality. This means improvements in one area could relate to improvements in others.

#Summary of Findings

Over the past several decades, diabetes has increasingly affected both wealthy and developing countries, primarily due to lifestyle changes, more accessible food, and reduced physical activity. This illness has a significant effect on a person's quality of life, which needs to be prioritized in diabetes care.

In our study, most participants were aged 41-60. This aligns with similar research conducted in the region. Gender distribution in our study showed male and female participants were relatively equal. This similarity might be due to shared cultural and economic conditions among neighboring countries.

The study found the social aspect of life had the highest quality scores, while physical health had the lowest. It’s crucial to consider why physical quality of life scores might be low; mental health struggles can diminish energy levels and discourage physical activity. Strict diets for diabetes management can also lead to physical health issues, reducing energy and overall well-being.

Significant differences were also found regarding gender, with males reporting better quality of life scores in all areas. This might relate to social and economic pressures that women often face, impacting their health-seeking behavior. Interestingly, having a family history of diabetes didn’t show a significant effect on quality of life, suggesting that personal health management and support systems are more crucial.

People with additional health issues reported lower scores across the board. Managing multiple health problems can be overwhelming, leading to a more complex care process and affecting overall well-being.

#Conclusion

Overall, diabetes has a serious impact on quality of life, especially for women and those with other health issues. The study results emphasize that addressing quality of life in diabetes management is vital. A focus on emotional support, lifestyle changes, and managing other health problems can help improve life quality for those living with diabetes.