Health-related Quality of Life of Diabetes Mellitus Patients and Non- Diabetics
CHAPTER ONE
Objectives of the Study
- Determine the HRQOL scores of patients with diabetes mellitus and the non-diabetic group in all the four domains of the WHOQOL-BREF.
- Compare the HRQOL scores of diabetes mellitus patients with non-diabetic group in all the four domains of the World Health Organization Quality Of Life-BREF (WHOQOL-BREF).
- Compare the HRQOL scores of DM patients with co-morbidities with the scores of DM patients without co-morbidities in the four domains of WHOQOL-BREF.
CHAPTER TWO
LITERATURE REVIEW
Conceptual Review
Concept of diabetes mellitus
The American Diabetes Association (ADA) defined Diabetes Mellitus as a group of metabolic diseases characterized by increased levels of glucose in the blood (hyperglycaemia), resulting from defects in insulin secretion, insulin action, or both (ADA, 2004). Similarly, Walsh & Crumbie (2007), defined diabetes mellitus as a group of disorders of carbohydrate, fat and protein metabolism characterized by chronic hyperglycaemia, degenerative vascular changes and neuropathy. Walsh & Crumbie further stated that the basic problem in diabetes is that either the Islets of Langerhans gradually diminish their insulin output or there is increased peripheral resistance to the action of insulin or there is a combination of decreased insulin secretion and increased insulin resistance. In normal circumstances, there is a certain amount of glucose that circulates in the blood. This glucose is derived from absorption of digested food from the gastrointestinal tract and the glucose formed by the liver from food substances. Normal plasma glucose level ranges from 3.3-5.5mmol/L.
Classification of diabetes mellitus
Diabetes has been classified in different ways. The different types differ in etiology, clinical course and treatment.
Type 1 Diabetes
This was formally called insulin dependent diabetes, or juvenile diabetes. It is caused by the destruction of beta cells in the Islets of Langerhans by an autoimmune response associated with environmental and genetic factors. The onset is usually very rapid, and affects people less than 30 years of age.
Type 2 diabetes
Type 2 diabetes, previously called non-insulin dependent diabetes or maturity onset diabetes covers various types of disorders. The problem here is either that the Islets of Langerhans gradually diminish in their insulin secretion or there is increased resistance to action of insulin or both. The onset is slow and patient live with it for some years before diagnosis. Obesity and lack of exercise are the commonest causes of insulin resistance and therefore type 2 diabetes. The most common age of onset is 50 to 70 years. There is a strong genetic influence, and as a result certain families and ethnic groups are much more likely to have type 2 diabetes (Erens et al, 2001, in Walsh & Crumbie, 2007).
Apart from Types 1 and 2 diabetes usually referred to as primary diabetes, secondary diabetes do exist. Secondary diabetes is due to a range of conditions such as diseases of the pancreas or disorders such as Cushing’s syndrome. It may occur as side effect of medications such as steroid therapy, diuretics or it may be pregnancy induced which is called gestational diabetes. Whatever the cause is, the result is deficiency of insulin or inadequate insulin function. This leads to inadequate transfer of glucose into the cells; the utilization of glucose for energy and cellular products and its conversion to glycogen and fat and storage as such are depressed. Glucose accumulates in the blood causing hyperglycaemia.
CHAPTER THREE
RESEARCH METHODS
Research design
This study adopted a descriptive cross sectional survey design. The design is considered appropriate for use in the study of HRQOL of diabetic patients. The researcher collected data from respondents and described the HRQOL of the respondents without any manipulation. It has successfully been used by other researchers in the study of HRQOL of patients with diabetes mellitus (Issa,&Baiyewu, 2006; Lima et al, 2009; Odili, et al, 2010;). The study adopted a cross-sectional design because data was to be collected once on HRQOL of diabetics and non-diabetics as recommended by Polit & Beck, (2008).
Population of the Study
The population of the study was all diabetic patients attending the Diabetic Out-Patient Clinic at the University of Port Harcourt Teaching Hospital. Non-diabetics were recruited from Catholic community of Mater Misericordiae Catholic Church Rumumasi, Port Harcourt and the Anglican Church of the Messiah, close 7, Elekahia Housing Estate, Port Harcourt. Many Christians attend these churches from different parts of Port Harcourt. The healthy respondents that were drawn from this population are of different socio-economic groups, same catchment area of the hospital and were a good match for the diabetic patient respondents in age and in socio-economic status. The population for the study was an estimated population of 480 diabetics. The non-diabetics are a matching group that met the inclusion criteria of the study, recruited from the same area of the study.
CHAPTER FOUR
ANALYSIS OF DATA AND PRESENTATION OF RESULT
From Table 1, the respondents were all Christians, predominantly married (81.8%), slightly more females (51.0%) than males (49.0%), majority (60.8%) had tertiary education and (54.2%) engaged in a salaried job. More diabetics are widowed (11.0%) than non-diabetics (6.5%).
There were no statistical significant differences between the diabetic and the non-diabetic group’s demographic variables. Mean duration of diabetes was 8.27 ± 6.447.
Table 2 showed the respondent’s co-morbidities of diabetes with other disease conditions, development of complications due to diabetes and the present treatment. The diabetic respondents 92 out of the 200 (46.0%) reported co-morbidities; the leading top three were hypertension (40.0%) arthritis (15.0%) and Duodenal/Stomach ulcers (6.5%).
CHAPTER FIVE
RECOMMENDATIONS AND CONCLUSION
Recommendations
- Based on the findings from this study, the researcher recommends that healthcare personnel should educate diabetics on physical care and prevention of complications that will impact negatively on physical health. Improvement on HRQOL can be achieved through increasing patients’ knowledge and giving them diabetic education which among other benefits improve overall health and well-being. Education that will acknowledge cultural background and their ability to understand information on health will improve their ability to follow treatment modalities.
- Nurses can also make home visits, accompany patients to hospitals and refer patients to support groups such as Diabetic Associations and Non-governmental Organizations that can provide funds.
Conclusion
The study revealed that diabetes mellitus impact negatively on the HRQOL of diabetic patients in the four domains of WHOQOL-BREF as compared with non-diabetic persons in Port Harcourt, Rivers State of Nigeria. It also showed that diabetic patients with higher level of education scored higher in the HRQOL than those that are less educated.
References
- Al-Shehri, A.H., Taha, A.Z., Bahnassy, A.A. & Sala, M. (2008). Health related quality of life in type 2 diabetic patients. Annals Saudi Medicine, 28, (5), 352-360. Retrieved from www.ncbi.nlm.nih.gov/pubmed/18779640
- Alwan,A.A.S.(2006).WHO-EM/DIN6/E/9.Management of diabetes mellitus standard of care and clinical practice guidelines. Retrieved from www.emro.who.int/dsaf/dsa
- American Diabetes Association,(2004).Gestational Diabetes Mellitus (Position Statement).Diabetes Care, 27(1), 88-90
- American Diabetic Association,(2004).Report of the Expert Committee on the Diagnosis and classification of Diabetes Mellitus (Position Statement) Diabetes Care 27(1), 5-10
- Andayani, T. M, Ibrahim, M.I.N. & Aside, A.H. (2010). The Association of Diabetes – related Factors and quality of life in type 2 Diabetes Mellitus.International Journal of Pharmaceutical Sciences. 2(1)
