Research Article: Is health related quality of life influenced by diabetic neuropathic pain among type II diabetes mellitus patients in Ethiopia?

Date Published: February 4, 2019

Publisher: Public Library of Science

Author(s): Hiwot Degu, Abigiya Wondimagegnehu, Yared Mamushet Yifru, Ayele Belachew, Rayaz A. Malik.


Polyneuropathy is one of the commonest complications of long-standing diabetes. Progressive sensory loss can predispose patients to foot ulcer and the neuropathy oftentimes causes pain. The pain can significantly affect the quality of life of patients.

To describes the health-related quality of life of patients with type II diabetes mellitus suffering from painful diabetic peripheral neuropathy at two referral hospitals in Addis Ababa, Ethiopia, 2017.

An institution based cross sectional study with internal comparison was conducted among a sample of 220 type II diabetes mellitus patients in a 1:1 matched ratio of those with and without diabetes associated peripheral neuropathic pain. All were having regular follow up at two hospitals in Addis Ababa, Ethiopia. The Short Form (SF-36) health-related quality of life instrument was used to collect data on quality of life while basic socio-demographic and other disease specific features were collected using a structured questionnaire. Descriptive statistics was used to examine the mean scores of health related quality of life. Cronbach’s alpha coefficient and Pearson’s correlation coefficient were applied to estimate the internal consistency, and the level of agreement between the different domains of SF-36, respectively. To measure association between health related quality of life domains and explanatory variables, independent T-test and ANOVA were performed followed by multiple linear regression analyses.

The health related quality of life of type II diabetes mellitus patients with peripheral neuropathic pain was poorer than those without pain in all the eight domains and the two summary scores by SF-36 (p < 0.001). Higher mean score difference was observed in Mental Component Summary Score (MCS) (14.6) compared to Physical Component Score (PCS) (9.3). Among the eight domains, the largest mean difference was found with the physical one (39.1) followed by mental health (38.2) and physical functioning (30). Pain intensity had a statistically significant negative correlation with all domains as well as the two summary scores. Younger age, a higher level of education, being single, a higher monthly income, normal body mass index, HbA1c less than seven mmo/L, absence of other diabetic complications and taking only oral hypoglycemic agents were found to predict better health related quality of life. The presence of diabetic peripheral neuropathic pain was found to negatively influence the health-related quality of life of type II diabetic patients; the greatest impact being on the ‘role physical’ and ‘mental health’ domains. Older age, presence of diabetes related complications, longer duration of illness negatively influenced the health-related quality of life.

Partial Text

Diabetes mellitus is one of the most common chronic diseases that affect people of all ages and races worldwide. The magnitude of Diabetes Mellitus (DM) continues to increase mainly due to changes in lifestyles resulting in physical inactivity and increased obesity. Globally 6% of adults are estimated to have either DM I or II, and of these 80% live in low and middle-income countries. If this trend continues, an estimated 592 million people, or one in ten adults will have diabetes by 2035 [1]. In Africa, diabetes is estimated to affect about 19.8 million adults; and in Ethiopia alone, 1.9 million patients are believed to exist [2]. In 2015, diabetes was responsible for about 6% of adult deaths in the African Region [2]. According to International Diabetes Federation (IDF) 2015 report, among the Ethiopian total adult population, 1.3 million had DM. According to the WHO estimates, 90% diabetic patients have type II diabetes [2].

A facility based cross-sectional study with internal comparison was conducted in 2017 among randomly selected 110 type II DM patients with DPNP matched with 110 type II DM patients without DPNP in a 1:1 ratio, attending the same outpatient clinics of two hospitals in Addis Ababa, Ethiopia. DM patients between the age of 18 and 65 years, having DPNP for more than 6 months, those able to communicate, not in disabling pain and with no known abuse of alcohol participated in this study. The study received ethical clearance from the Addis Ababa University, College of Health Science, School of Public Health Research and Ethics Committee. Informed written consent was obtained from all study participants.

This study compared HRQoL among type II DM patients with and without diabetic peripheral neuropathic pain and the result showed a statistically significant mean score differences in all eight domains and the two summary scores of SF-36 between the two groups. This finding is similar with studies done in Turkey, Croatia, Korea and the UK [2, 25]. In another study, DPNP in type II DM patients independently affected both the physical and mental components of QoL, even after adjusting for the pain intensity [26].

Health related quality of life of type II diabetic patients is negatively influenced by diabetic peripheral neuropathic pain, the common complication of diabetes. The Role Physical and Mental Health domains of health-related quality of life were the most impacted. Older diabetic patients, who suffered for longer duration of illness and those with diabetes related complications, were found to have poorer health related quality of life. Study using a combination of FS-36 with disease specific quality of life measurement is recommended. Furthermore, complimentary qualitative enquiry may also be required to explain issues such as why the role emotion is the list affected domain.




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