Quality of life among out-patients with type 2 diabetes managed by Yen Bai provincial endocrine hospital in 2020

Nội dung text: Quality of life among out-patients with type 2 diabetes managed by Yen Bai provincial endocrine hospital in 2020

1. RESEARCH ARTICLE QUALITY OF LIFE AMONG OUT-PATIENTS WITH TYPE 2 DIABETES MANAGED BY YEN BAI PROVINCIAL ENDOCRINE HOSPITAL IN 2020 Dang Thu Thuy 1, Nguyen Thi Hoa Huyen 2, Nguyen Ngoc Nghia 1, Nguyen Bich Hang 1 Nguyen Thi Ly 3 1 Yen Bai Medical College, 2VinUniversity, 3 Nam Dinh University of Nursing ABSTRACT Objectives: To describe quality of life foot complications (ß = -0.144) and renal (QOL) and to examine factors related to complications (ß = -0.093) QOL were lower QOL among patients with type 2 diabetes than those for hypertension. Female (ß = at Endocrine Hospital of Yen Bai province in -0.139) have lower QOL than male. QOL of 2020. Method: A cross-sectional descriptive patients with the other disease were lower study was conducted to collect data from than those without. These differences 275 type 2 diabetes patients at outpatient are statistically significant with p <0.05. department at Endocrine Hospital of Yen Conclusion: Using SF-36 questionnaires Bai province from September 2019 to May in this research to describe the current state 2020. Data were collected by using self- of QOL and identify factors affecting the determination questionnaire, including SF- physical health and mental health of QOL; 36 questionnaire (QOL scale). Results: In order to improve the QOL for patients The QOL score was 62.25 ± 0.8 points; and with type 2 diabetes, it is necessary to the average QOL scores in the eight health pay attention to help the patients relieve domains of SF-36 ranged from 46.74 to 73.21 anxiety, sadness and fatigue. In addition, points. The study was identifies the factors healthcare services needs more attention that negatively affect the quality of care as to the elderly, female, and with kidney and/ age (ß = -0.445) when the patient is 1 year or foot complications to increase the level of older, the QOL decreases by 0.445 points; QOL in this patient group. The HbA1c index (ß = -0.164) increased by 1%, the QOL decreased by 0.164 points. Keywords: Quality of life, type 2 The occurrence of complications, in which diabetes. 1. INTRODUCTION Diabetes is one of the most common largest among Southeast Asian countries chronic diseases worldwide [1]. The with 3.299 million people (about 5.8% of disease is increasing steadily in countries adults aged 20-79 years) [1], [2]. Long-term around the world, the most common being progressive disease with risk factors and type 2 diabetes [2]. In 2014, the rate of comorbidities often occur in psychological people with diabetes in Viet Nam was the disorders such as depression in patients [3]. Research in developed countries and some Asian countries shows that support Cor. author: Dang Thu Thuy from family and society has statistical Email: Thuydt@ymc.edu.vn significance in reducing anxiety, depression, Received: Nov 15, 2020 increasing QOL for patients with chronic Revised: Nov 22, 2020 diseases, including diabetes [4], [5]. Accepted: Mar 05, 2021 Measuring QOL has important implications Journal of Nursing Science - Vol. 04 - No. 01 5
2. RESEARCH ARTICLE in clinical care practice for chronic patients, The patients with other chronic illnesses focusing on factors that affect QOL; is or conditions at the time important evidence that helps nurses make 2.2. Setting and research period appropriate clinical decisions to improve the Research period was from September 1, quality of care; minimizing complications, 2019 to May 30, 2020. raising awareness and quality control for Period for data collection was from patients [6], [7]. January 1, 2020 to March 30, 2020. In Viet Nam, there were some studies on Setting: Endocrine department, the QOL of diabetes patients, but mainly to Endocrine Hospital of Yen Bai province. find out relevant factors, but the extent of 2.3. Research design their impact on QOL [8], [9], [10] has not been determined. Evaluate the current Cross-sectional descriptive study. status of QOL in patients with type 2 diabetes 2.4. Sample size and sampling method at outpatient department at Endocrine - Sample size hospital of Yen Bai province to evaluate Sample Size: Apply the formula to the effects of these factors on the QOL of estimate a proportion in a population patients. Measuring the patient’s QOL will n = Z2 (1- α / 2) pq / ∆2 help provide evidence for improving the quality of care in healthcare system. The n: Sample size required research: “Quality of life assessment of p: The percentage of patients with type patients with type 2 diabetes in outpatient 2 diabetes with QOL score below 50 points treatment at Yen Bai Endocrine Hospital in according to research by Hai Nguyen Thi 2020” was conducted to describe QOL and Bich ( 2018), p = 23.3% [8]. to examine factors related to QOL among ∆: Allowable deviation between the rate patients with type 2 diabetes at Endocrine obtained from the study sample and the rate Hospital of Yen Bai province in 2020. of the population. Deviation 5%, ∆ = 0.05. 2. RESEARCH METHOD Zα / 2: The Z value obtained from the Z table corresponds to the selected α value 2.1. Research subjects α: Significance level with α = 0.05, Z Type 2 diabetes patients were at coefficient (1-α / 2) = 1.96 outpatient department at Endocrine Hospital → n = 275 patients of Yen Bai province in 2020. - Sampling method: Using convenient - Inclusion criteria sampling method. The patients were at the age of 18 years 2.5. Data collection or older. All data were collected by using self- The patients agree to participate in study determination questionnaire. and can be able to hear and speak. 2.6. Research instruments - Exclusion criteria The SF-36 scale (Short Form-36) is one of The patients are being treated for the most commonly used tools for assessing comorbid mental illness, severe depression QOL in patients with type 2 diabetes [11]. or using drugs that affect mental performance The questionnaire was translated and used (sedatives, antidepressants...). to measure the QOL in patients with type 2 The patients did not have the cognitive diabetes in Viet Nam including 36 items with capacity to meet the research requirements. 8 subscales of health. 6 Journal of Nursing Science - Vol. 04 - No. 01
3. RESEARCH ARTICLE SF-36 divided into 2 parts: physical The responses would be kept strictly health and mental health. SF-36 scores confidential, and their identity will not be were coded for each question and revised, revealed, only use for research purposes. aggregated, and converted into a scale 3. RESULTS from the worst possible QOL (0 points) to the best possible QOL (100 points). 3.1. QOL characteristics of research The standardized average scores of the subjects physical health and mental health were 50, Table 1. Personal factor of research with scores above 50 presenting better than subjects normal function and below 50 presenting worse than normal function[12]. Characteristics Value Evaluate the reliability of the SF-36 scale: 62.11± 11.48 The SF-36 scale was used appropriately Age: ( X ± SD) for people with type 2 diabetes in Asia. Gender The reliability of SF - 36 was evaluated Male - n (%) 105 (38.2) using Cronbach’s α coefficient analysis. Female - n (%) 170 (61.8) The reliability of physical health and mental Education level health were proved to be reliable with Under primary school - n (%) 3 (1.1) coefficients ranging from 0.85 to 0.87 [54]. Primary school - n (%) 39 (14.2) The researcher had permission by the Secondary school - n (%) 41 (14.9) author for using the instrument in this study. High school - n (%) 97 (35.3) Other - n (%) 95 (34.5) 2.7. Data analysis Occupation The data were synthesized by using Farmer - n (%) 63 (22.9) SPSS 24.0 software. Appropriate tests were Officer - n (%) 26 (9.5) used to check the reliability and correlation Retire - n (%) 93 (33.8) and influence of variables on QOL. Other - n (%) 93 (33.8) Descriptive statistical including mean, Marital status percentage, standard deviation were used Married - n (%) 231 (84) to describe general factors and QOL of Single - n (%) 4 (1.5) subjects. Disvoced - n (%) 2 (0.7) Widow - n (%) 38 (13.8) Regression, Spearman Test, Mann- 23.25 ± 0.16 Whitney Test, Kruskal – Wallis test was used BMI ( X ± SD) to determine the relationships between Duration of illness some factors and the QOL. ≤ 5 years – n (%) 107 (38.9) Multivariate regression was used to > 5 -10 years – n (%) 116 (42.2) determine the factors affecting the QOL. > 10 years - n (%) 52 (18.9) 2.8. Ethical issues Complications Have complications 246 (89.5) The research proposal was approved Uncomplicated 29 (10.6) by the Ethical Review Board of Nam Dinh Retina - n (%) 99 (29) University of Nursing. An informed consent Hypertension - n (%) 41 (12) was obtained to ensure that the subjects Kidney - n (%) 22 (6.5) voluntarily participated in this study. Foot - n (%) 9 (2.6) Participants have the right to withdraw from Nervous - n (%) 141 (41.3) the study at any time Journal of Nursing Science - Vol. 04 - No. 01 7
4. RESEARCH ARTICLE Characteristics Value Table 1 showed that the average age of subjects was 62.11 ± 11.48 years old. The Other diseases majority of the subjects were female (61.8%) None – n (%) 24 (8.7) 1 disease – n (%) 121 (44) and married (84%). Most of the subjects 2 diseases – n (%) 95 (34.5) had certificate from high school and above ≥ 3 diseases – n (%) 35 (12.7) (69.8%). A large number of the patients were retired (33.8%) and had duration Treatments of disease from 5 to 10 years (42.2%). No medicin - n (%) 0 (0) medicine for oral use - n (%) 96 (34.9) Most of the patients had complications Insulin - n (%) 136 (49.5) (89.5%). The most common complications Combined medicine for 43 (15.6) was neurological (41.3%). The majority of oral use + insulin - n (%) the subjects were treated by using Insuin 6.85 ± 0.06 (49.5%). Mean of blood sugar was 8.86 ± HbA1C ( X ± SD) 0.14 mmol / L, HbA1c was 6.85 ± 0.06%. Blood sugar 8.86 ± 0.14 ( X ± SD) Table 2. Patients’ QoL scores by health domains Contents Domain of health X ± SD Mode, Range X ± SD Physical health problem 70.14 ± 1,3 75 (0-100) Physical health 58.98 ± 1.1 Limitations of activities 58.9 0± 1,9 75 (0-100) Pain 59.89 ± 1,2 57.5 (22,5- 100) General health perceptions 47.00 ± 0,8 45 (15-80) Energy and Emotions 46.74 ± 0,5 50 (20-70) Mental health 62.55 ± 0.7 Social activities 62.45 ± 1,1 62.5 (12.5-100) Emotion health problem 73.21 ± 1,7 66.6 (0-100) General mental health 67.79 ± 0,5 68 (36-84) General QOL 60.76 ± 0,8 62.25 (26.6 – 85.9) Table 2 showed the general QOL was 60.76 ± 0.8. Physical health and mental health had average scores more than 50 points. The scores of physical health (58.98 ± 1.1) were lower than mental health (62.55 ± 0.7). The eight health domains had a mean value from 46.74 (Energy and Emotions ) to 73.21 ± 1.7 (Emotion health problem). 8 Journal of Nursing Science - Vol. 04 - No. 01
5. RESEARCH ARTICLE 3.2. Relationships between QOL and other factors Table 3. Relationships between QOL and demographic factors (N= 275) Physical Demographic factors Mental health General QOL health rho -0.576 -0.345 -0.537 Age p-value * <0.05 <0.05 <0.05 Mean Rank 6298.0 7305.0 6510.5 Gender p-value ** <0.05 <0.05 <0.05 Under primary 49.5 ± 17.3 57.6 ± 7.9 44.7 ± 11.9 school Primary school 45.2 ± 2.9 58.5 ± 1.7 51.89 ± 2.2 Secondary 51.3 ± 2.8 59.79 ± 2.2 55.45 ± 2.3 Education school level High school 58.3 ± 1.7 62.37 ± 1.2 61.43 ± 1.3 Other 68.8 ± 1.4 66.91 ± 1.1 70.97 ± 1.1 p-value *** <0.05 <0.05 <0.05 Farmer 52.8 ± 2.5 59.37 ± 1.6 58.43 ± 1.9 Officer 73.0 ± 2.6 71.27 ± 1.8 72.41 ± 1.9 Occupation Retire 58.7 ± 1.6 63.04 ± 1.2 63.02 ± 1.2 Other 59.4 ± 2.0 63,16 ± 1.3 63.33 ± 1.5 p-value *** 0.05 <0.05 Married 60.1 ± 1.7 63.62 ± 0.8 63.56 ± 0.8 Marital Single 76.0 ± 8.6 74.06 ± 8.5 77.78 ± 8.2 status Divorced 65 ± 19.3 58.29 ± 4.8 61.64 ± 12.1 Widow 49.9 ± 3.2 59.41 ± 2.1 55.15 ± 2.4 p-value *** 0.05 <0.05 *Spearman Test ** Mann-Whitney Test *** Kruskal-Wallis Test QOL was nagetive correlated with age, when increasing 1 year of age, QOL decreased 0.537 points. There are differences in QOL scores of male and femae. The score increased in the group of higher education, the difference was statistically significant (p <0.05) (table 3). Journal of Nursing Science - Vol. 04 - No. 01 9
6. RESEARCH ARTICLE Table 4. Relationships between QOL and characteristics of disease Physical Mental Characteristics of disease General QOL health health ≤ 5 years 63.2 ± 1.6 65.0 ± 1.0 66.83 ± 1.2 Duration of > 5-10 years 58.8 ± 1.6 61.52 ± 1.2 60.51 ± 1.3 illness > 10 years 50.4 ± 2.8 61.45 ± 1.7 55.86 ± 2.0 p-value *** 0.05 <0.05 Retinal Mean Rank 7946.0 7909.0 7836.5 complication p-value ** >0.05 >0.05 >0.05 Hypertension Mean Rank 3918.0 3853.5 3762.5 complication p-value ** >0.05 <0.05 <0.05 Kidney Mean Rank 2156.0 2059.0 2017.0 complication p-value ** >0.05 <0.05 <0.05 Foot Mean Rank 583.5 493.0 497.0 complication p-value ** <0.05 <0.05 <0.05 Nervous Mean Rank 7976.0 9216.0 8583.0 complication p-value ** 0,05 >0,05 None 74.5 ± 2.1 64.41 ± 2.4 70.20 ± 1.9 1 disease 62.5 ± 1.5 66.79 ± 1.1 64.83 ± 1.2 Other 2 diseases 53.8 ± 1.8 60.79 ± 1.2 57.31 ± 1.4 diseases ≥ 3 diseases 49.6 ± 3.2 57.54 ± 2.2 54.08 ± 2.5 p-value *** <0.05 <0.05 <0.05 Medicine for oral 65.9 ± 1.7 63.5 ± 1.2 67.44 ± 1.3 use Insulin 56.1 ± 1.5 63.7 ± 1.0 61.04 ± 1.2 Treatments medicine for oral 52 ± 2.8 58,75 ± 2.0 54.79 ± 2.0 use + Insulin p-value *** <0.05 <0,05 <0.05 BMI 0.016 -0.010 0.009 rho >0.05 >0.05 >0.05 p-value * H b A 1 c -0.252 -0.166 - 0.239 rho p-value * <0.05 <0.05 <0.05 *Spearman Test ** Mann-Whitney Test *** Kruskal-Wallis Test There were difference between QOL with complications. However, only difference between foot complications and QOL were statistically significant. QOL of patients with other diseases was reduced. In addtion, The patients who have treated combine medicine for oral use and insulin had lower QOL than other methods. The HbA1c was negative correlated with the QOL meaning that when the HbA1c increased by 1%, the QOL score decreased by 0.252 points, having statistical significance at p <0.05 (Table 4). 10 Journal of Nursing Science - Vol. 04 - No. 01
7. RESEARCH ARTICLE 3.3. Effectting factors on the QOL in multi-variate regression analysis Table 5. Multi-variable regression model of QOL and related factors Evaluate the suitability of the Factors ß p - value model VIF Female -0.139 0.003 1,115 Gender R2 = 0,508 Male Ref* Under primary school -0,046 0,342 1,185 F=11.838 Primary school -0,126 0,081 2,631 Sig =0,000<0,005 Education level Secondary school -0,117 0,070 2,098 Ref*: High school -0,094 0,118 1,834 Dummy Other Ref* variable Farmer -0,013 0,816 1,712 ß: Officer 0,048 0,379 1,509 Regression Occupation Retire 0,124 0,053 2,086 coefficient Other Ref* standardized Single -0,043 0,374 1,171 Divorced 0,022 0,628 1,038 Marital status Widow -0,007 0,891 1,248 Married Ref* ≤ 5 years 0,019 0,778 2,269 Duration of > 5-10 years -0,076 0,247 2,200 illness > 10 years Ref* Kidney complication -0,093 0,044 1,083 Foot complication -0,144 1,110 Complications 0,002 Hypertension Ref* complication 1 disease 0,005 0,951 3,671 2 diseases -0,131 0,124 3,698 Other diseases ≥ 3 diseases -0,162 0,018 2,362 None Ref* Medicine for oral use 0,111 0,126 2,676 Insulin 0,060 0,372 2,325 Treatments medicine for oral use + Ref* Insulin Age -0,445 0,000 -,445 HbA1c -0,164 0,001 -,164 Journal of Nursing Science - Vol. 04 - No. 01 11
8. RESEARCH ARTICLE The factors that negatively affect the QOL areas in Viet Nam and international studies are age and the HbA1c index, age is the when the physical health score was lower most influential (ß = -0.445) when the patient than mental health [9], [13]. is 1 year older, the QOL decreases by 4.2. Some factors related to affect the 0.445 points; The HbA1c index (ß = -0,164) quality of care for patients with diabetes increased by 1%, the QOL decreased by type 2 outpatient treatment 0.164 points. The patients’ QOL whom had foot complications (ß = -0,144) and renal Age is one of the factors that have a linear, complications (ß = -0,093) was lower than nagative relationship and affect the QOL of the patients with hypertention complications . patients with diabetes type 2; Elderly age Female (ß = -0,139) had lower QOL than male. reduces QOL. This finding is similar to the Patients’ QOL with the other diseases was study of Hoang Thi Tuyet Nhi (2019) that lower than those without. These differences concluded that age is nagative correlated are statistically significant p <0.05 (Table 5). with the QOL, when increasing 1 year old, the QOL score was decreased by 0.06 4. DISCUSSION points [15]. Zurita-Cruz (2018) analyzed by 4.1. Patients’ QoL score using multi-variate regression, showing that age is associated with poor QOL in patients The results showed that scores of QOL with type 2 diabetes with OR = 1.04 (95% above 50 points. The scores of physical CI: 1,0008-1.09; p = 0.017) [16]. Aging and health (58.98 ± 1.1) were lower than mental combine other diseases will limit physical health (62.55 ± 0.7) (Table 2). This finding is activity from severe to moderate, even light similar to some studies in Viet Nam and other activities such as self-care are also limited countries such as Son Nguyen Thanh (36.74; depending on the severity of the associated 49.96 points), domains’score from general diseases. complications of long-term disease health perceptions (31.43) to Energy and will affect the QOL in the physical health quite Emotions (51.12) [10]; Luyster (42.93; 51.12 a lot. In addition, the elderly are susceptible points), domains’score from energy and to psychological factors due to changes in emotions (56.58) to social activities (81.71) their health status related to diseases or lack [13]. However, there are differences from the of attention from relatives and friends, which finding of Nguyen Thi Huong (2017) is (59.81; significantly affects quality of mental health. . 57.22 points), domains’score from general health perceptions (45.38) to Physical health Female had lower QOL than male(table problem (73.49) [9]. This difference can be 5). This finding is similar to the study of explained by the mean age in the different Hoang Thi Tuyet Nhi (2019), it means that studies. Demographic differences also affect sex correlates and affects the QOL [15 ]. the QOL score. Patients lived in rural and The study of Jessie N. Zurita-Cruz (2018) is mountainous areas often exercise physical related to QOL (statistically significant p <042) training and social activities more often than but has not noted the influence on QOL areas those in urban. This shows that the self- in this study [16]. It is possible that female are care activities affect the patient’s QOL [14]. less dominant than male in aspects including The elderly patients in the world is aware of biological structure (body development, the role of self-care, so the physical health changes in female hormones, especially problem score is high (70.14 points). Due premenopausal period ...) and psychosocial to the characteristics of the disease and the ( role of housewife, main caregiver in the other diseases, the subjective perception of family, poor social relationships, social each patient is different. This also explains support) through which signs of depression the similarity with the scores of patient health may appear early, this is also one of the 12 Journal of Nursing Science - Vol. 04 - No. 01
9. RESEARCH ARTICLE factors that seriously affect important to QOL factors and QOL shows that The HbA1c [17]. index has negative correlation to the QOL domains (rho = -0,205, p <0.05) [21]. The Patients’ QOL with the other diseases was percentage of patients with HbA1c <7% in lower than those without. Research by Hoang this study accounted for the majority of 68% Thi Tuyet Nhi (2018) showed the patients with (table 3.3). The majority of participants in the other diseases reduces QOL (with p <0.001 study are retired staff, with education from statistically significant). However, they have high school or higher, 100% participating in not evaluated their effects on QOL. Wermeling health insurance. Therefore, patients will et al (2012) evaluated 2086 patients with type enjoy maximum health service policies and 2 diabetes in the Netherlands and found that at the same time communication activities patients with other diseases had significantly are provided with more knowledge about the lower health status than those without [18 ]. disease to help increase self-management Along with the disease status and associated and better control of the disease. diseases increases the uncomfortable fatigue condition in the patient, affecting the operation 5. CONCLUSION of organs, causing limited daily physical The results provide evidence for clinical activities, and reducing the public health and nursing practice to improve the QOL for general quality of care. patients with type 2 diabetes. Healthcare Complications have a negative effect on system need more attention on this issue. For patients, attention to the elderly, women, with QOL in which the presence of complications kidney and/or foot complications because of the kidneys and foot (ß = - 0.093; ß = - this group of patients tended to have a lower 0.14; p <0.05) reduces QOL more than other QOL compared to other groups. complications. Compared with the study of Tran Ngoc Hoang (2014), foot complications, REFERENCES cerebrovascular accident and coronary artery 1 World Health Organization (2019). disease affect their QOL p <0.05 in 8 domains Classification of Diabetes Mellitus. 6-7. of QOL (SF-36). Study of Wu (2014), showed the relationship between QOL and kidney 2 International Diabetes Federation complications and foot ulcers was not (2017). IDF DIABETES ATLAS Eighth significant, while the presence of hypertension edition 2017. (8th), 16-150. in patients with type 2 diabetes made their 3. An Tran Thi Ha (2018). Factors QOL worse than [19]. The presence of related to the clinical features of depression complications such as complications such a in patients with diabetes type 2, as foot complications, high blood pressure Dissertation of medicine, Hanoi Medical can increase physical discomfort, decrease University, Hanoi. [in Vietnamese] physical activity affecting self-care. Various 4 Göz F., Karaoz S., Goz M. et al complications may made treatment time (2007). Effects of the diabetic patients’ longer and increasing the cost of treatment, perceived social support on their quality- reducing QOL [20]. Complications impaired of-life. Journal of Clinical Nursing, 16 (7), self-care activities is associated with a 1353-1360. reduced prognosis [14]. 5 Ramkisson S., Pillay B. J., Sibanda HbA1c index has a negative effect on QOL W. (2017). Social support and coping in of patients with type 2 diabetes. This finding is adults with type 2 diabetes. African journal similar to some studies such as Marte (2019), of primary health care & family medicine, 9 which studies the effects of metabolic control (1), e1-e8. Journal of Nursing Science - Vol. 04 - No. 01 13
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