Health-related quality of life and associated factors among patients with diabetes mellitus in Botswana

Peer review under responsibility of Alexandria University Faculty of Medicine.

Available online 9 June 2017

Figures & data

Table 1 Socio-demographic and clinical characteristics of study participants.

Variable	Frequency (%)
Gender
Male	116 (30.5%)
Female	264 (69.5%)
Age
Up to 54	159 (41.8%)
55–64	106 (27.9%)
65 years and more	115 (30.3%)
Level of education
No formal education	70 (18.4%)
Any primary school	181 (47.6%)
Secondary and above	129 (33.9%)
Marital status
Never married	102 (26.8%)
Currently married	157 (41.3%)
Others	121 (31.8%)
Body Mass Index
None obese ( < 30 kg/m^2)	168 (50.0%)
Obese ( ≥ 30 kg/m^2)	168 (50.0%)
Duration of diabetes (years)
< 5	178 (49.2%)
5–10	91 (25.1%)
> 10	93 (25.7%)
Type of diabetes
Type 1	23 (6.1%)
Type 2	357 (93.9%)
Modality of treatment
Diet	4 (1.1%)
Oral hypoglycemic agents (OHA)	224 (58.9%)
Insulin	51 (13.4%)
Both OHA and Insulin	101 (26.6%)
Glycemic control (HbA1C)
Normal ( < 7%)	147 (39.9%)
Poor ( ≥ 7%)	221 (60.1%)
Presence of DM complications
Yes	311 (81.8%)
No	69 (18.2%)
HIV status within past 1 year
Positive	38 (10.0%)
Negative	235 (61.8%)
Don’t know	107 (28.2%)
CD4 (only for HIV positive)^a
Up to 500	12 (36.4%)
Over 500	21 (63.6%)
Average Blood Pressure (mmHg)
<140/90	162 (42.6%)
≥140/90	218 (57.4%)
Presence of musculoskeletal disease
Yes	62 (16.4%)
No	316 (83.6%)

a Missing 5 CD4 values.

Table 2 Overall health related quality of life.

Variable	Frequency (%)	Mean ± SD (Range)
Physical Composite score (PCS-12)		44.39 ± 10.67 (16.2–63.7)
Below average (<50%)	227 (59.7%)
Above average (≥50%)	153 (40.3%)
Mental Composite score (MCS-12)		45.96 ± 10.57 (17.4–63.4)
Below average (<50%)	210 (55.3%)
Above average (≥50%)	170 (44.7%)

Table 3 Association of health related quality of life and sociodemographic and clinical variables.

Variables	PCS < 50%	PCS ≥ 50%	P-value	MCS < 50%	MCS ≥ 50%	P-value
Gender			0.000			0.041
Male	53 (45.7%)	63 (54.3%)		55 (45.4%)	61 (52.6%)
Female	174 (65.9%)	90 (34.1%)		155 (58.7%)	109 (41.3%)
Age			0.000			0.000
Up to 54	66 (41.5%)	93 (58.5%)		75 (47.2%)	84 (52.8%)
55–64	71 (67.0%)	35 (33.0%)		52 (49.1%)	54 (50.9%)
65 years and more	90 (78.3%)	25 (21.7%)		83 (72.2%)	32 (27.8%)
Level of education			0.000			0.001
No formal education	55 (78.6%)	15 (21.4%)		46 (65.7%)	24 (34.3%)
Any primary school	115 (63.5%)	66 (36.5%)		109 (60.2%)	72 (39.8%)
Secondary and above	57 (44.2%)	72 (55.8%)		55 (42.6%)	74 (57.4%)
Marital status			0.000			0.000
Never married	44 (43.1%)	58 (56.9%)		42 (41.2%)	60 (58.8%)
Currently married	100 (63.7%)	57 (36.3%)		86 (54.8%)	71 (45.2%)
Others	83 (68.6%)	38 (31.4%)		82 (67.8%)	39 (32.3%)
Body Mass Index			0.374			0.442
None obese (<30 kg/m^2)	96 (57.1%)	72 (42.9%)		90 (53.6%)	78 (46.4%)
Obese (≥30 kg/m^2)	104 (61.9%)	64 (38.1%)		97 (57.7%)	71 (42.3%)
Duration of diabetes (years)			0.003			0.053
<5	90 (50.6%)	88 (49.4%)		93 (52.2%)	85 (47.8%)
5–10	55 (60.4%	36 (39.6%)		45 (49.5%)	46 (50.5%)
>10	67 (72.0%)	26 (28.0%)		61 (65.6%)	32 (34.4%)
Type of diabetes			0.000	10 (43.5%)	13 (56.5%)	0.241
Type 1	4 (17.4%)	19 (82.6%)
Type 2	223 (62.5%)	134 (37.5%)		200 (56.0%)	157 (44.0%)
Modality of treatment			0.337			0.719
Oral hypoglycemic agents (OHA)	134 (59.8%)	90 (40.2%)		120 (53.6%)	104 (46.4%)
Insulin	26 (51.0%)	25 (49.0%)		28 (54.9%)	23 (45.1%)
Both OHA and Insulin	64 (63.4%)	37 (36.6%)		59 (58.4%)	42 (41.6%)
Glycemic control (HbA1C)			0.808			0.883
Normal (<7%)	89 (60.5%)	58 (39.5%)		80 (54.4%)	67 (45.6%)
Poor (≥7%)	131(59.3%)	90 (40.7%)		122 (55.2%)	99 (44.8%)
Presence of DM complications			0.000			0.000
Yes	205 (65.9%)	106 (34.1%)		192 (61.7%)	119 (38.3%)
No	22 (31.9%)	47 (68.1%)		18 (26.1%)	51 (73.9%)
HIV status within past 1 year			0.181			0.044
Positive	18 (47.4%)	20 (52.6%)		15 (39.5%)	23 (60.5%)
Negative	140 (59.6%)	95 (40.4%)		128 (54.5%)	107 (45.5%)
Don’t know	69 (64.5%)	38 (35.5%		67 (62.6%)	40 (37.4%)
Average Blood Pressure (mmHg)						0.028
<140/90	82 (50.6%)	80 (49.4%)	0.002	79 (50.6%)	83 (49.4%)
≥140/90	145 (66.5%)	73 (33.5%)		131 (66.5%)	87 (33.5%)
Presence of musculoskeletal disease						0.000
Yes	51 (82.3%)	11 (17.7%)	0.000	51 (82.3%)	11 (17.7%)
No	174 (55.1%)	142 (44.9%)		158 (50.0%)	158 (50.0%)

Table 4 Multivariate logistic regression analysis of factors associated with below average PCS-12.

Variables	Adjusted odds ratio (95% CI)	P-value
Gender
Male	Reference
Female	1.95 (1.09, 3.48)	0.023
Age in years
21–54	Reference
55–64	1.67 (0.86, 3.22)	0.127
65 & above	2.43 (1.18, 4.99)	0.015
Level of education
No formal education	2.01 (0.84, 4.84)	0.116
Any primary education	1.10 (0.59, 2.04)	0.747
Secondary and above	Reference
Marital status
Never married	Reference
Currently married	1.37 (0.70, 2.66)	0.346
Others	1.60 (0.80, 3.20)	0.182
BMI
Non-obese (<30 kg/m^2)	Reference
Obese (≥30 kg/m^2)	0.97 (0.57, 1.65)	0.917
Type of DM
Type 1	Reference
Type 2	1.38 (0.24–7.78)	0.715
Documented diabetes complications
None	Reference
One	1.30 (0.59, 2.86)	0.511
Two	2.14 (0.97, 4.72)	0.058
Three or more	3.47 (1.56, 7.71)	0.002
HIV status
Positive	Reference
Negative	0.89 (0.38, 2.06)	0.795
Unknown	0.68 (0.26, 1.74)	0.425
Average BP measurement
Controlled (<140/90 mmHg)	Reference
Uncontrolled (≥140/90 mmHg)	1.14 (0.67, 1.94)	0.617
Type of medication
OHA	Reference
Insulin	1.00 (0.42, 2.37)	0.984
Both	1.18 (0.65, 2.13)	0.586
Muskulo-skeletal disease
Yes	1.79 (0.81, 3.93)	0.147
No	Reference

Table 5 Multivariate logistic regression analysis of factors associated with below average MCS-12.

Variables	Adjusted odds ratio (95% CI)	P-value
Gender
Male	Reference
Female	1.19 (0.68, 2.11)	0.530
Age in years
21–54	Reference
55–64	0.56 (0.29, 1.08)	0.085
65 & above	1.26 (0.61, 2.58)	0.526
Level of education
No formal education	1.68 (0.72, 3.90)	0.223
Any primary education	1.53 (0.82, 2.85)	0.172
Secondary and above	Reference
Marital status
Never married	Reference
Currently married	1.01 (0.52, 1.95)	0.969
Others	1.58 (0.79, 3.13)	0.190
BMI
Non-obese (<30 kg/m^2)	Reference
Obese (≥30 kg/m^2)	1.10 (0.65, 1.85)	0.707
Documented diabetes complications
None	Reference
One	1.98 (0.90, 4.38)	0.089
Two	2.40 (1.09, 5.26)	0.028
Three or more	5.37 (2.41, 11.96)	0.000
HIV status
Positive	Reference
Negative	1.28 (0.55, 2.97)	0.551
Unknown	1.73 (0.67, 4.43)	0.250
Average BP measurement
Controlled (<140/90 mmHg)	Reference
Uncontrolled (≥140/90 mmHg)	0.92 (0.54, 1.56)	0.776
Type of medication
OHA	Reference
Insulin	1.78 (0.77, 4.09)	0.170
Both	1.37 (0.76, 2.47)	0.284
Muskulo-skeletal disease
Yes	2.52(1.15, 5.52)	0.020
No	Reference

Table 6 Health related quality of life association with CD4 among HIV positive patients.

	CD4 up to 500 (%)	CD4 over 500	p-value
PCS-12			1.00
<50% below average	5 (41.7%)	10 (47.6%)
≥50% above average	7 (58.3%)	11 (52.4%)
MCS-12			0.46
<50% below average	3 (25.0%)	9 (42.9%)
≥50% above average	9 (75.0%)	12 (57.1%)

Mean CD4 is 641.58 μmol/l.