Health Related Quality of Life Measurements for Diabetes: A Systematic Review

Health-related quality of life (HRQOL) is an essential measure that is used to assess the effect of chronic disease management on the health status of an individual. Previous studies have identified various instruments used in the measuring of diabetes-specific health-related quality of life (HRQOL). The aim of this paper is to provide a systematic review of the various instruments used for the diabetes-specific measure of HRQOL, and place emphasis on its content and measurement properties. Methods Preferred Reporting Items for Systematic Reviews and Meta analyses (PRISMA) guidelines was used. A systematic search strategy was used to identify publications reporting diabetes HRQOL measures. The search terms used were: “diabetes quality of life”, “measurements”, and “instruments”. The database that was searched includes PubMed, Science Direct, CINAHL, and Medline. Articles written in the English language and published from January 1990 to December 2020 were included. Those articles that did not measure HRQOL for diabetic patients were excluded. Results: A total of seventeen instruments met the inclusion criteria and included in the review. The appraisal of diabetes scale (ADS), Audit of Diabetes-Dependent QOL measure (ADDQOL), Diabetes Health Profile (DHP), and Problem Areas in Diabetes (PAID) are more suitable for single-scale questionnaires when investigating one or more specific aspects of diabetes-specific quality of life (QOL). The ADDQOL, ADS, Diabetes Impact Measurement Scales (DIMS), Diabetes Quality of Life Clinical Trial Questionnaire (DQLCTQ-R), Malay Version of Diabetes Quality of Life (DQOL), Iranian Diabetes Quality of Life (IRDQOL), Brief Clinical Inventory, and PAID are relevant measures of HRQOL for insulin dependent diabetes mellitus (IDDM) and non-insulin dependent diabetes mellitus (NIDDM) patients. The Asian Diabetes Quality of Life AsianDQOL, The Chinese Short Version of DQOL, Elderly Diabetes Burden Scale (EDBS), Malay Version of Diabetes Quality of Life (DQOL), are relevant measures of HRQOL for NIDDM patients. Only two instruments assess for responsiveness, namely PAID and DQLCTQ-R. In PAID, the effect sizes ranged from 0.32 to 0.65 for interventions. The DQLCTQ-R four domains were responsive to clinical change in metabolic control. Based on this review ADDQOL, DSQOLS, and EDBS psychometric properties are sufficient. Conclusion: Most studies did not check for responsiveness, and future studies should prioritize responsiveness to change, which was not included in the psychometric finding of the reviewed instruments.

UNDERSTANDING THE ROLE OF VAYU AND AKASH MAHABHUTA IN THE MUTATIONS IN TYROSINE KINASE PORTION OF INSULIN RECEPTOR GENE FOUND IN NIDDM PATIENTS.

Normally, when insulin binds to the extracellular alpha chain of the insulin-receptor, it originates a change within receptor’s structure, resulting in autophosphorylation of particular tyrosines in the cytoplasmic part of the beta chains. This change causes an initiation of a multifaceted cascade, which lastly results in secretion of the insulin. It is a well-known fact that the determination of any function of a protein is dependent on the sequence of the amino acids. Obviously any changes in the sequence result in differed function. This change is called as mutation. It is an established fact that missense mutations in the tyrosine kinase portion of the insulin receptor gene are present in patients with NIDDM. This mutation in the insulin-receptor prevents the relay of the stimuli, resulting in inhibition of insulin secretion finally. Here, we have demonstrated that the mutations in tyrosine kinase portion of insulin receptor gene found in the patients of NIDDM, are actually the derangement in the ruksa, laghu attributes, which are due to the combination of Vayu mahabhuta and Akash mahabhuta. We have also concluded that the replacement of Vayu mahabhuta and Akash mahabhuta by Prithvi mahabhuta and Jala mahabhuta, is the backbone of the pathology in NIDDM.

Studies on lipid profile in patients with non insulin dependent diabetes mellitus

Diabetes mellitus is a global health problem and is associated with abnormalities of lipids and lipoprotein metabolism in variable frequency. The aim of the present work was to study the lipid abnormalities in NIDDM patients. Dyslipidaemia is of special interest because to compare it between male and female NIDDM patients and as well as to see the impact between women of reproductive age group and post menopausal women. For this purpose total serum cholesterol, triglyceride, LDL-C, HDL-C and LDL/HDL ratio were determined of a total number of 160 subjects. Out of these 80 subjects were diabetic and 80 were non-diabetic control subjects of both sexes. In this study, the total serum cholesterol levels were higher in NIDDM than control subjects and showed significant statistical difference (P<0.05) between control and NIDDM subjects. The serum triglyceride levels were found higher amongst diabetics as compared to the normal healthy controls and showed statistically significant difference (P<0.05). Higher LDL-C levels were showed in NIDDM and revealed significant difference (P<0.05) in comparison to control non-diabetic subjects and NIDDM patients. HDL-C levels were found decreased in patients with NIDDM compared to controls. The findings in the patients with NIDDM between male and female revealed no significant difference (P>0.05) in mean TC, TG, HDL-C and LDL-C between male and female diabetic patient in unpaired t-test. With improvement of diabetic control some improvement of the lipid abnormalities can be achieved. Most studies have shown that improvement of lipid abnormalities occur with proper glycaemic control in patients with NIDDM. The atherosclerotic process in the diabetic patient is indistinguishable from that seen in the non-diabetic population but it begins earlier and is more severe. Risk factors associated with atherosclerosis in the non-diabetic subject appear to have a similar relation to coronary heart disease among diabetics. Further studies are necessary to confirm the present suggestions, studies involving more number of subjects, estimation of Hb AIC.DOI: http://dx.doi.org/10.3329/kyamcj.v2i1.13516 KYAMC Journal Vol.2(1) 2011 pp.123-127

Abstract P338: Adverse Outcomes Following Percutaneous Coronary Intervention in Insulin Dependent and Non-Insulin Dependent Diabetes Mellitus

Background: ACC guidelines suggests late outcomes in diabetic patients after percutaneous coronary intervention (PCI) are similar to non-diabetics if the hgbA1C can be maintained less than 7.0%. To achieve this level of glycemic control many patients require the addition of insulin. The differences in outcomes amongst insulin dependent (IDDM) and non-insulin dependent (NIDDM) patients are not well known. We wish to analyze the cardiovascular (CV) outcomes and glycemic control of diabetic patients 6 months post PCI stratified by insulin usage. Methods: We conducted a retrospective cohort study investigating the impact of DM on clinical outcomes in patients who underwent a PCI at a Veterans Health Institution from September 2004 to March 2009. Adverse cardiovascular outcomes (death, myocardial infarct, revascularization, cardiac hospitalization, and combined outcomes) six months post-PCI were recorded and compared in IDDM and NIDDM patients. Data pertaining to glucose levels, HgbA1C, lipids, and blood pressure were also collected. Results: Of the 771 unique patients in our analysis, 302 had DM of which, 132(44%) were on insulin and 169(56%) were on oral medications. Although not statistically significant, in IDDM patients there was an increased rate of death, MI, cardiac hospitalization, and combined outcomes. HgbA1C and glucose values in IDDM were significantly higher pre and post-PCI. Conclusion: Our study suggested that both IDDM and NIDDM groups had poor glycemic control, however, IDDM patients were less controlled. Although lack of power in our study may have led to our inability to detect statistically significant differences in adverse CV outcomes we can see a trend toward worse outcomes in the IDDM group. Increased attention to promote tighter glycemic control particularly among IDDM veterans is warranted. We can conclude that more attention needs to be paid to diabetics patients, especially IDDM patients, to maintain a tighter glycemic control and hence reduce adverse cardiovascular outcomes post PCI.