Negative effects of diabetes–related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in MalaysiaReport as inadecuate

Negative effects of diabetes–related distress on health-related quality of life: an evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia - Download this document for free, or read online. Document in PDF available to download.

Health and Quality of Life Outcomes

, 13:187

First Online: 24 November 2015Received: 17 February 2015Accepted: 17 November 2015


BackgroundPatients with type 2 diabetes mellitus T2D often experienced change in life, altered self-esteem and increased feelings of uncertainty about the future that challenge their present existence and their perception of quality of life QoL. There was a dearth of data on the association between diabetes-related distress DRD and health-related quality of life HRQoL. This study examined the determinants of HRQoL, in particular the association between DRD and HRQoL by taking into account the socio-demographic-clinical variables, including depressive symptoms DS in adult patients with T2D.

MethodsThis cross-sectional study was conducted in 2012–2013 in three public health clinics in Malaysia. The World Health Organization Quality of Life-Brief WHOQOL-BREF, 17-items Diabetes Distress Scale DDS-17, and 9-items Patient Health Questionnaire PHQ-9 were used to measure HRQoL, DRD and DS, respectively. The aim of this research was to examine the association between the socio-demographic-clinical variables and HRQoL as well as each of the WHOQOL-BREF domain score using multivariable regression analyses.

ResultsThe response rate was 93.1 % 700-752. The mean SD for age was 56.9 10.18. The majority of the patients were female 52.8 %, Malay 53.1 % and married 79.1 %. About 60 % of the patients had good overall HRQoL. The mean SD for Overall QoL, Physical QoL, Psychological QoL, Social Relationship QoL and Environmental QoL were 61.7 9.86, 56.7 10.64, 57.9 11.73, 66.8 15.01 and 65.3 13.02, respectively. The mean SD for the total DDS-17 score was 37.1 15.98, with 19.6 % 136-694 had moderate distress. DDS-17 had a negative association with HRQoL but religiosity had a positive influence on HRQoL B ranged between 3.07 and 4.76. Women, especially younger Malays, who had diabetes for a shorter period of time experienced better HRQoL. However, patients who were not married, had dyslipidaemia, higher levels of total cholesterol and higher PHQ-9 scores had lower HRQoL. Macrovascular complications showed the largest negative effect on the overall HRQoL adjusted B = −4.98, 95 % CI −8.56 to −1.40.

ConclusionThe majority of primary care adult with T2D had good overall HRQoL. Furthermore, the independent determinants for HRQoL had also concurred with many past studies. In addition, the researchers found that DRD had negative effects on HRQoL, but religiosity had positive influence on HRQoL. Appropriate support such as primary care is needed for adult patients with T2D to improve their life and their HRQoL.

Trial registrationNMRR-12-1167-14158

KeywordsQuality of life Distress Depression Type 2 diabetes mellitus Primary care Religious beliefs AbbreviationsAHAAnti-hypertensive agents

BMIBody mass index

DDS-1717-items diabetes distress

DKDengkil health clinic

DRDDiabetes-related distress

DSDepressive symptoms

EQOLEnvironment quality of life

HDL-CHigh density lipoprotein-cholesterol

HRQoLHealth-related quality of life

LDL-CLow density lipoprotein-cholesterol

LLALipid-lowering agents

MicroCxMicrovascular complications

MacroCxMacrovascular complications

MRECMedical Research Ethics Committee, Ministry of Health, Malaysia

OHAOral hypoglycaemic agents

OQOLOverall quality of life

PHQ-99-items Patient Health Questionnaire

PQOLPhysical quality of life

QoLQuality of life

SKSeri Kembangan health clinic

SLSalak health clinic

SRQOLSocial relationships quality of life


T2DType 2 diabetes

WHOQOL-BREFWorld Health Organization Quality of Life- Brief

YQOLPsychological quality of life

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Author: Boon-How Chew - Sherina Mohd-Sidik - Sazlina Shariff-Ghazali


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