Quality of life in patients with diabetes mellitus

This quasi-experimental study aimed to evaluate the health-related quality of life in individuals with diabetes mellitus before and after their participation in a five-month educational program in a primary care service in Brazil in 2008. The sample consisted of 51 individuals, 56.9% female and 43.1% male, who had a mean age of 57.65 ± 11.44 years. Data were collected using the Portuguese version of the SF-36 questionnaire. The instrument had adequate reliability estimates for the study sample. Cronbach’s alpha for the two components of the instrument, physical and mental, were 0.83 and 0.89, respectively. The findings suggested improvements in all the domain components; however, only the general health domain, before (63.96 ± 19.03) and after (70.59 ± 17.82) the educational program, presented statistically significant mean differences, t(50) = 2.16, p<0.05. Participation in the educational program also contributed to improvements in the perceptions of the individuals regarding their general health status. dEScRiPtoRS Diabetes mellitus Quality of life Health education Nursing care RESUmEn Estudio cuasi-experimental objetivando evaluar la calidad de vida relacionada a la salud de personas con diabetes mellitus, antes y después de participar de un programa educativo de cinco meses. Participaron 51 sujetos, predominantemente de sexo femenino (56,9%), promedio etario y desvío estándar de 57,65±11,44 años, en un servicio de atención primaria del interior paulista durante 2008. Datos recolectados mediante cuestionario SF-36. El instrumento se demostró confiable para la población estudiada, el Alpha de Cronbach para componentes físicos y mentales fue de 0,83 y 0,89, respectivamente. Los resultados mostraron discreta mejora en casi todos los dominios, a pesar de que el estado general de salud antes (63,96±19,03) y después (70,59±17,82) del programa educativo haya presentado diferencia estadísticamente significativa t(50)=-2,16; p<0,05. La participación de los sujetos en el programa educativo en diabetes mellitus contribuyó también para mejorar la percepción acerca de su estado general de salud. dEScRiPtoRES Diabetes mellitus Calidad de vida Educación en salud Atención de enfermería Heloisa turcatto Gimenes Faria1, Vívian Saraiva Veras2, Antônia tayana da Franca Xavier3, carla Regina de Souza teixeira4, maria Lúcia Zanetti5, manoel Antônio dos Santos6 Qualidade de vida de pacientes com diabetes mellitus antes e após participação em programa educativo calidad de vida de pacientes de diabetes mellitus antes y después de participar en un programa educativo 1registered nurse. doctoral student in Fundamental nursing at the university of são paulo at ribeirão preto college of nursing, WHo collaborating centre for the development of nursing research. ribeirão preto, sp, brazil. helogimenes@hotmail.com 2registered nurse. doctoral student in Fundamental nursing at the university of são paulo at ribeirão preto college of nursing, WHo collaborating centre for the development of nursing research. ribeirão preto, sp, brazil. vivianveras@hotmail.com 3registered nurse. msc. in Fundamental nursing from the university of são paulo at ribeirão preto college of nursing, WHo collaborating centre for the development of nursing research. ribeirão preto, sp, brazil. tayanaxavier@usp.br 4registered nurse. associate professor at the university of são paulo at ribeirão preto college of nursing, WHo collaborating centre for the development of nursing research. ribeirão preto, sp, brazil. carlast@eerp.usp.br 5registered nurse. associate professor at the university of são paulo at ribeirão preto college of nursing, WHo collaborating centre for the development of nursing research. ribeirão preto, sp, brazil. zanetti@eerp.usp.br 6psychologist, professor in the department of psychology and education of the Faculty of philosophy, sciences and languages of ribeirão preto, university of são paulo. ribeirão preto, sp, brazil. masantos@ffclrp.usp.br received: 07/14/2011 approved: 07/24/2012 português / inglês www.scielo. br/reeusp 345 Rev Esc Enferm USP 2013; 47(2):344-9 www.ee. usp.br/reeusp/ Quality of life in patients with diabetes mellitus before and after their participation in an educational program Faria HTG, Veras VS, Xavier ATF, Teixeira CRS, Zanetti ML, Santos MA intRodUction Diabetes mellitus (DM) represents a public health problem because of its increasing incidence and prevalence. Because it is a progressive disease, the health status of the affected individual tends to deteriorate over time, when complications begin to appear arising from poor glycemic control(1). This situation can lead to a depreciation in the quality of life (QoL), as it is reflected in different aspects, such as a weakened physical state, impaired physical functioning, lower limb pain, lack of vitality, difficulty in social relationships, and emotional instability. It is estimated that 15 years after the onset of DM, 2% of affected individuals present blindness, 10% severe visual impairment, 30% to 45% some degree of retinopathy, 10% to 20% nephropathy, 20% to 35% neuropathy and 10% to 25% cardiovascular disease(2). These health problems significantly increase the costs of caring for individuals with DM and impair their QoL, considering the pain and anxiety generated by the gradual emergence of these complications(2). Patients with DM, particularly type 2 (DM2), face many adjustment difficulties, which can affect the subjective assessment they make of their living conditions, according to the development stage of the complications related to the disease. Furthermore, it is a chronic condition that persists throughout life and is sometimes accompanied by other comorbidities. Acute complications arising from DM also have a direct impact on QoL because they increase the predisposition to depressive disorders and anxiety, as well as interfering in the work relationships, in the performance of household and school tasks, and in the independence of the individual(3). Because of the complexity and extent of the problem of living with a chronic disease, studies have focused on investigating the impact of the disease on the health-related quality of life (HRQoL) of the patients affected. Thus, it can be investigated in relation to treatment choice, symptom relief, knowledge about the disease, future perspectives and skills to manage its complications, psychological adaptation to the problems faced and the social impact of the increasing incidence and prevalence. These factors are directly or indirectly related to the HRQoL of the population(4). Quality of life has been defined as a concept deeply influenced by subjectivity; it includes several factors, such as the perception of well-being and satisfaction of the individual in relation to their physical condition, their emotional and spiritual states, and their performance of functions, which are essential components of the human condition and involve values, attitudes and skills that impact on the quality of the participation in the various dimensions of social life. HRQoL reflects the intention to quantify the impact of a disease and its treatment, according to the perceptions that people have about their abilities to develop their potential and lead a full life. Its measurement is subjective because its domains cannot be measured directly by physical means. Health-related quality of life is related to the perception that the person has of both the impact of their dysfunction and their existence(5). DM educational programs have been advocated as one of the care strategies that contribute to improving the indicators related to the perception of the physical aspects, functionality, pain, general health condition, vitality, and social, emotional and mental health aspects that affect the health-related quality of life of the patients. However, a literature review found that there is still a lack of studies that evaluate HRQoL before and after the provision of an educational program in DM2. Investigations of this nature can contribute to improving the design of diabetes care and healthcare integrality. Furthermore, measures of HRQoL can support the planning of educational programs and intervention strategies for DM2(6-7). Given the above statements, the present study aimed to evaluate the health-related quality of life of patients with type 2 diabetes mellitus before and after implementing an educational program.