Evaluation of Quality of Life in Geriatric Diabetic Patients

Abstract

Objectives: Type 2 diabetes mellitus has an incidence that increases with age. Many factors affect the life qualities of geriatric diabetic patients. The aim of this study was to evaluate the quality of life in diabetic patients and to examine the effects of diabetic complications, biochemical parameters, and socio-demographic features on the quality of life. Materials and Methods: Biochemical parameters, socio-demographic features, and clinical characteristics of 208 diabetic patients at or above 65 years of age who were admitted to the Department of Internal Medicine of Erzurum Regional Research and Education Hospital between January 1st 2018 and December 31st 2018 were evaluated with the short version of the World Health Organization Quality of Life Scale (WHOQOL-BREF). Results: This study included 208 subjects; 50% (n=104) of them were male and 50% (n=104) were female. The ages of the cases included in this study were between 65 and 88, and the mean age was 70.82±5.25 years. The mean glycosylated hemoglobin (HbA1C) of the subjects was 8.33±1.86 (range: 5.9-14.5). The mean score of the cases from the General Health dimension of WHOQOL-BREF (TR) was 5.52±1.75 (range: 2-9), from Physical Health dimension was 16.63±4.52 (range: 7-28), from Psychological Health dimension was 15.26±4.08 (range: 6-26), from Social Relations dimension was 6.40±1.94 (range: 3-13), from environmental quality of life was 19.55±4.58 (range: 9-31), and from the total scale was 63.56±15.23 (range: 34-97). The mean scores of the subjects that have diabetic complications from general health, physical health, psychological health, social relations, and environmental quality of health were higher than cases without complications (p=0.001, p=0.001, p=0.001, p=0.001, p=0.001, respectively). Conclusion: In geriatric diabetic patients, diabetic complications, age, body mass index, level of education, marital status, duration of diabetes, treatment type, comorbid systemic illness, HbA1C, fasting and postprandial plasma glucose level, glomerular filtration rate, low serum albümin level, and low hemoglobin levels are the factors that affect the quality of life. We believe that effective treatment and close follow up of the patients with geriatric diabetes will increase the quality of life of geriatric diabetic patients.

Keywords

• Geriatric Patient
• Diabetes Mellitus
• Complication
• Quality of Life

Geriatrik Diyabetik Hastalarda Yaşam Kalitesinin Değerlendirilmesi

Abstract

Amaç: Tip 2 Diabetes Mellitus ileri yaşla artan bir insidansa sahiptir. Geriatrik diyabetik hastaların yaşam kalitelerini birçok faktör etkilemektedir. Bu çalışma ile diyabetik hastalarda yaşam kalitesinin değerlendirilmesi ve diyabetik komplikasyonlar, biyokimyasal parametreler ve sosyodemografik özelliklerin yaşam kalitesine olan etkilerinin incelenmesi amaçlandı. Gereç ve Yöntem: Erzurum Bölge Eğitim ve Araştırma Hastanesi, İç Hastalıkları Kliniği’ne 1 Ocak 2018 ile 31 Aralık 2018 tarihleri arasında başvurmuş 65 yaş ve üstü 208 diyabetik hastanın, biyokimyasal parametreleri, sosyodemografik özellikleri ve klinik özellikleri, Dünya Sağlık Örgütü Yaşam Kalite Ölçeği (WHOQOL-BREF) yaşam kalite ölçeği kullanılarak değerlendirildi. Bulgular: Bu çalışmaya, %50’si (n=104) erkek ve %50’si (n=104) kadın toplam 208 olgu dahil edildi. Çalışmaya katılan olguların yaşları 65 ile 88 arasında değişmekte olup, ortalama 70,82±5,25 yaş olarak saptanmıştır. Olguların glikozile hemoglobin (HbA1C) ölçümleri 5,9 ile 14,5 arasında, ortalama 8,33±1,86 idi. Olguların WHOQOL-BREF (TR) Yaşam Kalite Ölçeği “Genel Sağlık Durumu” alt boyutundan aldıkları puanlar 2 ile 9, ortalama 5,52±1,75, “Fiziksel Sağlık” alt boyutundan aldıkları puanlar 7 ile 28, ortalama 16,63±4,52, “Psikolojik” alt boyutundan aldıkları puanlar 6 ile 26, ortalama 15,26±4,08, “Sosyal İlişkiler” alt boyutundan aldıkları puanlar 3 ile 13, ortalama 6,40±1,94, “Çevre” alt boyutundan aldıkları puanlar 9 ile 31 ortalama 19,55±4,58 ve ölçek toplamından aldıkları puanlar 34 ile 97, ortalama 63,56±15,23 saptanmıştır. Diyabetik komplikasyonu olan olguların WHOQOL-BREF (TR) Yaşam Kalitesi Ölçeği “Genel Sağlık Durumu”, “Fiziksel Sağlık”, “Psikolojik”, “Sosyal İlişkiler” ve “Çevre” alt boyutundan aldıkları puanlar, komplikasyon olmayan olgulara göre istatistiksel olarak anlamlı düzeyde düşük saptanmıştır (sırasıyla p=0,001; p=0,001; p=0,001; p=0,001; p=0,001; p<0,01). Sonuç: Geriatrik diyabetik hastalarda diyabetik komplikasyonlar, yaş, vücut kitle indeksi, eğitim düzeyi, medeni durum, diyabet süresi, tedavi şekli, ek sistemik hastalık, HbA1C, açlık ve tokluk şekeri, glomerüler filtrasyon hızı, düşük serum albümin düzeyi ve düşük hemoglobin düzeyleri yaşam kalitesini etkileyen faktörlerdir. Geriatrik diyabetik hastalarda etkin tedavi ve diyabetik komplikasyonlar için hastaların yakın takip ve kontrollerinin yapılmasının yaşam kalitesini artıracağını düşünmekteyiz.

Keywords

• Geriatrik Hasta
• Diabetes Mellitus
• Komplikasyon
• Yaşam Kalitesi

Ethical Statement

Etik Kurul Onayı: Çalışma protokolü, gözden geçirildi ve Helsinki Bildirgesi uyarınca (Sağlık Bilimleri Üniversitesi Erzurum Bölge Eğitim ve Araştırma Hastanesi Klinik Araştırmalar Etik Kurulu’nun 2018/18-182 kararı) etik kurul tarafından onayı alındı. Hasta Onayı: Retrospektif çalışma. Hakem Değerlendirmesi: Editörler kurulunun içinden ve dışından olan kişiler tarafından değerlendirilmiştir.

References

1. 1. American Diabetes Association. 12. Older Adults: Standards of Medical Care in Diabetes-2019. Diabetes Care. 2019;42(Suppl 1):139-147.
2. 2. Satman I, Imamoglu S, Yilmaz C; ADMIRE Study Group. A patient-based study on the adherence of physicians to guidelines for the management of type 2 diabetes in Turkey. Diabetes Res Clin Pract. 2012;98:75-82.
3. 3. American Diabetes Association. Standards of Medical Care in Diabetes-2016 Abridged for Primary Care Providers. Clin Diabetes. 2016;34:3-21.
4. 4. Arcaya MC, Arcaya AL, Subramanian SV. Inequalities in health: definitions, concepts, and theories. Glob Health Action. 2015 Jun 24;8:27106.
5. 5. Bradley C, de Pablos-Velasco P, Parhofer KG, et al. PANORAMA: a European study to evaluate quality of life and treatment satisfaction in patients with type-2 diabetes mellitus--study design. Prim Care Diabetes. 2011;5:231- 239.
6. 6. Al Hayek AA, Robert AA, Al Saeed A, et al. Factors associated with healthrelated quality of life among Saudi patients with type 2 diabetes mellitus: a cross-sectional survey. Diabetes Metab J. 2014;38:220–229.
7. 7. Bourdel-Marchasson I, Helmer C, Fagot-Campagna A, et al. Disability and quality of life in elderly people with diabetes. Diabetes Metab. 2007;33 Suppl 1:S66-74.
8. 8. Clarke P, Gray A, Legood R, et al. The impact of diabetes-related complicationson healthcare costs: results from the United Kingdom Prospective DiabetesStudy (UKPDS Study No. 65). Diabet Med. 2003;20:442-450.

9. 9. Lotfy M, Adeghate J, Kalasz H, et al. Chronic Complications of Diabetes Mellitus: A Mini Review. Curr Diabetes Rev. 2017;13:3-10.
10. 10. Ahn S, Song R. Effects of Tai Chi Exercise on Glucose Control, Neuropathy Scores, Balance, and Quality of Life in Patients with Type 2 Diabetes and Neuropathy. J Altern Complement Med. 2012;18:1172–1178.
11. 11. van Son J, Nyklícek I, Pop VJ, et al. The effects of a mindfulness-based intervention on emotional distress, quality of life, and HbA(1c) in outpatients with diabetes (DiaMind): a randomized controlled trial. Diabetes Care. 2013;36:823-830.
12. 12. Kargar Jahromi M, Ramezanli S, Taheri L. Effectiveness of diabetes selfmanagement education on quality of life in diabetic elderly females. Glob J Health Sci. 2014;7:10-15.
13. 13. Development of the World Health Organization WHOQOL-BREF quality of life assessment. The WHOQOL Group. Psychol Med. 1998;28:551-558.
14. 14. Fidaner H, Elbi H, Fidaner C, et al. WHOQOL-100 ve WHOQOL-BREF’in psikometrik özellikleri. Psikiyatri Psikoloji Psikofarmakoloji (3P) Dergisi. 1999;7(Ek 2):23-40.
15. 15. American Diabetes Association. Introduction: standards of medical care in diabetes—2018. Diabetes Care. 2018;41(suppl 1):1-2.
16. 16. Nezu S, Okamoto N, Morikawa M, et al. Health-related Quality of Life (HRQOL) Decreases Independently of Chronic Conditions and Geriatric Syndromes in Older Adults With Diabetes: The Fujiwara-kyo Study. J Epidemiol. 2014;24:259-266.
17. 17. Eren İ, Erdi Ö, Çivi İ. Tip II Diabetes Mellitus Hastalarında Yaşam Kalitesi ve Komplikasyonların Yaşam Kalitesine Etkisi. Klinik Psikiyatri. 2004;7:85-94.
18. 18. Shamshirgaran SM, Ataei J, Iranparvar Alamdari M, et al. Predictors of health-related quality of life among people with type II diabetes Mellitus in Ardabil, Northwest of Iran, 2014. Prim Care Diabetes. 2016;10:244-250.
19. 19. Lesman-Leegte I, Jaarsma T, Coyne JC, et al. Quality of life and depressive symptoms in the elderly: a comparison between patients with heart failure and age- and gender-matched community controls. J Card Fail. 2009;15:17-23
20. 20. dos Santos EA, Tavares DM, Rodrigues LR, et al. Morbidity and quality of life of elderly individuals with diabetes mellitus living in urban and rural areas. Rev Esc Enferm USP. 2013;47:393-400.
21. 21. Huang MC, Hung CH. Quality of life and its predictors for middle-aged and elderly patients with type 2 diabetes mellitus. J Nurs Res. 2007;15:193-201.
22. 22. Tchicaya A, Lorentz N, Demarest S, et al. Relationship between selfreported weight change, educational status, and health-related quality of life in patients with diabetes in Luxembourg. Health Qual Life Outcomes. 2015;13:149.
23. 23. Fal AM, Jankowska B, Uchmanowicz I, et al. Type 2 diabetes quality of life patients treated with insulin and oral hypoglycemic medication. Acta Diabetol. 2011;48:237-242.
24. 24. Williams SA, Pollack MF, Dibonaventura M. Effects of hypoglycemia on health-related quality of life, treatment satisfaction and healthcare resource utilization in patients with type 2 diabetes mellitus. Diabetes Res Clin Pract. 2011;91:363-370.
25. 25. Martínez YV, Prado-Aguilar CA, Rascón-Pacheco RA, et al. Quality of life associated with treatment adherence in patients with type 2 diabetes: a cross-sectional study. BMC Health Serv Res. 2008;8:164.
26. 26. Shim YT, Lee J, Toh MP, et al. Health-related quality of life and glycaemic control in patients with Type 2 diabetes mellitus in Singapore. Diabet Med. 2012;29:e241-248.
27. 27. Landman GW, Van Hateren KJ, Kleefstra N, et al. Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC-18). Diabetes Care. 2010;33:2378-2382.