Comparison of quality of life among patients with and without diabetic retinopathy at Muhimbili National Hospital

Abstract

ABSTRACT Background: Diabetes mellitus (DM) is a chronic metabolic condition of public health importance. About 463 million individuals worldwide have DM. Diabetic retinopathy (DR) is a potentially blinding micro vascular consequence of DM causing 2.6 million visual impairment and 2.52 million blindness cases among the working age group. The presence of DM comorbidities and complications tend to have an impact on the quality of life of an affected individual. Visual impairment and blindness caused by DR may affect the individual socially, emotionally and economically. This will consequently disturb the overall life of individual patients, family and the community at large. There is scarcity of data on the quality of life among patients with diabetic retinopathy hence the need to conduct this study. Aim: To assess quality of life and associated factors in patients with and without diabetic retinopathy at Muhimbili National Hospital. Methodology: A cross-sectional analytical comparison study was conducted among adult patients with DM aged 18 years and above. A total of 160 patients were recruited, 86 with DR and 74 were those without DR. Participants were selected by stratified random sampling, stratum 1 with DR and stratum 2 without DR, then systematic random sampling was done in each stratum. Comprehensive ocular examination and OCT were done after a short interview. The National eye institute visual functioning questionnaire 25 (NEI-VFQ 25) tool was used for collection of data on quality of life. Data analysis was done by SPSS version 23. Chi square test was used to show the relationship between quality of life (QoL) and associated factors in which P value of <0.05 was considered statistically significant, and t-test was used to compare the means of two groups. Univariate and multivariate linear regression analysis was used to determine the strength of association between quality of life and the associated factors. Results: Ninety-four (58.8%) patients were females and majority (60%) of participants were aged between 44-56 years with mean age of 55.2 (+8.9) years. One hundred thirteen (70.6%) had attained college or university education and Dar es Salaam accounted for 114 (71.3%) of the majority. Cataract was the most frequent ocular comorbidity occurring in 79 (65.2%) . vi The overall QoL was lower in participants with DR (45.8±11.3) compared to those without DR (71.8±10.2). Participants with DR had poor vision related and general health scores compared to those without DR. After adjusting for confounders employment (b coefficient=14.3, p=0.0012) associated with higher QoL, longer duration of DM (b= -25.2, p=0.014) and DR (b= -17.2, p=0.001), higher level of HBA1c (b= -10.4, p=0.001), PDR (b= -27.1, p=0.001), presence of multiple ocular comorbidities (b= -12.5, p= 0.001), blindness category (b= -19.4, p= 0.001) and presence of DR complications (b= -34.3, p=0.001) contributed to a marked QoL score decline in multivariate analysis. Conclusion: The QoL was lower in participants with DR compared to those without DR. Factors like presence of multiple ocular co-morbidities, severe visual impairment, PDR, high HBA1c levels, longer DM and DR duration, presence of DR complications were significantly associated with a low QoL score. Recommendations: People with DM should have regular eye examinations to detect DR in its early stages, this can prevent vision loss and improve overall QoL, Maintaining optimal blood sugar levels is important to prevent or delay the onset of DR this can be achieved by including eye services and creating a comprehensive multi-modal approach where patient-centred therapy and lifelong follow-up is required taking into account their wellbeing. Key words: Diabetes mellitus, diabetic retinopathy, quality of life.