A comparative study on quality of life among type 1 and type 2 diabetes mellitus clients at selected hospitals of district Mohali, Punjab.

 

Jyoti Bhardwaj1, Rashmi Choudhary2, Poonam Sharma3

1M.Sc. Nursing, Mata Sahib Kaur College of Nursing, Mohali, Punjab, India

2Associate Professor, Mata Sahib Kaur College of Nursing, Mohali, Punjab, India

3Assistant Professor, Mata Sahib Kaur College of Nursing, Mohali, Punjab, India

*Corresponding Author Email: jyotishukla2509@gmail.com

 

ABSTRACT:

Diabetes is the sixth leading cause of death. It is a metabolic disease characterized by high blood glucose level. This study aimed to compare quality of life among type 1 and type 2 diabetes mellitus clients at selected hospitals of district Mohali, Punjab. A quantitative approach with comparative research design was adopted for the study. 120 diabetes mellitus clients (60 type 1 and 60 type 2 diabetes mellitus clients) were selected through convenient sampling technique. Study showed that 73.3%, 23.4% and 3.3% were having fair, good and poor quality of life among type 1 diabetes clients whereas 46.7%, 35.0% and 18.3% were having poor, fair and good quality of life among type 2 diabetes mellitus clients. Comparison shows that there was significant difference between the quality of life among type 1 and type 2 diabetes mellitus clients. Clients with type 1 diabetes mellitus have better quality of life as compared to type 2 diabetes mellitus clients. Domain wise comparison indicates significant difference in quality of life among type 1 and type 2 diabetes mellitus clients in domains of role limitation due to physical health, physical endurance, general health, emotional/ mental health and diet satisfaction. There was significant association of age and education with quality of life among both type 1 and type 2 diabetes mellitus clients (p<0.05). Quality of life of type 1 diabetes mellitus clients had significant association with duration of diabetes mellitus, duration of taking treatment and duration of prescribed medication moreover among type 2 diabetes mellitus clients significant association with gender, marital status, occupation and family history of diabetes mellitus with quality of life (p<0.05).

 

KEYWORDS:  Quality of life, type 1 diabetes mellitus clients, type 2 diabetes mellitus clients, domain wise comparison, association

 


 

INTRODUCTION:

Diabetes mellitus is a global public health problem of epidemic proportion .1Diabetes is the sixth leading cause of death and affects 246 million worldwide. According to statistics from International Diabetes Federation, India has more diabetics than any other nation of the world. Current estimates regarding the number of diabetics in the country is about 62 million. Although diabetes occurs most often in older adults, it is one of the most common chronic disorders in children. About 123,000 children and teenagers age 19 and younger have diabetes.2

 

Diabetes mellitus is a metabolic disease characterized by high blood glucose level that results from defects in insulin secretion or its action or both. If the insulin isn't functioning properly, glucose cannot enter the cells. This causes glucose levels in the blood to rise, creating a condition of high blood sugar or diabetes, and leaving the cells without fuel. There are the two main types of diabetes mellitus: Type 1 and Type 2 diabetes mellitus.3

As new advancement is taking place in medical technology, more aggressive treatments succeeded in increasing survival rates therefore attention increasingly turned towards quality of life of patient rather than longevity alone.4 Quality of life assessment is considered as important measure of outcome in disease management. Several studies have demonstrated that diabetes has a strong impact on quality of life. People with diabetes rate their quality of life significantly less favorable on average than people without diabetes. Hence, it is important to assess quality of life for better care and control.5

 

OBJECTIVES:

1.      To assess the quality of life among type1 and type 2 diabetes mellitus clients.

2.      To compare quality of life among type1 and type 2 diabetes mellitus clients.

3.      To find out association between quality of life among type 1 and type 2 diabetes mellitus clients with selected socio-demographic variables.

 

MATERIAL AND METHOD:

A quantitative research approach was adopted for the study with comparative research design to achieve the objectives of the study. Non probability convenient sampling technique was used to draw sample of 120 diabetic mellitus clients (60 clients with type 1 diabetes mellitus and 60 clients with type 2 diabetes mellitus) attending OPD or admitted in IVY Hospital and Shri Guru Harkrishan Hospital of district Mohali who fulfilled inclusion criteria. Quality of life instrument for Indian diabetes patient (QOLID) standardized tool was used to assess quality of life.6

 

Inclusion criteria: Subjects who:

1.    Gave written informed consent for participating in research study .

2.    Were able to  understand English/Hindi/Punjabi.

3.    Were already diagnosed as client with diabetes mellitus type 1 or type 2, three months ago or more.

 

Exclusion criteria: Subject who were

1.      Seriously ill.

2.      Unconscious.

 


 

RESULTS:

Table -1: Frequency and percentage distribution of socio- demographic variables among type 1 and type 2 diabetes mellitus clients. N=120

Socio-demographic variables

Type of Diabetes Mellitus

Type 1 diabetes mellitus ( n 1=60)

Type 2 diabetes mellitus (n 2= 60)

1

%

  f  2

%

Age  (in years)

21-30

29

48.3

2

3.3

31-40

16

26.7

4

6.7

41-50

12

20.0

10

16.7

51-60

 2

3.3

21

35.0

> 60

1

1.7

23

38.3

Gender 

Male

28

46.7

28

46.7

Female

32

53.3

32

53.3

Marital status

Unmarried

27

45.0

2

3.3

Married

33

55.0

46

76.7

Widow/widower

0

0.0

12

20.0

Divorce

0

0.0

0

0.0

Education

No formal Education

1

1.7

12

20.0

Primary

3

5.0

14

23.3

Matric

5

8.3

16

26.7

Senior Secondary

26

43.3

10

16.7

Graduate & Above

25

41.7

8

13.3

Occupation

Home Maker

18

30.0

30

50.0

Self Employed

12

20.0

11

18.3

Private Job

17

28.3

6

10.0

Government Job

9

15.0

13

21.7

Unemployed

4

6.7

0

0.0

Family Income

≤15000

33

55.0

22

36.7

15001-30000

25

41.7

32

53.3

30001-45000

2

3.3

6

10.0

450001-60000

0

0

0

0

>60000

0

0

0

0

 

Socio-demographic variables

 

Type of Diabetes Mellitus

Type 1 diabetes mellitus

            (n1=60)

Type 2 diabetes mellitus

(n 2=60)

 

 f  1

%

  f 2

%

Area of Residence

 

Urban

   29

48.3

21

35.0

Rural

   31

51.7

39

65.0

Family history of diabetes mellitus

Yes

24

40.0

22

36.7

No

36

60.0

38

63.3

Duration of diabetes mellitus

<5

1

1.7

13

21.7

5-10

2

3.3

23

38.3

10-15

6

10.0

10

16.7

15-20

23

38.3

13

21.7

>20

28

46.7

1

1.7

Duration of taking treatment

<5

1

1.7

16

26.7

5-10

2

3.3

21

35.0

10-15

6

10.0

9

15.0

15-20

22

36.7

13

21.7

>20

29

48.3

1

1.7

Type of prescribed medication regimen for diabetes mellitus

Anti diabetic agents(oral)

4

6.7

38

63.3

Insulin

29

48.3

8

13.3

Both

27

45.0

14

23.3

None

0

0.0

0

0.0

Compliance with medication

Yes

55

91.7

59

98.3

No

5

8.3

1

1.7

Alternative medicine

Ayurvedic

6

10.0

10

16.7

Homeopathic

0

0.0

0

0.0

None

54

90.0

50

83.3

Regular monitoring

Yes

59

98.3

59

98.3

No

1

1.7

1

1.7

 


Table 1 Majority of clients (48.3%) were in the age group of 21-30 years among type 1 diabetes mellitus whereas majority of clients (38.3%) were above 60 years of age among type 2 diabetes mellitus. Both type 1 and type 2 diabetes mellitus clients consisted of 53.3% females and 46.7% males. Majority of clients i.e. 55% were married among type 1 diabetes mellitus, whereas majority of clients i.e. 76.7% were married among type 2 diabetes mellitus.

 

43.3% were having education up to senior secondary closely followed by 41.7% who were graduate and above among type 1 diabetes mellitus. Majority of clients 26.7% were having education up to matric, followed by 23.3% having education up to primary level among type 2 diabetes mellitus. 30% were home maker followed by 28.3% in private job among type 1 diabetes mellitus clients, whereas 50% were home maker among type 2 diabetes mellitus clients. 55% were having family income less of than and equal to Rs15,000/ month among type 1 diabetes mellitus clients whereas 53.3% were having family income of Rs15,001-30,000 / month among type 2 diabetes mellitus.

 

51.7% and 65% were from rural area among type 1and type 2 diabetes mellitus clients respectively. 60% and 63.3% were not having family history of diabetes mellitus among type 1 and type 2 diabetes mellitus clients respectively. Majority of clients (46.7%) had diabetes for more than 20 years of duration among type 1 diabetes mellitus clients and majority of clients (38.3%) had duration of diabetes as 5-10 years among type 2 diabetes mellitus.

 

48.3% were taking treatment for diabetes more than 20 years among type 1 diabetes mellitus clients, 35% were taking treatment since 5-10 years among type 2 diabetes mellitus majority of clients. 48.3% were on insulin, closely followed by 45% who were taking both anti diabetic agents (oral) and insulin, whereas among type 2 diabetes mellitus majority of clients i.e.63.3% were on anti diabetic agents (oral). 91.7% and 98.3% were compliant with medication regimen among type 1 and type 2 diabetes mellitus clients. 90% and 83.3% took no alternative medicine for treating diabetes mellitus among type 1 and type 2 diabetes mellitus clients. 98.3% client’s regularly monitored their blood glucose level as prescribed by doctor among type 1 and type 2 diabetes mellitus clients.

 

Table 2: Criteria of Percentage total score obtained for quality of life               N= 120

Level of Quality of life

Percentage of total score obtained for quality of life

Very poor

20-40%

Poor

41-60%

Fair

61-80%

Good

81-100%

                             

Table 2 depicts criteria of percentage total score obtained for quality of life

 


 

 

Table 3: Frequency and percentage distribution of quality of life among type 1 and type 2 diabetes mellitus clients        N=120

Type of diabetes mellitus                

Quality of life

Very poor

  f1               %

Poor

   f2              %

Fair

f3                    %

Good

      f4                         %

Type 1 diabetes mellitus

0

0

2

3.3

44

73.3

14

23.4

Type 2 diabetes mellitus

0

0

28

46.7

21

35.0

11

18.3

Total

0

0

30

25.0

65

54.2

25

20.8

 


Table 2. shows that 73.3% were having fair quality of life, 23.4% have good quality of life, only 3.3% were have poor quality of life among type 1 diabetes mellitus clients whereas 46.7% were having poor quality of life, 35.0% have fair quality of life and only 18.3% have good quality of life among type 2 diabetes mellitus clients.

 


 

 

Table 4: Comparison of quality of life among type 1 and type 2 diabetes mellitus clients                       N=120

Type of diabetes mellitus

n

Mean

SD

Unpaired t-value

p-value

Quality of life

Type 1 diabetes mellitus

60

126.633

14.534

4.831

.0001**

Type 2 diabetes mellitus

60

108.850

24.530

 

 

**significant (p<0.01)

 


Table 4 shows that there is significant difference between the quality of life among type 1 and type 2 diabetes mellitus clients. Clients with type 1 diabetes mellitus have better quality of life as compared to type 2 diabetes mellitus clients. Research hypothesis (H1) which states that there is significant difference between quality of life among type 1 and type 2 diabetes mellitus is accepted.

 


 

Table 5:  Domain wise comparison of quality of life among type 1 and type 2 diabetes mellitus clients                                 N=120

Domains

Type of diabetes mellitus

Mean

SD

Unpaired t-value,

p-value

Role limitation due to Physical Health

Type 1 diabetes mellitus

22.683

5.080

3.685,

.0001**

Type 2 diabetes mellitus

18.366

7.517

Physical Endurance

Type 1 diabetes mellitus

24.400

3.880

5.942,

.0001**

Type 2 diabetes mellitus

18.183

7.115

General Health

Type 1 diabetes mellitus

8.433

2.150

4.647,

.0001**

Type 2 diabetes mellitus

6.383

2.655

Treatment Satisfaction

Type 1 diabetes mellitus

16.350

2.609

1.423,

.157NS

Type 2 diabetes mellitus

15.616

3.020

Symptoms Botherness

Type 1 diabetes mellitus

12.400

1.498

1.151,

.252NS 

Type 2 diabetes mellitus

11.933

2.760

Financial Worries

Type 1 diabetes mellitus

14.033

2.655

.425,

 .671NS 

Type 2 diabetes mellitus

14.283

3.696

Emotional/ Mental Health

Type 1 diabetes mellitus

19.083

2.423

3.370,

.001** 

Type 2 diabetes mellitus

16.766

4.742

Diet Satisfaction

Type 1 diabetes mellitus

9.200

2.081

4.469,

.0001**

Type 2 diabetes mellitus

7.316

2.514

NS= Non Significant ,**Significant (p<0.01)

 


Table 5 shows that there is significant difference in quality of life among type 1 and type 2 diabetes mellitus clients in domains of role limitation due to physical health, physical endurance, general health, emotional/ mental health and diet satisfaction.  But in domains of treatment satisfaction, symptom botherness and financial worries, there is no significant difference among type 1 and type 2 diabetes mellitus clients.

 

 


 

Table 6: Association of quality of life among type 1 clients with their selected socio-demographic variable.                                   N= 120

Socio-demographic variables

Type 1 diabetes mellitus

Chi-square,

df,  p-value

Poor

Fair

Good

Age (in years)

21-30

22

7

17.188,

 8,

.028*

31-40

0

11

5

41-50

1

2

51-60

1

0

>60

0

1

0

Gender

Male

0  

20

8

2.393,

2,

0.302NS

Female

2

24

6

Marital status

Unmarried

21

6

1.795,

2,

 0.408NS

Married

23

8

Widow/widower

0  

0

Divorce

0  

0

Education

No formal education

1

0

0

45.683,

8,

.000*

Primary

1

2

0

Matric

0

4

1

Senior secondary

0

23

3

Graduate and above

0

15

10

Occupation

Home maker

1

13

4

4.233 ,

8,

0.835NS

Self employed

1

10

1

Private job

0

12

5

Government job

0

6

3

Unemployed

0

3

1

Family income per month (in rupees)

 ≤15,000

0

26

7

 

4.188,

4,

 0.381NS

15,001-30,000

2

16

7

30,001-45,000

0

2

45,001-60,000

0

0

>60,000

0

0

 Area of residence

Urban

2

18

9

4.536,

2, 0.104NS

 

Rural

0

26

5

 Family history

Yes

 2

14

8

5.942,

 2,

 0.051NS

No

0

 

30

 

6

 

Duration of diabetes mellitus

 <5 years

0

1

0

20.846,

8,

.008*

5-10 years

0

2

0

10-15 years

2

4

0

15-20 years

0

17

6

>20years

0

20

8

Duration of taking treatment

 <5years

0

1

0

20.803,

8,

.008*

5-10 years

0

2

0

10-15 years

2

4

0

15-20 years

0

16

6

>20years

0

21

8

Types of prescribed medication

Anti diabetic agent (oral)

1

2

9.552,

4,

 .049*

 

Insulin

1

21

7

 

Both

0

22

5

 

None 

0

0

Compliance with medication

Yes

1

41

13

4.704,

 2,

0.095NS

 

No

1

 

3

1

Alternative remedies for diabetes mellitus

Ayurvedic

1

4

1

3.723,

2,

0.155NS

Homeopathy

None

1

40

13

Regular monitoring of blood glucose level as prescribed by doctor

Yes

 2

43

14

.370,

2,

0.831NS

No

0

 

1

 

 

NS= Non significant ,Significant (p<0.05)  

 

 

Table no. 7: Association of quality of life among type 2 clients with their selected socio-demographic variable.   N=120

Socio-demographic variables

Type 2 diabetes mellitus

Chi-square,

df,

p-value

Poor

Fair

Good

Age (in years)

21-30

2

43.131,

8,

 .000*

31-40

3

1

41-50

8

2

51-60

7

9

5

>60

21

1

1

Gender

Male

10

9

7.842,

 2,

.020*

Female

19

11 

 

Marital status

Unmarried

2

20.667,

 4,

 .000*

Married

17

20

9

Widow/widower

11

1

Divorce

0

Education

No formal education

10

1

1

17.695,

8,

 .024*

Primary

8

4

2

Matric

8

5

3

Senior secondary

0

7

3

Graduate and above

2

4

2

Occupation

Home maker

19

9

2

16.124,

6,

.013*

Self employed

4

4

3

Private job

0

2

4

Government job

5

6

2

Unemployed

0

0

0

Family income per month (in rupees)

 ≤15,000

10

6

6

 

2.253,

 4,

 0.689NS

15,001-30,000

15

13

4

30,001-45,000

3

2

1

45,001-60,000

0

0

>60,000

0

0

 Area of residence

Urban

11

 8

 2

1.682,

2 ,

0.431NS

 

Rural

17 

 

13

 

9

 Family history

Yes

6

 9

7

6.592,

2,

.037*

No

22

 

12 

 

4

Duration of diabetes mellitus

 <5 years

4

6

3

9.638,

8,

 0.291NS

5-10 years

8

10

5

10-15 years

5

4

1

15-20 years

10

1

2

>20years

1

Duration of taking treatment

 <5years

5

7

4

10.254,

 8,

 0.248NS

5-10 years

7

10

4

10-15 years

5

3

1

15-20 years

10

1

2

>20years

1

0

Types of prescribed medication

Anti diabetic agent (oral)

16

16

6

8.581,

 4,

 0.072NS

 

Insulin

3

1

4

 

Both

9

4

1

 

None 

0

0

Compliance with medication

Yes

27

21

11

1.162,

 2,

 0.559NS

 

No

1

 

0  

 

0

Alternative remedies for diabetes mellitus

Ayurvedic

4

5

1

1.340,

2,

0.512NS

Homeopathy

0

None

24

16

10

Regular monitoring of blood glucose level as prescribed by doctor

Yes

28

20

11

1.889,

2,

 0.389NS

No

 

 

0

 

NS= Non significant,  Significant (p<0.05)

 

 

 

 

 

  


CONCLUSION:

·      Quality of life among  majority of type 1 diabetes mellitus clients was fair i.e. 73.3% followed by good quality of life in 23.3% clients whereas majority of clients 46.7% with type 2 diabetes mellitus clients were having poor quality of life followed by fair quality of life in 35% clients.

·      Unpaired t-test value shows significant difference between quality of life among type 1 and type 2 diabetes mellitus clients.

·      Domain wise comparison highlighted significant difference in role limitation due to physical health, physical endurance, general health, emotional/ mental health and diet satisfaction among type 1 ad type 2 diabetes mellitus.

 

DISCUSSION:

·      A cross sectional study conducted in Spain among 67 patients with  type 1 diabetes mellitus clients, result revealed that 68.5% of the patients reported that diabetes had changed their lives, 83.5% identified complications as their most important long-term concern and 59.7% said that they needed more training to manage the disease.7

·      A descriptive study conducted in Cartagena de Indias, Colombia among 315 type 2 diabetic mellitus patients, results revealed that 196 (62.2%) of patients have a good quality of life.8

·      A cross- sectional study conducted among type 1 and type 2 diabetic clients in Portuguese revealed the same results i.e. people with type 2 diabetes mellitus have poor quality of life than type 1.9

·      A cross- sectional descriptive survey in Sargodha City, Pakistan among 392 type 2 diabetes mellitus clients revealed that gender, marital status, education, monthly income, occupation, location and duration of the disease were reported to be significantly associated with HRQoL.10

 

ACKNOWLEDGEMENT:

I would like to express my sincere gratitude to the participants of study who had spent their valuable time for giving the information. Grateful acknowledgement is extended to Mr. Rajesh Kumar for the valuable help in statistical analysis.

 

CONFLICT OF INTEREST:

There was no conflict of interest in the study.

 

SOURCE OF FUNDING:

Self.

 

ETHICAL CLEARANCE:

Permission for the research study was taken from ethical and research committee of Mata Sahib Kaur College of Nursing Balongi, Mohali to conduct research study.

Permission from the Nagpal J. was taken to use “Quality of life instrument for Indian diabetes patient” as a tool in this study.

 

A formal written permission was obtained from the Nursing Superintendent Indus Superspeciality Hospital, Phase-1, Mohali to conduct pilot study.

 

A formal written permission was obtained from the Nursing Superintendent of Sri Guru Harkrishan Hospital Sohana, Mohali and IVY Hospital, Sector-71, Mohali for main study.

 

Written informed consent was obtained from all diabetes mellitus clients.

 

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1.   Diabetesatlas. Making difference to global diabetes. 4th ed. Latest diabetes figure paint grim global volume 54.

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3.   Black M J, Hawks JN. Medical Surgical Nursing 8th ed. New Delhi. Harnout publishers; 2010.

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5.   Reema M, Preemkumar S, Anitha B. Prevalence of diabetic retinopathy in urban India. The Chennai Urban Rural Epidemiology Study (CURES) Eye Study, I. Invest opthalmol vis sci 2005, 46:2328-33. Available from: http://iovs.arvojournals.org/article.aspx?articleid=2182886.

6.   Nagpal J, Kumar A, Kakar S, Bhartia A. The development of ‘Quality of Life Instrument for Indian Diabetes Patients (QOLID): a validation and reliability study in middle and higher income groups. J Assoc Physicians India. 2010 May; 58:295-4.

7.   Martel Alvardo Dacil, Velasco Rebcas. Quality of life and type 1 diabetes: a study assessing patients’ perceptions and self -management needs .2015; 9: 1315–23. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4576890/.

8.   H Amer, Attia Z, Ahmed A, Mohammad S. Health-related quality of life in type 2 diabetic patients. Annals of Saudi medicine. 2008. Available from: http://www.ncbi.nlm.nih.gov/pubmed/ .

9.   Sepuluveda E, Poinhos R. Health related quality of life in type 1 and type 2 diabetic patient in Portuguese central public hospital : a cross sectional studies. 2014. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425233/.

10. Nazir Saeed, Hansali MA, Saleem F . A Cross-Sectional Assessment of Health-Related Quality of Life Among Type 2 Diabetic Patients In Pakistan. 2015. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4766782/.

 

 

 

 

 

 

 

 

 

Received on 06.10.2017       Modified on 20.12.2017

Accepted on 14.01.2018      ©A&V Publications All right reserved

Asian J. Nursing Education and Research. 2018; 8(1): 152-158.

DOI: 10.5958/2349-2996.2018.00032.0