Factors Related with Quality of Life of Type 2 Diabetes Mellitus

Patients in Dr. M. Djamil Hospital Padang 2017

Fauziah Elytha*, Vivi Triana1,Yoni Fitri Aprilla1, Roma Yuliana1

Background : Type 2 diabetes mellitus patient had much lower quality of life was 71,2%.
This study aim toidentify the factors related with quality of life of type 2 diabetes mellitus
patients atDr. M.Djamil Hospital Padang 2017.
Materials and methods: This study is quantitative research with cross sectional design. The
population arepatients who are diagnosed with type 2 diabetes mellitus and they were treated
and 57 respondents as samples. The sampling technique is simple random sampling. Data was
collected through interview use questionnaire and analyzed using univariate, bivariate and
multivariate analysis.
Results: The resultsof univariate analysisobtained the percentage of low quality of life was
68,4%, while the result of bivariate analysis obtained that there was significant relationship
between diabetes complications (p=0,02), family support (p=0,01) and depression level
(p=0,001) with quality of life type 2 diabetes mellitus patients. Multivariate end modeling
showed that the dominant factor related with quality of life was depression level (POR=17,8).
Conclusions : Diabetes complications, family support and depression level influenced the
quality of life of type 2 diabetes mellitus patients at Dr. M.Djamil Hospital Padang 2017.
Suggested to the health officer to improve education about four pillars of the management
diabetes mellitus and involve the family in counseling and management of care and treatment
diabetes mellitus.
Acknowledgements : Thanks to the Dr. M. Djamil hospital Padang who has given permission
to do this research.

Keywords: Quality of life, diabetes mellitus, complication, family support, depression

* Correspondence: elytha12@gmail.com,
1
Epidemiology and Biostatistics of Public Health,
Andalas University, Padang, Indonesia, 25148, Indonesia
 Introduction mellitus, while in 2016 as many as 17 203
people and 22.62% of them are people
Diabetes mellitus is one of the
with diabetes mellitus. This shows that the
degenerative diseases concern of major
number of people with diabetes mellitus
globally in healthcare. Every year, there is
have increased from year 2015 to 2016.
an increase in cases with the most are
Diabetes  mellitus  is  known as  the
classified as type 2 diabetes mellitus,
mother of disease, because it is the mother
namely 90% of all people with diabetes.
The data collected from the International or   the   mother   of   other   diseases,   such   as

Diabetes Federation (IDF), shows that the hypertension, stroke, kidney failure,  heart

number of people with diabetes in 2014 and blood vessel disease, and blindness. In

amounted to 387 and increase to 415 general, diabetes mellitus is one
million by 2015. It is estimated to rise to contributor to health care costs, that
642 million in 2040. diabetes not can be cured, it can only be
The increase in the number of controlled or prevented (slowed), are prone
patients with diabetes mellitus also occurs to complications and accompanying
in Indonesia. In 2013 there were 8.5 lifetime. The emergence of these problems
million cases, while in 2014 reached 9 can interfere with quality of life and have
million and increased by 10 million in an impact on the level of quality of life for
2015. This puts Indonesia at seventh in the people with diabetes.
world and is predicted to increase to 16.2 Quality of life is an individual's
million by 2040. perception of their position in life in
Prevalence   diabetes   mellitus   in society in the context of culture and value
West   Sumatera   in   2007   by   0.7%  and systems that exist related goals,

increased  to   1.3%  in  2013.  this  indicates expectations, standards and concerns.

that   the  prevalence   rate   approaching Quality   of   life   is a very broad concept

national  average  in 2013 of 1.5%. Based influenced by the physical, psychological,

on the data register Specialty Clinic of level of independence, as well as the

Internal Medicine, showed that the number individual's relationship with the

of outpatients in 2015 as many as 18 069 environment.

people and 20.41% of them are diabetes

 Diabetes mellitus type 2 could
increase the risk for disability, physically,
psychologically and socially as a result of
various complaints experienced by people
with diabetes. Physical health conditions
such as complications diabetes and
management should be done constantly can
cause physiological changes in patients
with such anxious, desperate and often
complain of health problems. Other
changes patients will experience
stigmatization and isolation in social
groups, limiting him self to go out and
socialize with people. These expenses
coupled with a decrease in labor
productivity associated with the disease
experienced throughout life (long life
disease). Some people may live longer, but
to carry the burden of chronic disease or
disability so that the measurement of the
quality of life is a major concern in health
care related to diabetes management.
The patient experienced changes in
restrictions   on   diet,   exercise,   and  blood
sugar   control   throughout   life   should   be
lived.   If   these   restrictions  can   not   be
controlled   and   managed   properly,   it   can
cause   complications   for  both   acute   and
chronic. Research conducted by
Chusmeywati (2016) gained as much as
71.2% of patients with diabetes mellitus
have low a quality of life. Therefore, the
patient needs not only in the treatment of
physical symptoms, but also requires
support for the need of psychological,
social and spiritual order management and
care of diabetes can be done properly so
that quality of life is well maintained.
The complexity of the problems
that occur in people with diabetes can to
lead changes in quality of life. Not only
strike in adulthood, but also attacked a
young age (productive) to improve
disability, premature death and health
costs. This of course would threaten the
demographic bonus West Sumatera
Indonesia in particular is highly dependent
on the quality of human resources at this
time. Lower quality of life and problems
psychological can aggravate metabolic
disorders, either directly through hormonal
stress reaction, or indirectly through the
complications.
Based   on   the   problems   described
above,   the   researchers   interested   in
studying factors related with quality of life
of type 2 diabetes mellitus patients at Dr.
M.Djamil hospital Padang 2017.
Method
This research uses a cross-sectional
design. The population in this study were
all patients who are diagnosed with type 2
diabetes mellitus based on the examination
in Internal Medicine Specialty Clinic Dr.
M.Djamil Hospital Padang who were
ambulatory, with a sample of 57 peoples.
The technique sampling using simple
random sampling. Processing data using
univariate analysis, bivariate analysis
using chi-square and multivariate logistic
regression. The data is processed by
computer using SPSS version 23.0.
Results
Table 1 shows that the percentage
of patients with diabetes mellitus type 2
who have the quality of life was lower by
68.4%. Patients with type 2 diabetes are
more at the level of higher education
(80.7%), did not work (70.2%), having a
partner/married (84.2%), bears the DM
complications (73.7%), lower family
support (73.7%), and lower levels of
depression (61.4%).
Table 2 shows that there is a
relationship between diabetes
complications (p=0.02), family support
(p=0.01) and the level of depression
(p=0.001) with the quality of life patients
with diabetes mellitus type 2, and there is
no relationship between the level of
education (p= 0.47), occupational status
(p=0.93), and marital status (p=1) with the
quality of life of patients with diabetes
mellitus type 2.
Table 3 shows that at the end of the
multivariate modeling showed that the rate
of depression is a factor the most dominant
influence on quality of life of patients with
diabetes mellitus type 2 with a value of
POR 17.8 that patients with high
depression levels likely to have a lower
quality of life of 17.8 times compared
diabetic patients with lower levels of
depression.
Discussion
The results showed that there was
no relationship between level of education
with quality of life of patients diabetes
mellitus type 2. In line with research
conducted by Chusmeywati (2016) and
Adikusuma (2013), showed that no
significant relationship between level of
education with quality of life. Not proven
research hypothesis in this case is because
people with diabetes who have higher
education or education lower are both
currently on a low quality of life. In this
case it can be said that the education level
of patients diabetes mellitus can not be
used as a benchmark to distinguish the
level of quality of life. Someone who is
highly educated tend not guaranteed to be
directly said to have a good quality of life.
The results showed that there was
no relationship between occupational
status with quality of life of patients
diabetes mellitus type 2. In line with
research conducted by Retnowati (2014)
and Sari (2011) which stated that there is
no relationship between occupational
status with quality of life of patients
diabetes mellitus type 2. In contrast with
the results obtained by Isa and Baiyewu
(2006) which states that there is a
relationship between occupational status
with quality of life.. Not proven research
hypothesis in this case is because most of
the patients who visit for treatment to Dr.
M.Djamil hospital Padang using health
insurance, so that with treatment program
can to help patients type 2 diabetes
mellitus in the treatment process. Also, the
patient who work and patient who do not
work have to work for dependents a family
a like are at a low quality of life.
In addition to financial factors,
busyness and the time spent by the person
can also affect the quality of life of patients
with diabetes mellitus. In patients who do
not have occupational have plenty of time
to do the treatment and care of diabetes so
it has a great opportunity to control blood
sugar regularly to health services. In
addition, patients who do not have a
occupational nor had other activities, so as
to affect the handling of stress to disease.
The results showed that there was
no relationship between marital status with
quality of life of patients diabetes mellitus
type 2. Similar results were obtained from
studies Wahyuni (2014) using descriptive
quantitative method,that patients who do
not get married to get married and have a
quality of life lower that is not much
different. These results are not in line with
research conducted by Ningtyas (2013)
which shows that there is association a
significant between marital status and
quality of life of patients with diabetes
mellitus type 2. There is proven research
hypothesis in this case because many
patients still have a pair (84, 2%) and a lot
of them (68.8%) are in lower quality of
life, while those who do not have a regular
partner to get family support of children
and their parents.
The results showed that there was
relationship between DM complications
with quality of life of patients diabetes
mellitus type 2, with a lower quality of life
is more common in patients who have
complications of diabetes. In line with
Retnowati (2014) and Narkaukaite (2013)
which states that there are significant
differences in quality of life scores in
patients with diabetes who have
complications with uncomplicated. This is
because respondents who have
complications of diabetes showed a high
awareness of the disease, making it more
sensitive and active in every treatment and
care of diabetes, such as being submissive type 2. In line with research conducted by
to control blood sugar and do the advice of Safitri (2013) in Surakarta Islamic
health professionals. In this case strongly Hospital, suggests that there is a
influenced by psychological coping relationship between the level of
mechanism respondents themselves and to depression and quality of life. Patients with
adapt to change or disease burden. This is diabetes often experience higher levels of
in line with Donald et al (2013) that the depression, fear not to be satisfied, the
duration of diabetes mellitus accompanied future is not light on their personal lives
with compliance and blood sugar proper and adjustment poorer psychosocial to
control, although it has been exposed to illness. Depression disorders can be
complications would make the patient have described as the perceived burden in
a quality of good life and well-maintained. patients with diabetes mellitus who makes
Based on this study, show a positive any activity in life is limited. They will
attitude towards the management of experience social isolation in society, have
patients with diabetes mellitus diabetes and low mobility which will affect negatively
life. on the patient's psychological. Based on
The results showed that there was studies, these that depression is the
relationship   between   family   support  with perceived burden of diabetes to be able to
quality of life of patients diabetes mellitus form a lower quality of life to life.
type 2. In line with research conducted by Based on multivariate analysis
Tamara   (2014)   and   Retnowati   (2014). known that the rate of depression is the

High family support is more protected in factor most dominant of the quality of life

maintaining quality of life, while patients of patients with diabetes mellitus type 2 in

with low family support is more prone to Dr. M.Djamil Hospital Padang POR score

have lower quality of life. In this case, of 17.8 shows that diabetes patients type 2

show that family support will increase mellitus with high depression levels likely

motivation and help patients manage the to have a quality of lower life of 17.8 times

disease based on the four pillars of diabetes compared to diabetics with lower

disease management. depression levels.

The results showed that there was Depression   is   a   disorder   that   is

relationship between depression level with often found in patients with DM, that DM

quality of life of patients diabetes mellitus is a chronic disease that  is  incurable  and

lifelong   accompany   that   affect   quality   of M.Djamil hospital Padang who
life.   Someone   who   is  depressed   will participated and helped in this research.
experience interference and restrictions in
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TABLE
Table 1 Frequency Distribution of Respondents Based on Dependent and Independent
Variables

Variables f %
Quality of Life
Low 39 68,4
High 18 31,5
Education Level
Low 11 19,3
High 46 80,7
Occupational Status
No work 40 70,2
Work 17 29,8
Marital Status
No married 9 15,8
Married 48 84,2
DM Complication
Yes 42 73,7
No 15 26.3
Family Support
Low 42 73,7
High 15 26.3
Depression Level
High 22 38,6
Low 35 61,4

Table 2 The Relationship Dependent and Independent Variables

Quality of Life
Independent Total POR
Low High p-value
Variables (95% CI)
f % f % f %
Education Level
2,4
Low 9 81,8 2 18,2 11 100 0,473
(0,4-12,4)
High 30 65,2 16 34,8 46 100
Occupational Status
1,2
No work 28 70,0 12 30,0 40 100 0,935
(0,3-4,23)
Work 11 64,7 6 35,3 17 100
Marital Status
0,9
No married 6 66,7 3 33,3 9 100 1
(0,2-4,1)
Married 33 68,8 15 31,3 48 100
DM Complication
0,1
Yes 25 59,5 17 40,5 42 100 0,022
(0,01-0,87)
No 14 93,3 1 6,7 15 100
Family Support
5,5
Low 33 78,6 9 21,4 42 100 0,010
(1,5-19,5)
High 6 40,0 9 60,0 15 100
Depression Level
19,8
High 21 95,5 1 4,5 22 100 0,001
(2,3-164)
Low 18 51,4 17 48,6 35 100
Table 3 The Final Model of Multivariate Analysis of Factors Related with Quality of
Life of Type 2 Diabetes Mellitus Patients in Dr. M.Djamil Hospital Padang 2017

95% CI
Variables POR p-value
Lower Upper
DM Complication 0,1 0,01 1,26 0,078
Family Support 5,7 1,14 28,42 0,034
Depression Level 17,8 1,94 164,92 0,011