Background
Methods
Ethics, consent and permission
Setting
Patient
Definitions of study participants
Definitions of diseases
Definitions of diabetes-related complications
Instruments
Health-related quality of life
Diabetes-Related Distress (DRD)
Depressive Symptoms (DS)
Statistical analyses
Results
Tertile WHOQoL-BREF total score, n (%) |
X
2
|
P
*
| |||||
---|---|---|---|---|---|---|---|
Totala
| Lowb
| Intermediateb
| Highb
| ||||
Health Clinic | Seri Kembangan | 218 (31.4) | 79 (36.2) | 75 (34.4) | 64 (29.4) | 12.40 | 0.015 |
Dengkil | 123 (17.7) | 43 (35.0) | 50 (40.7) | 30 (24.4) | |||
Salak | 353 (50.9) | 107 (30.3) | 107 (30.3) | 139 (39.4) | |||
Age, year | ≤50 | 186 (26.9) | 62 (33.3) | 52 (28.0) | 72 (38.7) | 5.90 | 0.206 |
51–60 | 268 (38.7) | 90 (33.6) | 88 (32.8) | 90 (33.6) | |||
>60 | 238 (34.4) | 76 (31.9) | 91 (38.2) | 71 (29.8) | |||
Diabetes Duration, year | <5 | 341 (50.8) | 111 (32.6) | 106 (31.1) | 124 (36.4) | 8.61 | 0.072 |
5–9.9 | 187 (27.9) | 58 (31.0) | 60 (32.1) | 69 (36.9) | |||
≥10 | 143 (21.3) | 52 (36.4) | 57 (39.9) | 34 (23.8) | |||
Gender | Female | 365 (52.8) | 120 (32.9) | 127 (34.8) | 118 (32.3) | 0.79 | 0.673 |
Male | 326 (47.2) | 106 (32.5) | 105 (32.2) | 115 (35.3) | |||
Ethnicity | Malay | 365 (53.1) | 109 (29.9) | 120 (32.9) | 136 (37.3) | 16.48 | 0.002 |
Chinese | 160 (23.3) | 73 (45.6) | 46 (28.8) | 41 (25.6) | |||
Indian | 163 (23.7) | 46 (28.2) | 62 (38.0) | 55 (33.7) | |||
Religion | No religion | 32 (4.6) | 13 (40.6) | 10 (31.3) | 9 (28.1) | 26.22 | 0.003 |
Moslem | 373 (53.9) | 109 (29.2) | 124 (33.2) | 140 (37.5) | |||
Buddhist | 81 (11.7) | 45 (55.6) | 19 (23.5) | 17 (21.0) | |||
Hinduism/Sikh | 147 (21.2) | 41 (27.9) | 57 (38.8) | 49 (33.3) | |||
Christian/Catholic | 22 (3.2) | 7 (31.8) | 7 (31.8) | 8 (36.4) | |||
Others | 37 (5.3) | 13 (35.1) | 14 (37.8) | 10 (27.0) | |||
Religiosity | Religious | 590 (85.5) | 183 (31.0) | 197 (33.4) | 210 (35.6) | 11.95 | 0.018 |
Unsure | 24 (3.5) | 13 (54.2) | 9 (37.5) | 2 (8.3) | |||
Not religious | 76 (11.0) | 31 (40.8) | 25 (32.9) | 20 (26.3) | |||
Marital status | Married/living with a partner | 546 (79.1) | 176 (32.2) | 184 (33.7) | 186 (34.1) | 4.69 | 0.584 |
Widowed | 97 (14.1) | 30 (30.9) | 35 (36.1) | 32 (33.0) | |||
Divorced/separated | 21 (3.0) | 11 (52.4) | 4 (19.0) | 6 (28.6) | |||
Single | 26 (3.8) | 10 (38.5) | 8 (30.8) | 8 (30.8) | |||
Education | Never | 45 (6.6) | 18 (40.0) | 16 (35.6) | 11 (24.4) | 7.15 | 0.128 |
Primary & secondary | 563 (82.4) | 185 (32.9) | 195 (34.6) | 183 (32.5) | |||
Tertiary | 75 (11.0) | 22 (29.3) | 19 (25.3) | 34 (45.3) | |||
Employment | Retired/home manager | 368 (53.3) | 127 (34.5) | 131 (35.6) | 110 (29.9) | 7.64 | 0.106 |
Employed | 312 (45.2) | 95 (30.4) | 98 (31.4) | 119 (38.1) | |||
Unemployed | 11 (1.6) | 6 (54.5) | 2 (18.2) | 3 (27.3) | |||
Income (RM) | <1000 | 323 (47.4) | 113 (35.0) | 101 (31.3) | 109 (33.7) | 3.32 | 0.506 |
1000–2999 | 320 (47.0) | 99 (30.9) | 115 (35.9) | 106 (33.1) | |||
≥3000 | 38 (5.6) | 9 (23.7) | 14 (36.8) | 15 (39.5) | |||
Exercise | No | 293 (42.5) | 112 (38.2) | 91 (31.1) | 90 (30.7) | 10.94 | 0.027 |
≤3 times in a week | 231 (33.5) | 77 (33.3) | 79 (34.2) | 75 (32.5) | |||
>3 times in a week | 166 (24.1) | 39 (23.5) | 60 (36.1) | 67 (40.4) | |||
Smoking | Never | 526 (76.1) | 177 (33.7) | 175 (33.3) | 174 (33.1) | 5.14 | 0.273 |
Stop > 5 years | 60 (8.7) | 20 (33.3) | 14 (23.3) | 26 (43.3) | |||
Stop ≤ 5 years and active smoker | 105 (15.2) | 32 (30.5) | 41 (39.0) | 32 (30.5) | |||
BMI, Kgm−2
| <23.0 | 76 (11.2) | 32 (42.1) | 22 (28.9) | 22 (28.9) | 7.75 | 0.101 |
23.0–27.4 | 237 (35.0) | 82 (34.6) | 82 (34.6) | 73 (30.8) | |||
≥27.5 | 365 (53.8) | 103 (28.1) | 125 (34.2) | 137 (37.5) | |||
HbA1c, % | HbA1c ≥ 6.5 | 515 (83.3) | 168 (32.6) | 171 (33.2) | 176 (34.2) | 0.26 | 0.879 |
HbA1c <6.5 | 103 (16.7) | 36 (35.0) | 34 (33.0) | 33 (32.0) | |||
HbA1c ≥ 7.0 | 455 (73.6) | 148 (32.5) | 153 (33.6) | 154 (33.8) | 0.23 | 0.892 | |
HbA1c <7.0 | 163 (26.4) | 56 (34.4) | 52 (31.9) | 55 (33.7) | |||
Hypertension | No | 148 (21.7) | 46 (31.1) | 45 (30.4) | 57 (38.5) | 1.71 | 0.426 |
Yes | 534 (78.3) | 180 (33.7) | 179 (33.5) | 175 (32.8) | |||
BP, mmHg | BP > 130/80 | 479 (69.5) | 155 (32.4) | 155 (32.4) | 169 (35.3) | 1.53 | 0.466 |
BP ≤130/80 | 210 (30.5) | 72 (34.3) | 74 (35.2) | 64 (30.5) | |||
Dyslipidaemia | No | 406 (60.9) | 124 (30.5) | 125 (30.8) | 157 (38.7) | 9.94 | 0.007 |
Yes | 261 (39.1) | 95 (36.4) | 96 (36.8) | 70 (26.8) | |||
LDL-C, mmol/L | LDL-C > 2.6 | 336 (59.9) | 106 (31.5) | 120 (35.7) | 110 (32.7) | 2.72 | 0.257 |
LDL-C ≤ 2.6 | 225 (40.1) | 74 (32.9) | 66 (29.3) | 85 (37.8) | |||
HDL-C, mmol/L | HDL-C < 1.1 | 407 (72.2) | 118 (29.0) | 143 (35.1) | 146 (35.9) | 5.86 | 0.053 |
HDL-C ≥ 1.1 | 157 (27.8) | 62 (39.5) | 45 (28.7) | 50 (31.8) | |||
TG, mmol/L | TG > 1.7 | 250 (44.3) | 81 (32.4) | 85 (34.0) | 84 (33.6) | 0.36 | 0.837 |
TG ≤1.7 | 314 (55.7) | 99 (31.5) | 102 (32.5) | 113 (36.0) | |||
Total-C, mmol/L | Total-C > 4.5 | 357 (58.1) | 121 (33.9) | 126 (35.3) | 110 (30.8) | 4.81 | 0.090 |
Total-C ≤ 4.5 | 257 (41.9) | 78 (30.4) | 78 (30.4) | 101 (39.3) | |||
Any diabetes complication | No | 608 (87.7) | 193 (31.7) | 201 (33.1) | 214 (35.2) | 6.31 | 0.043 |
Yes | 85 (12.3) | 36 (42.4) | 30 (35.3) | 19 (22.4) | |||
Microvascular complication | No | 641 (92.5) | 207 (32.3) | 212 (33.1) | 222 (34.6) | 4.23 | 0.120 |
Yes | 52 (7.5) | 22 (42.3) | 19 (36.5) | 11 (21.2) | |||
Macrovascular complication | No | 648 (93.9) | 206 (31.8) | 217 (33.5) | 225 (34.7) | 6.92 | 0.031 |
Yes | 42 (6.1) | 21 (50.0) | 13 (31.0) | 8 (19.0) | |||
OHA | No | 60 (8.7) | 25 (41.7) | 20 (33.3) | 15 (25.0) | 3.03 | 0.220 |
Yes | 630 (91.3) | 202 (32.1) | 210 (33.3) | 218 (34.6) | |||
Insulin | No | 422 (61.2) | 132 (31.3) | 139 (32.9) | 151 (35.8) | 2.27 | 0.687 |
1 type | 187 (27.1) | 66 (35.3) | 64 (34.2) | 57 (30.5) | |||
2 types | 80 (11.6) | 29 (36.3) | 26 (32.5) | 25 (31.3) | |||
Number of AHA agents | No | 81 (11.8) | 22 (27.2) | 30 (37.0) | 29 (35.8) | 4.71 | 0.581 |
1 type | 204 (29.6) | 70 (34.3) | 65 (31.9) | 69 (33.8) | |||
2 types | 203 (29.5) | 73 (36.0) | 59 (29.1) | 71 (35.0) | |||
3 types | 201 (29.2) | 62 (30.8) | 75 (37.3) | 64 (31.8) | |||
LLA | No | 156 (22.6) | 50 (32.1) | 47 (30.1) | 59 (37.8) | 1.59 | 0.451 |
Yes | 533 (77.4) | 177 (33.2) | 182 (34.1) | 174 (32.6) | |||
APA | No | 612 (89.1) | 194 (31.7) | 202 (33.0) | 216 (35.3) | 6.48 | 0.039 |
Yes | 75 (10.9) | 32 (42.7) | 27 (36.0) | 16 (21.3) |
OQOL, n = 490 | PQOL, n = 472 | YQOL, n = 457 | SRQOL, n = 560 | EQOL, n = 535 | ||||||
---|---|---|---|---|---|---|---|---|---|---|
Crude B (95.0 % CI) | Adjusted B (95.0 % CI) | Crude B (95.0 % CI) | Adjusted B (95.0 % CI) | Crude B (95.0 % CI) | Adjusted B (95.0 % CI) | Crude B (95.0 % CI) | Adjusted B (95.0 % CI) | Crude B (95.0 % CI) | Adjusted B (95.0 % CI) | |
(Constant) | - | 71.36 (61.34, 81.38) | - | 60.18 (48.9, 71.44) | - | 69.38 (55.35, 83.41) | - | 76.54 (65.10, 87.99) | - | 69.34 (54.07, 81.61) |
DDS scorea
| −0.18 (−0.22, −0.13) | −0.04 (−0.10, 0.02) | −0.13 (−0.17, −0.08) | 0.01 (−0.06, 0.08) | −0.18 (−0.23, −0.13) | −0.12 (−0.20, −0.04) | −0.19 (−0.26, −0.12) | 0.001 (−0.09, 0.09) | −0.22 (−0.28, −0.16) | −0.07 (−0.14, 0.01) |
PHQ scoreb
| −0.95 (−1.11, −0.80) | −0.81 (−1.02, −0.60) | −0.95 (−1.12, −0.77) | −0.87 (−1.11, −0.63) | −0.68 (−0.87, −0.48) | −0.42 (−0.69, −0.14) | −1.19 (−1.43, −0.95) | −1.21 (−1.52, −0.90) | −1.02 (−1.23, −0.80) | −0.74 (−1.02, −0.47) |
Men | 0.36 (−1.12, 1.83) | −0.76 (−2.42, 0.90) | 1.70 (0.12, 3.29) | 0.21 (−1.73, 2.14) | 0.75 (−1.01, 2.50) | −0.19 (−2.42, 2.05) | −1.86 (−4.10, 0.38) | −2.70 (−5.06, −0.35) | 0.90 (−1.05, 2.84) | −0.06 (−2.16, 2.03) |
Malayd
| 1.94 (0.47, 3.42) | 0.67 (−1.11, 2.45) | 1.35 (−0.24, 2.94) | −0.70 (−2.78, 1.37) | 2.58 (0.83, 4.33) | −0.57 (−2.96, 1.82) | 2.58 (0.83, 4.33) | 1.21 (−1.15, 3.56) | 2.81 (0.87, 4.75) | 2.60 (0.33, 4.88) |
Age (year) | −0.06 (−0.13, 0.02) | −0.06 (−0.15, 0.03) | −0.14 (−0.21, −0.06) | −0.06 (−0.16, 0.05) | −0.14 (−0.23, −0.06) | −0.11 (−0.24, 0.01) | 0.01 (−0.10, 0.12) | −0.12 (−0.24, −0.003) | 0.05 (−0.05, 0.14) | −0.01 (−0.11, 0.10) |
Diabetes duration (year) | - | - | −0.18 (−0.32, −0.04) | 0.04 (−0.13, 0.21) | −0.18 (−0.34, −0.02) | −0.03 (−0.24, 0.17) | - | - | - | - |
Health clinicc
| 0.93 (0.10, 1.76) | −0.95 (−2.32, 0.425) | 1.44 (0.56, 2.32) | −0.46 (−2.02, 1.10) | 1.95 (0.98, 2.93) | −0.78 (−2.56, 1.00) | - | - | 1.41 (0.32, 2.50) | −1.00 (−2.64, 0.64) |
Mosleme
| - | - | - | - | −4.85 (−8.95, −0.75) | 0.48 (−5.52, 6.32) | - | - | - | - |
Religiosityf
| 3.93 (1.86, 6.00) | 3.07 (0.46, 5.67) | −2.37 (−3.60, −1.14) | 3.22 (0.27, 6.18) | 5.29 (2.85, 7.73) | 4.76 (1.15, 8.36) | - | - | - | - |
Not married | - | - | - | - | −2.20 (−4.35, −0.06) | −2.11 (−4.62, 0.40) | - | - | −2.54 (−4.94, −0.15) | −2.82 (−5.39, −0.25) |
Educational statusg
| - | - | 3.25 (1.36, 5.14) | 0.88 (−1.42, 3.17) | 2.86 (0.76, 4.96) | 0.76 (−1.83, 3.34) | - | - | - | - |
Employment statush
| 1.41 (0.03, 2.80) | 2.08 (0.43, 3.72) | 2.93 (1.46, 4.41) | 2.34 (0.46, 4.22) | 2.59 (0.93, 4.24) | 1.31 (−0.83, 3.45) | - | - | - | - |
Exercisei
| 1.61 (0.69, 2.53) | 1.31 (0.32, 2.29) | 1.01 (0.01, 2.00) | 1.08 (−0.04, 2.20) | - | - | 2.61 (1.21, 4.00) | 2.38 (0.93, 3.83) | 2.05 (0.84, 3.26) | 1.99 (0.69, 3.29) |
BMI (kgm−2) | - | - | - | - | 0.16 (0.0001, 0.31) | 0.08 (−0.14, 0.29) | - | - | - | - |
SBP (mmHg) | - | - | - | - | - | - | - | - | 0.07 (0.01, 0.12) | 0.07 (0.01, 0.13) |
BP < 130/80 mmHg | - | - | −1.11 (−2.10, −0.13) | −1.43 (−3.37. 0.51) | - | - | - | - | - | - |
Hypertension (Yes) | - | - | −2.44 (−4.37, −0.50) | −1.73 (−4.05, 0.58) | −2.83 (−4.95, −0.71) | −1.97 (−4.58, 0.63) | 2.96 (0.22, 5.70) | 2.57 (−0.29, 5.42) | - | - |
CBG (mmol/L) | −0.30 (−0.50, −0.10) | −0.22 (−0.44, 0.001) | - | - | - | - | - | - | - | - |
HDL-C (mmol/L) | −3.82 (−6.34, −1.31) | −2.71 (−5.49, 0.06) | −7.17 (−9.86, −4.48) | −4.51 (−7.58, −1.44) | −3.96 (−6.94, −0.99) | −1.42 (−4.91, 2.07) | - | - | - | - |
Total-C (mmol/L) | −0.72 (−1.40, −0.05) | −0.19 (−0.91, 0.54) | - | - | - | - | −1.09 (−2.11, −0.08) | −0.63 (−1.65, 0.40) | −0.90 (−1.80, −0.01) | −1.04 (−1.94, −0.15) |
Dyslipidaemia (Yes) | −2.18 (−3.71, −0.65) | −1.53 (−3.52, 0.46) | −1.98 (−3.61, −0.34) | 0.32 (−1.96, 2.59) | −4.75 (−6.54, −2.96) | −3.14 (−5.78, −0.50) | - | - | −3.76 (−5.75, −1.76) | −2.78 (−4.48, −0.07) |
MicroCx (Yes) | - | - | - | - | −3.28 (−6.66, 0.003) | −0.07 (−2.78, 2.64) | - | - | −4.34 (−7.99, −0.70) | −1.40 (−4.28, 1.48) |
MacroCx (Yes) | −4.31 (−7.38, −1.23) | −4.98 (−8.56, −1.40) | −4.45 (−7.77, −1.13) | −3.50 (−7.36, 0.37) | −4.80 (−8.45, −1.14) | −4.45 (−9.42, 0.52) | - | - | −4.44 (−8.51, −0.38) | −4.38 (−8.30, −0.46) |
OHA (Yes) | 3.02 (0.41, 5.63) | 1.56 (−1.40, 4.51) | 3.42 (0.62, 6.21) | 3.82 (0.43, 7.21) | - | - | 5.37 (1.42, 9.31) | 3.01 (−1.24, 7.26) | - | - |
APA (Yes) | −2.73 (−5.10, −0.37) | 0.13 (−2.56, 2.81) | −3.35 (−5.89, −0.81) | −1.53 (−4.65, 1.59) | −5.28 (−8.08, −2.49) | −0.15 (−3.73, 3.42) | - | - | - | - |