DOI QR코드

DOI QR Code

Sex differences in health-related quality of life among older Korean adults with type 2 diabetes mellitus: a cross-sectional study

  • Hyeonji Jeong (Department of Food and Nutrition, Yeungnam University) ;
  • Kyong Park (Department of Food and Nutrition, Yeungnam University)
  • Received : 2024.05.13
  • Accepted : 2024.06.25
  • Published : 2024.08.31

Abstract

Objectives: This cross-sectional study examined sex differences in Health-Related Quality of Life (HRQoL) among seniors with Type 2 Diabetes Mellitus (T2DM). Methods: Data from the Korea National Health and Nutrition Examination Survey (2008-2020) were analyzed. The EuroQol-5 Dimensions (EQ-5D), a measure of HRQoL, was used. It comprises five dimensions: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression, each with three levels. Results: Analysis of 3,826 older adults with T2DM showed a significant increasing trend in the EQ-5D Index from the 4th survey phase onwards (P for trend < 0.001 for both men and women). Men consistently reported higher EQ-5D levels than women across all survey years. Women's EQ-5D levels remained lower than men's, maintaining a decade-old disparity (P < 0.05). Men scored significantly higher (P < 0.05) in most EQ-5D domains, except for self-care and anxiety/depression, resulting in a higher total EQ-5D Index (P = 0.001). Increased comorbidities were strongly associated with lower EQ-5D levels in both sexes. Additionally, there was a negative correlation between the EQ-5D Index and refined grain intake for both sexes (P for trend < 0.001), with high-EQ-5D groups consuming fewer refined grains. Women in the high-EQ-5D group consumed more nuts, vegetables, and meat compared to men (P for trend < 0.05). Conclusions: Our study highlights the sex disparities in HRQoL among older adults with T2DM. The findings suggest the need for tailored treatment guidelines aimed at improving the HRQoL of elderly T2DM patients, with a focus on their sex-specific characteristics. Implementing these tailored guidelines could enhance the HRQoL of older women with T2DM and promote more equitable healthcare outcomes. This underscores the importance of considering sex differences to comprehensively improve the well-being of this population.

Keywords

Acknowledgement

The authors are thankful to the investigators and participants of KNHANES.

References

  1. Li Y, Schoufour J, Wang DD, Dhana K, Pan A, Liu X, et al. Healthy lifestyle and life expectancy free of cancer, cardiovascular disease, and type 2 diabetes: prospective cohort study. BMJ 2020; 368: l6669.
  2. Lowsky DJ, Olshansky SJ, Bhattacharya J, Goldman DP. Heterogeneity in healthy aging. J Gerontol A Biol Sci Med Sci 2014; 69(6): 640-649.
  3. Yoon H, Kim Y, Lim YO, Lee HJ, Choi K. Factors affecting quality of life of older adults with cancer in Korea. Geriatr Gerontol Int 2015; 15(8): 983-990.
  4. Statistics Korea. 2021 life table Daejeon, Korea [Internet]. Statistics Korea; 2022 [cited 2023 Nov 6]. Available from: https://kostat.go.kr/board.es?mid=a10301060900&bid=208&act=view&list_no=422107
  5. Kaplan RM, Hays RD. Health-related quality of life measurement in public health. Annu Rev Public Health 2022; 43: 355-373.
  6. Watkins K, Connell CM. Measurement of health-related QOL in diabetes mellitus. Pharmacoeconomics 2004; 22(17): 1109-1126.
  7. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al.; IDF Diabetes Atlas Committee. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Diabetes Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157: 107843.
  8. Won KC. Diabetes Fact Sheet In Korea 2022 [Internet]. Korean Diabetes Association; 2023 [cited 2023 Nov 6]. Available from: https://www.diabetes.or.kr/bbs/?code=fact_sheet&-mode=view&number=2500&page=1&code=fact_sheet
  9. ElSayed NA, Aleppo G, Aroda VR, Bannuru RR, Brown FM, Bruemmer D, et al.; American Diabetes Association. Introduction and methodology: standards of care in diabetes-2023. Diabetes Care 2023; 46(Suppl 1): S1-S4.
  10. Murman DL. The impact of age on cognition. Semin Hear 2015; 36(3): 111-121.
  11. Grandy S, Fox KM; SHIELD Study Group. Change in health status (EQ-5D) over 5 years among individuals with and without type 2 diabetes mellitus in the SHIELD longitudinal study. Health Qual Life Outcomes 2012; 10: 99.
  12. Jing X, Chen J, Dong Y, Han D, Zhao H, Wang X, et al. Related factors of quality of life of type 2 diabetes patients: a systematic review and meta-analysis. Health Qual Life Outcomes 2018; 16(1): 189.
  13. Campos AC, Ferreira e Ferreira E, Vargas AM, Albala C. Aging, Gender and Quality of Life (AGEQOL) study: factors associated with good quality of life in older Brazilian community-dwelling adults. Health Qual Life Outcomes 2014; 12: 166.
  14. Janssen MF, Szende A, Cabases J, Ramos-Goni JM, Vilagut G, Konig HH. Population norms for the EQ-5D-3L: a cross-country analysis of population surveys for 20 countries. Eur J Health Econ 2019; 20(2): 205-216.
  15. Unden AL, Elofsson S, Andreasson A, Hillered E, Eriksson I, Brismar K. Gender differences in self-rated health, quality of life, quality of care, and metabolic control in patients with diabetes. Gend Med 2008; 5(2): 162-180.
  16. Huang LC, Lin CL, Chang YT, Chen RY, Bai CH. Gender impact on diabetes distress focus at medical communication concerns, life and interpersonal stress. Int J Environ Res Public Health 2022; 19(23): 15678.
  17. Jang E. Gender difference in quality of life among workers with diabetes mellitus. J Digit Converg 2020; 18(8): 281-291.
  18. Faria HT, Veras VS, Xavier AT, Teixeira CR, Zanetti ML, Santos MA. Qualidade de vida de pacientes com diabetes mellitus antes e apos participacao em programa educativo [Quality of life in patients with diabetes mellitus before and after their participation in an educational program]. Rev Esc Enferm USP 2013; 47(2): 348-354; Portuguese.
  19. Jorgetto JV, Franco LJ. The impact of diabetes mellitus on quality of life - differences between genders. J Diabetes Metab Disord 2018; 17(1): 11-17.
  20. Kautzky-Willer A, Harreiter J, Pacini G. Sex and gender differences in risk, pathophysiology and complications of type 2 diabetes mellitus. Endocr Rev 2016; 37(3): 278-316.
  21. Takahashi F, Hashimoto Y, Kaji A, Sakai R, Kawate Y, Kondo Y, et al. Relationship between diabetes diet-related quality of life and dietary fiber intake among people with type 2 diabetes: a cross-sectional study. Endocr J 2024; 71(6): 583-592.
  22. Sugandh F, Chandio M, Raveena F, Kumar L, Karishma F, Khuwaja S, et al. Advances in the management of diabetes mellitus: a focus on personalized medicine. Cureus 2023; 15(8): e43697.
  23. Korea Disease Control and Prevention Agency. The Eighth Korea National Health and Nutrition Examination Survey (KNHANES VIII-2) [Internet]. Korea Disease Control and Prevention Agency; 2020 [cited 2021 Nov 7]. Available from: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_02_05.do
  24. Oh K, Kim Y, Kweon S, Kim S, Yun S, Park S, et al. Korea National Health and Nutrition Examination Survey, 20th anniversary: accomplishments and future directions. Epidemiol Health 2021; 43: e2021025.
  25. Ainsworth BE, Haskell WL, Leon AS, Jacobs DR Jr, Montoye HJ, Sallis JF, et al. Compendium of physical activities: classification of energy costs of human physical activities. Med Sci Sports Exerc 1993; 25(1): 71-80.
  26. Rabin R, de Charro F. EQ-5D: a measure of health status from the EuroQol Group. Ann Med 2001; 33(5): 337-343.
  27. Lee YK, Nam HS, Chuang LH, Kim KY, Yang HK, Kwon IS, et al. South Korean time trade-off values for EQ-5D health states: modeling with observed values for 101 health states. Value Health 2009; 12(8): 1187-1193.
  28. Korea Disease Control and Prevention Agency. Korea National Health and Nutrition Examination Survey 8th 1st year (2019-2021) Nutritional Survey Guidelines [Internet]. Korea Disease Control and Prevention Agency; 2023 [cited 2024 Jun 6]. Available from: https://knhanes.kdca.go.kr/knhanes/sub03/sub03_06_02.do
  29. Teli M, Thato R, Rias YA. Predicting factors of health-related quality of life among adults with type 2 diabetes: a systematic review. SAGE Open Nurs 2023; 9: 23779608231185921. Erratum in: SAGE Open Nurs 2023; 9: 23779608231202935.
  30. Tusa BS, Weldesenbet AB, Gemada AT, Merga BT, Regassa LD. Heath related quality of life and associated factors among diabetes patients in sub-Saharan countries: a systemic review and meta-analysis. Health Qual Life Outcomes 2021; 19(1): 31.
  31. Carmel S. Health and well-being in late life: gender differences worldwide. Front Med (Lausanne) 2019; 6: 218.
  32. Knurowski T, Lazic D, van Dijk JP, Geckova AM, Tobiasz-Adamczyk B, van den Heuvel WJ. Survey of health status and quality of life of the elderly in Poland and Croatia. Croat Med J 2004; 45(6): 750-756.
  33. Tsai SY, Chi LY, Lee LS, Chou P. Health-related quality of life among urban, rural, and island community elderly in Taiwan. J Formos Med Assoc 2004; 103(3): 196-204.
  34. Kwon M, Kim SA, So WY. Factors influencing the quality of life of Korean elderly women by economic status. Int J Environ Res Public Health 2020; 17(3): 888.
  35. Statistics Korea. National quality of life 2021 report [Internet]. Statistics Korea; 2022 [cited 2023 Nov 6]. Available from: https://kostat.go.kr/board.es?mid=a10301150000&bid=246&tag=&act=view&list_no=417249&ref_bid=
  36. Matud MP, Bethencourt JM, Ibanez I. Relevance of gender roles in life satisfaction in adult people. Personal Individl Differ 2014; 70: 206-211.
  37. Abad-Diez JM, Calderon-Larranaga A, Poncel-Falco A, Poblador-Plou B, Calderon-Meza JM, Sicras-Mainar A, et al. Age and gender differences in the prevalence and patterns of multimorbidity in the older population. BMC Geriatr 2014; 14: 75.
  38. Hajian-Tilaki K, Heidari B, Hajian-Tilaki A. Are gender differences in health-related quality of life attributable to sociodemographic characteristics and chronic disease conditions in elderly people? Int J Prev Med 2017; 8: 95.
  39. Adriaanse MC, Drewes HW, van der Heide I, Struijs JN, Baan CA. The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res 2016; 25(1): 175-182.
  40. Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS. Descriptions of barriers to self-care by persons with comorbid chronic diseases. Ann Fam Med 2003; 1(1): 15-21.
  41. Piette JD, Kerr EA. The impact of comorbid chronic conditions on diabetes care. Diabetes Care 2006; 29(3): 725-731.
  42. Sarsangi P, Sasanfar B, Dehghani F, Nadjarzadeh A, Esmaillzadeh A, Salehi-Abargouei A, et al. Substituting whole grains for refined grains and risk of developing psychological disorders in Iranian adults: YaHS and TAMYZ studies. Curr Psychol 2023; 42(34): 30250-30261.
  43. Ludwig DS. The glycemic index: physiological mechanisms relating to obesity, diabetes, and cardiovascular disease. JAMA 2002; 287(18): 2414-2423.
  44. Musa-Veloso K, Poon T, Harkness LS, O'Shea M, Chu Y. The effects of whole-grain compared with refined wheat, rice, and rye on the postprandial blood glucose response: a systematic review and meta-analysis of randomized controlled trials. Am J Clin Nutr 2018; 108(4): 759-774.
  45. Yen TS, Htet MK, Lukito W, Bardosono S, Setiabudy R, Basuki ES, et al. Increased vegetable intake improves glycaemic control in adults with type 2 diabetes mellitus: a clustered randomised clinical trial among Indonesian white-collar workers. J Nutr Sci 2022; 11: e49.
  46. Jenkins DJ, Hu FB, Tapsell LC, Josse AR, Kendall CW. Possible benefit of nuts in type 2 diabetes. J Nutr 2008; 138(9): 1752S-1756S.
  47. Rajput SA, Ashraff S, Siddiqui M. Diet and management of type ii diabetes mellitus in the United Kingdom: a narrative review. Diabetology 2022; 3(1): 72-78.
  48. Dipnall JF, Pasco JA, Meyer D, Berk M, Williams LJ, Dodd S, et al. The association between dietary patterns, diabetes and depression. J Affect Disord 2015; 174: 215-224.