INTRODUCTION

Diabetes mellitus (DM) is a chronic disease of global scope that continues to increase alarmingly, affecting millions of people worldwide, due to changes in lifestyles, the increase in obesity, together with population aging and urbanization¹. Alqurashi et al.²reported in their study that 30% of the population had diabetes, with a notable difference in prevalence between men and women, with a greater impact on men (34.1%).

In developed countries, DM affects older people, whereas in developing countries, the incidence increases among middle-aged people. This demographic difference may persist in the future¹, representing a public health problem for all countries, due to the high costs of treating its long-term complications^3,4.

In Latin America, the situation is also worrying, with a significant increase in the prevalence of type 2 diabetes and shocking figures of associated mortality. Between 2010 and 2020, 601,521 deaths related to DM were registered in Brazil and strongly associated in places with worse social indicators⁴; a recent study in Brazil indicates an overall prevalence of 24%⁵. In Mexico, the prevalence was 18.3%, and 22.1% of the sample presented prediabetes⁶; likewise, Chile reports a prevalence of 12.3%, reducing this value to 10.2% at the self-report⁷.

In the Peruvian context, the General Law for the Protection of People with Diabetes drives the implementation of the National Program for the Prevention and Care of Patients with Diabetes, in order to improve health and their quality of life⁸. In 2015, the prevalence reported by PERUDIAB was 7.0% nationally and 8.4% for metropolitan Lima, with a cumulative prevalence of 19.5 cases per thousand people per year⁹. Data from the National Institute of Statistics and Information-INEI-202210¹⁰confirms an increase in the prevalence of DM^9,11,12, reaching 5.1% of the population over 15 years of age, with a greater impact on women, where geographically the Peruvian coast has the highest prevalence. Two new cases are registered for every 100 people per year¹².

This fact affects the quality of life of people¹³, due to long-term complications, especially microvascular complications, such as diabetic retinopathy, chronic renal failure, and diabetic foot, identified as serious threats to physical and mental health, generating not only a high economic cost but also suffering for families and society as a whole¹⁴.

Studies on quality of life in patients with DM show diverse results. In Mexico^15,16, quality of life was rated as good, although there were concerns about sexual functioning^15,17. In Paraguay, quality of life was rated as poor¹⁸; another study indicates that patients with type 2 diabetes and renal failure maintained an average quality of life, with a significant impact on the physical dimension¹⁹and relatively good levels in the dimensions of physical health and psychological health²⁰.

These findings underscore the complexity of QoL in patients with type 2 diabetes, with the need for an individualized and multifaceted approach to clinical care and management. However, there is a paucity of data in certain regions and contexts, which highlights the relevance of this study, whose objective was to evaluate the level of quality of life of patients with type 2 diabetes mellitus in a public hospital in the province of Barranca, Lima Region.

METHODS

RESULTS

With respect to the characterization of the sample, Table 1 shows that 70% were aged between 40-64 years; 69% identified themselves as women; 38% were cohabiting and 34% were married; 24% had technical studies and 20% were illiterate.

Figure 1 shows the results of the quality of life, with 86% (124 patients) being rated as medium level QoL.

Figure 1: Quality of life of patients with type 2 diabetes, MINSA Hospital, Barranca province, April-June 2021. 

In Figure 2, in the social dimension 74% (107 patients) achieved a high level VC, in the psychological and environmental dimension, the VC was medium level (107 and 104 patients respectively), in the physical dimension, 64% (92 patients) achieved a low level VC.

Figure 2: Quality of life of patients with type 2 diabetes by dimensions, MINSA Hospital, Barranca province, April-June 2021. 

In Figure 3, medium-level QOL predominated in both sexes (90% and 86% in men and women, respectively), with women perceiving low-level QOL in a higher proportion than men.

Figure 3: Quality of life of patients with type 2 diabetes according to sex, MINSA Hospital, Barranca province, April-June 2021. 

In Figure 4, patients in the 65-80 years age range presented a low level of QOL (29%), while 94% of the 40-65 years age range perceived a medium level of QOL.

Figure 4: Quality of life of patients with type 2 diabetes mellitus according to age group, Laura Esther Rodríguez Dulanto Hospital, Barranca, April-June 2021. 

DISCUSSION

QoL, as a subjective variable, provides a comprehensive perspective of the impact of diseases on people's lives. In the case of type 2 DM, a significant influence on biopsychosocial aspects is observed²⁵. This statement is based on the difficulty patients face in maintaining a healthy diet, the lack of frequent physical activity, and the prevalence of overweight in this group²⁵.

The World Health Organization (WHO) supports this concern, given the alarming increase of patients diagnosed with type 2 DM worldwide. In 2014 there were 422 million cases, and by 2019, type 2 DM was positioned as the ninth leading cause of death, with 1.5 million deaths attributed to this disease³⁰. Figures that underline the urgency that represents in public health for type 2 DM, not only in terms of mortality, but also in terms of its negative impact on the health and QoL of those affected²⁵. As shown by several studies^15-20.

Certainly, QoL is a term with multiple definitions, since each construction is influenced by the social and cultural environment; a context that conditions the behavior of people, where objective and subjective factors are combined and that will have an impact on one's own life. When old age arrives, changes in lifestyle inevitably occur, which in turn alter the QoL, in addition to the presence of a disease and the complications it brings with it²¹.

The findings of the study highlight the need for effective interventions at a global level for people with diabetes, addressing both the medical and socioeconomic aspects associated with this disease³¹. The study highlights the public health context experienced in the country during the COVID-19 pandemic, when attention to non-communicable diseases in health services was reduced or suspended as a control measure. This may have aggravated the situation of patients.

When analyzing QoL with the variables sex and age group, the results reveal that both men and women, as well as in the different age groups, QoL was of medium level (Figure 3, 4), although this could vary when considering the time of the disease and the capacity for self-care. This perspective shows the importance of promoting self-care as a key strategy to improve health and prevent chronic diseases, which could raise the level of QoL, both at the individual and community level^17,20.

In terms of QoL dimensions, there is greater affectation in the physical dimension, followed by the psychological, environmental, and social dimensions (Figure 2). Reflecting the complexity of the experience of living with type 2 DM, which not only involves physical, but also emotional, social, and environmental challenges. There is an urgent need for a multidisciplinary and intersectoral approach in the therapeutic approach, which goes beyond glycemic control and integrates psychosocial support, promotion of healthy lifestyles, and improved access to medical care³².

The study highlights the social relationships, the environment, and the health care received during the COVID-19 pandemic. Varillas¹⁹reported patient dissatisfaction in sexual life, as a consequence, of the antidiabetic treatment; despite the fact that most of them presented a high level QoL; living with a partner, seems to positively influence QoL, although this does not translate into sexual satisfaction³³.

In the environment-environment, most patients reported living in satisfactory conditions and having economic resources to cover their basic needs, as did the findings of Guzmán et al.¹⁷. However, the lack of opportunities for leisure activities reveals a limitation in QoL. The analysis by dimensions of QoL offers valuable information to health personnel, where it is important to include the family, and thus involve them in the process of patient care and treatment³⁴. Law Nº28553⁸, designed to protect people with diabetes and improve their QoL, still seems to be deficient in the Peruvian health system.

The analysis of QoL by age group revealed (Figure 4) a greater deterioration in people over 65 years of age, possibly attributed to the wear and tear and complications associated with diabetes over the years, as well as to the presence of multiple chronic degenerative diseases¹⁵.

The multidisciplinary and intersectoral approach to DM should prioritize the first level of care, where primary care professionals play a fundamental role, strengthening prevention and health promotion interventions in families and at-risk groups. Comprehensive and preventive care contributes significantly to the QoL and well-being of patients, thus helping to control the disease, delay complications and reduce the impact on public health³⁵.

To achieve this purpose, it is necessary to expand multiprofessional teams at the primary care level in order to comply with primary care policies. There is a high deficit of personnel and infrastructure at this level of care, given the demographic and epidemiological changes that have been occurring in middle and low-income countries, such as Peru. It is necessary, the confluence of policies and greater investment in health at this level, in order to control and reduce non-communicable diseases, which are the cause of premature deaths in the population.

The scarcity of updated information highlights the importance of continuing to explore QoL in patients with diabetes and to apply more effective interventions considering its associated factors, such as home accompaniment, glucose monitoring, and self-care practices, including healthy diet, use of hemoglucotest, care and prevention of diabetic foot, participation in recreational activities, in addition to strict medical check-ups every 90 days. Need for an increase in the health budget at the central level.

Among the limitations recognized in the study is memory and attention bias, particularly due to the nature of the telephone interviews. The lack of face-to-face interaction and the limited time of the calls may have influenced the quality of responses and the accuracy of the information collected.

In conclusion, the importance of identifying areas of intervention and the need for public health policies and programs that respond to the specific needs of this vulnerable population is highlighted. Despite the limitations, the study findings may guide future research and clinical practice in the field of type 2 DM.