Iraqi J Pharm Sci, Vol.23(2) 2014 Quality of life of diabetes 99 Quality of Life of Patients with Type II Diabetes Mellitus in Al- Hilla City-Iraq Haydar F. Al - Tukmagi 1,* and Miamin A. Moussa ** * Department of Clinical Pharmacy, College of Pharmacy, University of Baghdad, Baghdad, Iraq. ** Babil Health Directorate, Ministry of Health, Babil, Iraq. Abstract Diabetes mellitus is a global problem nowadays due to increase the disease cases all over the world, in both the developed and developing countries which may affect the quality of life (QOL ) of diabetic patients. This study was conducted to assess the quality of life of patients with type 2 diabetes mellitus (DM) and to determine some selected clinical and sociodemographic factors that affect the quality of life of these patients in Al Hila city-Iraq. This was a cross sectional study in which 100 patients with type 2 diabetes mellitus attending diabetic outpatient clinics of Merjan Teaching Hospital- Al Hila. To assess the quality of life of those diabetic patients, the World Health Organizations Quality of Life Assessment (WHOQOL) was applied, but in a short version questionnaire and abbreviated form called (WHOQOL-BREF). Concerning the results of this study, it was found that the patients responded fairly well on the questionnaire used, 39% had good score, 47% had fair score and 14% had poor score. For physical health domain 17% had poor score, for social domain 22% had poor score, for psychological domain 19% and environmental domain 18% had poor score. It was concluded from the results that although it supports previous reports in which QOL of patients with DM were fairly good but this disease is significantly affects physical health, social relations and environment. Furthermore, there is association with marked impairment in aspects of quality of life relating to mental health and psycho-social functioning and at least some aspects of physical health. Given this, and given its high prevalence, greater attention is needed to watch DM as a public health problem. The fact that DM is “normative” should not be taken to infer that it is benign. Keywords: Diabetes mellitus, Quality of life. العراق –النوع الثانً فً مذٌنت الحلت نمط حٍاة مرضى السكر التكمجًحٍذر فخري *،1 و مٍامن عبذ الرضا موسى ** .ثغذاد،ثغذاد،انؼشاق انصٍذنخ،جبيؼخ كهٍخ ،نخ انسشٌشٌخانصٍذ فشع* ** . ، انؼشاقثبثم ،ٔصاسح انصحخ ثبثم،دائشح صحخ الخالصة انزأثٍش ٌٔكًٍ ،يٍ انًًكٍ اػزجبس رضاٌذ حبالد االصبثّ ثًشض انسكشي ْزِ االٌبو كًشكهّ ػبنًٍّ ٌؼبًَ يُٓب انؼبنى اجًغ، انًجبل ٔخبصخ انًجبالد جًٍغ فً انحٍبح َٕػٍخ ٔجٕدح أسهٕة فً انسكشي يشض ٌحذثٓب انزً انزغٍشاد فً انًشض نٓزا األسبسً .ٔانؼبغفً االجزًبػً انجذًَ، ػهى رؤثش انزً ٔانسكبٍَخ ٔاالجزًبػٍخ انسشٌشٌخ انؼٕايم ٔرحذٌذ 2 انًُػ يٍ انسكشي نًشظى انحٍبح َٕػٍخ نزقٍٍى صًًذ ْزِ انذساسّ انؼٍبدح انخبسجٍخ نهسكشي فً يسزشفى يشجبٌ انزؼهًًٍ فً يشاجؼً يٍ يشٌط100 انذساسخ فقذ شًهذ .انًشظى نٓؤالء انحٍبح َٕػٍخ .انؼبنًٍخ انصحخ نًُظًخ اسزجٍبٌ اسزًبسح ثبسزخذاو انحٍبح َٕػٍخ ٔقًٍّذ يذٌُخ انحهّ نهُشبغ ثبنُسجخ .سدٌئخ %14 ٔ يزٕسطخ %47 ٔ جٍذح حٍبح َٕػٍخ ًٌهكٌٕ انًشظى يٍ %39 ػبيخ ثصٕسح أَّ انذساسخ خهصذ َزبئج نهٕظغ ثبنُسجخ أيب ،يٍ انًشظى % 22 سدٌئّ ػُذ كبَذ االجزًبػٍخ انؼالقبد ٔاٌ ،يٍ انًشظى% 17ػُذ سدٌئخ كبَذ انجذًَ .يٍ انًشظى % 18 سدٌئّ ثُسجخ ػُذْى انحٍبح َٕػٍخ ٔانجٍئً فكبَذ ,يُٓى %19سدٌئّ ػُذ كبَذفانُفسً رؼزجش ثهذَب فً انسكشي يشظىل انحٍبح َٕػٍخ يٍ خالل انُزبئج انزً رٕصهذ انٍٓب انذساسّ،، يٍ انًًكٍ اػزجبس ثبَّ ثبنشغى يٍ اٌ انجذٍَخ ٔاالجزًبػٍّ ٔانُفسٍخ ٔ انجٍئٍخ فقذ رأثشد ثشكم يهحٕظ فعال ػٍ رنك اسرجبغ انسكشي ثبنعشس انجبنغ فً أٔجّ انُبحٍخ نكٍ. جٍذِ َٔزٍجخ نزنك ٔالَزشبس . َٕػٍخ انحٍبح انًزؼهقخ ثبنصحخ انؼقهٍخ ٔانٕظبئف األجزًبػٍخ ٔانُفسٍخ ٔثذسجخ أقم األٔجّ انًزؼهقخ ثبنصحخ انجذٍَخ . ٌٕجت أٌ ٌؼطى اْزًبو أكجش نهسكشي ثأػزجبسِ يشكهخ صحخ ػبيخ ، انكجٍش فً انؼبنىي انسكشيشض .داء السكري ، نمط الحٍاة :الكلماث المفتاحٍت 1 Corresponding author E-mail: h.tukmagi@hotmail.com Received:24 /9/2014 Accepted: 23/11/2014 Iraqi J Pharm Sci, Vol.23(2) 2014 Quality of life of diabetes 100 Introduction It is very clear nowadays that Diabetes Mellitus (DM) is one of the chronic non- communicable diseases that can affects all world population whether developed or non- developed countries (1) Many reports from World Health Organization (WHO) stated that the life style and quality of life of diabetic patients can strongly affected by the disease. Diabetes Mellitus is common both in the developed and the developing world. In Iraq, according to the national chronic non- communicable diseases risk factor survey done in 2006, the prevalence of DM is 10.4%. Women seem to be at a greater risk for type II DM; this may be due to enhanced sensitivity to a Western lifestyle in certain ethnic groups. Traditionally considered a disease of adults, type II DM is increasingly diagnosed in children in parallel with rising obesity rates. Type II DM is now diagnosed as frequently as type I DM in teenagers in the United States (1-3) . In spite of lacking of diabetic patients’ assessment incorporating their perception of health status, psycho-social status and other aspects of life are affected by the disease. Quality of Life (QOL) is defined by the WHO as “individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns” (4-7) . The significance of QOL in diabetes can be addressed in the following perspectives. First is to supplement objective clinical or biological measures of disease. The subjective factors are especially important for people with DM because there is a significant difference in how clinicians, diabetes and the general public perceive the effect diabetes has upon QOL (8) . Second is to assess the need for health care. The researches have indicated that QOL is a useful surrogate maker for a multitude of factors and can provides useful information of how well a patient is coping with diabetes overall (9) . Third is to evaluate the effectiveness of interventions. Because the overall goal for the treatment of all diabetes is to prevent acute and chronic complication, while preserving a good quality of life for the patient the true impact of a successful medical intervention can be understood in the way that the treatment has a positive influence on patients’ immediate and/or future well-being (10) . Fourth is to predict the health o utcome. That is, in individuals with a variety of chronic diseases QOL is known to be diminished and has been shown to predict long-term outcomes, disease progression, and response to therapy (11) . The diabetes-related changes may cause the disability in physiological, psychological and social function. At first, the mobility impairment and decline of activity of daily life (ADL) related to diabetes complications and common co-morbidities have a significant impact on patients’ QOL (11- 13) . It is already known that people with diabetes are much more likely to have a physical limitation than those without diabetes after controlling possible confounding factors and was one of the strongest direct predictors of recovery of mobility difficulty (14). It is recommended that use of both general and disease-specific measures of QOL facilitates comparisons of findings across studies and disease treatment as well as providing insight into the mechanisms specific to diabetes self-management (11) . Specifically, generic measures are necessary to compare outcomes across different populations and interventions. On the other hand, disease- specific measures are more sensitive for the detection and quantification of small changes that are important to clinicians or patients (15) . Patients and Method This study was carried out at Diabetic Outpatient Clinic of Merjan Teaching Hospital . 100 patients enrolled in this cross sectional study which conducted to determine the quality of life of diabetic patients and to find the association between that quality and certain variables including (age, sex, occupation, residence, educational level, marital status, family history of diabetes and duration of diabetes). The study duration continued from June the 1st to September the 1st 2013. All patients visited the diabetic outpatient clinics of Merjan Teaching Hospital during period of data collection .A sample of 100 hundred diabetic patients were collected during that period. During period of data collection, patients were interviewed by questionnaire from those visited the diabetic outpatient clinics of Merjan Teaching Hospital. In addition to age ,sex ,occupation, residence, educational level ,marital status, family history of diabetes and duration of diabetes , the questionnaire consist of four domains including (physical health, psychological wellbeing , social relationship, environmental status) from them score was obtained to determine the quality of life . for each question there is a score and the median score is calculated in each domain. A score of mean ± SD on each domain is considered fair, Iraqi J Pharm Sci, Vol.23(2) 2014 Quality of life of diabetes 101 a score of ˂ mean-1 SD is poor and a score of ˃ +1SD is good. The dependent variable for this study was the quality of life of diabetic Patients while The independent variables of this study were including (age, sex, occupation, residence, educational level, marital status, family history of diabetes and duration of diabetes). Statistical analysis was carried out using SPSS version 18. Categorical variables were presented as frequencies and percentages. Continuous variables were presented as (Means ± SD). Pearson’s chi square (X2) test was used to find the association between the categorical variables. Analysis of variance ( ANOVA) was used to compare means between two groups. A p- value of ≤ 0.05 was considered as significant. Results Hundred consecutive attendees of the diabetes clinic met the inclusion criteria during the course of the study; 52 were females and 48 were males. For overall QOL, 39 (39%) had good score,47 (47%) had a fair score and 14(14%) had poor score, Table (1). Table (1): Relationship between qualities of life outcomes and sociodemographic variables. Variables Overall quality of life Good % Fair % Poor % Total % All patients 39 39% 47 47% 14 14% 100 100% Sex Female Male 14 25 26.9 52 29 18 55.7 37.5 9 5 17.3 10.6 52 48 52% 48% Marital Status Single Married Widowed Divorced 1 32 4 2 33.3 45 18.1 50 1 32 12 2 33.3 45 54.5 50 1 7 6 0 33.3 0.098 27.2 0 3 71 22 4 3% 71% 22% 4% The QOL score is high in all the domains except in environmental domain at which the majority of patients had fair to poor score and only (13) patients had good score, in the four domains the QOL score is higher in males than in females, for example, in physical health domain more than half (27) patients from (42) patients who had good score were males and the remaining were females, Table (2). Table (2): Relationship between quality of life outcomes and sociodemographic variables according to domains. Variables Domain 1 Physical health Domain 2 Psychological well being Domain 3 Social relation ship Domain 4 Environmental good fair poor good fair poor good fair poor good fair poor Sex Female Male 42 15 27 28 15 13 30 22 8 43 16 27 34 19 15 23 17 6 53 24 29 33 19 14 14 9 5 13 2 11 63 40 23 24 10 14 Marital status Single Married Widowed Divorced 42 1 36 3 2 28 1 19 7 1 30 1 16 12 1 43 1 34 5 3 34 1 26 6 1 23 1 11 11 0 53 0 43 10 0 33 2 20 8 3 14 1 8 4 1 13 2 9 1 1 63 0 49 13 1 24 1 13 8 2 Discussion The present study found that the overall perception of (HRQOL) of patients with DM type 2 was affected by the disease. The result of this study showed that (43%) patients with DM experienced a fair QOL. However this study has been agreed with the study that has been done in Mosul (16) . This study it was seen that there is an increase in HRQOL with increasing mean age of the patients; this is different to the results of Mosul study (16) as well as another study in Saudi Arabia .This study showed that there is no effect of gender on QOL, however this result was in agreement with other studies which Iraqi J Pharm Sci, Vol.23(2) 2014 Quality of life of diabetes 102 showed that female highly associated with poor QOL due to high prevalence of obesity in female patients (17-19) . Duration of DM in this study has significant association with QOL, good QOL is related to duration of DM of less than 6 years due to short time for complication of DM to appear. However this finding was in agreement with Mosul study but disagreement with a study in Saudi Arabia showed that the duration of illness had no significant effect on QOL (17) . Findings from another study from Sweden showed that there is a strong relationship between the QOL and the duration of disease in which patients suffering from the disease for more than 5 years had better QOL (20) . Although, those findings are related to good life style and the good treatment with best control. Issa et al, showed in his study in 2006 that environmental domain is the only one that affected by the duration of the illness (18) . In the current study, it has been shown that means of physical health, social relation and environmental domains have been strongly differ by QOL items; meanwhile there was no significant mean different of psychological wellbeing domain by QOL items. The social domain which assesses personal relationships showed a high mean score in (HRQOL) of our patients; this probably is due to a very large extent to high degree of satisfaction to the items of this domain. This finding however was consistent with Mosul study as well as other study by Awadalla et al who reported that there is no difference in the score of patients with diabetes in relation to general population on the social relationships domain (19) . It is worthy of note that patients with a good level of social support and had strong family care giver support system. It was found from previous studies and researches about the relation between QOL and DM, that good psychological adjustment of the patients is depending on the family members supports (19) . Our study showed that environment domain has been demonstrated that the majority of patients got fair score. However, this was in agreement with previous study , meanwhile differs from the finding of other studies (21,22) , which revealed that: the score of the environment domain was much lower than the other three domains and this could be due to bad environmental condition in these localities. Finally, this was a cross-sectional study. Conceivably, poor quality of life could be conducive to DM. Although the direction of the observed associations cannot be determined on the basis of the present study, it may be noted that findings from prospective epidemiological studies strongly support the role of (WHOQOLBREEF) in IRAQ, for predicting adverse health outcomes in diabetic patients. Notable strengths of the current study were the recruitment of a large, general population sample of diabetic patient, widely- used measures of quality of life and the assessment of DM symptoms. Conclusion The study is in agreement with other studies and reports that found in spite of affected physical health of diabetic patients, but still those diabetic patients are with fairly good QOL. For further supporting results concerning the effect of DM type 2 on QOL, it is highly recommended to do future studies on high number of Iraqi diabetic patients. 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