Predictors of Health-Related Quality of Life among Patients with Diabetes Mellitus

*Bikila Regassa Feyisa*

### **Abstract**

The health of general population cannot be well characterized from the analyses of mortality and morbidity statistics alone, particularly for patients of chronic diseases including diabetes mellitus. It is equally important to contemplate health in terms of people's assessment of their sense of well-being and ability to perform social roles. A number of reasons are there to measure the health-related quality of life among patients with diabetes mellitus. For one thing, diabetes patients are highly interested in functional capacity and well-being. On the other hand, patients in the same clinical manifestations might have different responses. Either general or specific instruments could be utilized to measure the health-related quality of life of diabetes patients. Choice of the instrument depends on time of the measurement, validity of the instrument and the interpretability. In Ethiopia, short form 36 (SF-36) instruments were utilized and the highest (63.2 34.4) and the lowest (30.2 22.9) mean score scored in physical functioning and general health domain respectively. The study indicated that age, sex, marital status, educational status, feeling of stigmatized, co-morbidity status, chronic complication and body mass index are some of the predictors of health-related quality of life for patients living with diabetes mellitus.

**Keywords:** Health-related quality of life, diabetes mellitus, Ethiopia

#### **1. Introduction**

Diabetes mellitus (DM) is a chronic disease that occurs when the pancreas fails to produce enough insulin or when the body's insulin is not used correctly. There are numerous forms of diabetes, and each form is caused by a complex mix of genetics and environmental factors. Type 1 and type 2 diabetes mellitus are two basic classifications of the disease. Chronic high blood glucose levels (>126 mg/dl for fasting blood sugar and/or a 2-hour postprandial glucose of 200 mg/dl, or if the individual experienced symptoms of diabetes and random plasma glucose of 200 mg/dl (confirmed by repeat testing) are indications of diabetes [1–3].

Diabetes mellitus (DM) is a rising condition that has a significant influence on health and quality of life. It is seen as a pressing public health issue that has the potential to negatively impact health-related quality of life [2, 4, 5]. In 2015, around 8.8% of persons aged 20 to 79 had diabetes worldwide. Over 2030, this tendency is expected to reach 366 million cases, rising to 642 million cases (one in every ten individuals) by the next decade. Around 75% of them were from low- and

middle-income nations. Diabetes was responsible for over 5 million deaths worldwide between the ages of 20 and 99 [6–8].

The increasing burden of diabetes has also great economic impact directly for medical costs and indirectly by loss of jobs and wages. The global healthcare expenditure on people with diabetes was estimated to be USD 850 billion in 2017 [3, 8].

There is now an universal agreement that the general population's health cannot be adequately assessed solely through the analysis of mortality and morbidity statistics, and that health must also be considered in terms of people's perceptions of their sense of well-being and ability to perform social roles [9, 10].

This evaluation could be correct if the health-related quality of life of individuals, particularly those with chronic illness, could be accurately assessed. The phrase "health-related quality of life" (HRQoL) refers to a multifaceted notion that considers how patients are affected by sickness and treatment. It can assess patients' views of sickness and treatment, as well as their perceived needs for healthcare providers, treatment preferences, and disease outcomes [11, 12].

The subjective and objective assessments of an individual with particular conditions are included in health-related quality of life. The word is used because there are many parts of life that are highly valued but are not considered to be "healthy." It's been described as "an overall general well-being that includes objective descriptors and subjective evaluations of physical, material, social, and emotional wellbeing, as well as the extent of personal development and purposeful activity, all weighted by a personal set of values [13]."

Although clinicians and experienced professionals can assess the severity of the condition and the extent to which it has progressed, their assessment of the clients' health-related quality of life may differ from the patients' personal perspective. This is because psychosocial and cultural factors may have a significant impact on patients' personal perspectives [3].

Diabetes mellitus has a negative impact on patients' HRQoL. This, in turn, has an impact on many aspects of a person's life, including the psychological impact of being chronically ill, dietary restrictions, social changes, and imprecise symptoms of an inadequate metabolic system, chronic complications, and, eventually, lifelong infirmities [14, 15].

The objective of chronic care are not to cure but to enhance functional status, minimize distressing symptoms, prolong life through secondary prevention and improve the quality of life [16].

Diabetes Mellitus also has a profound effect on social, economic, physical, psychological, behavioral and clinical conditions of the person affected. These effects will have a great impact on the health-related quality of life and it is one of the most psychologically demanding of the chronic diseases; with psychosocial factors pertinent to nearly every aspect of the disease and its treatment [11].

#### **2. Health-related quality of life and chronic diseases**

Health status, functional status, and quality of life are the three categories of health that are most frequently used interchangeably [17]. The health domains vary from death, which is one of life's adversely valued features, to extreme happiness or full functioning, which is one of life's favorably valued aspects. The rationale for assessing health and the specific concerns of patients, clinicians, and researchers in the subject of study usually determine the definition's boundaries.

While income level, independence, and environmental quality may all play a role in determining HRQoL, they do not directly affect people's health or medical concerns. HRQoL is the right focus for clinicians, having in mind that when a patient is suffering from disease or illness, practically every area of their life might become health-related.
