Diabetess is basically characterized by raised blood glucose degrees. [ 18 ] If non adequately managed and controlled, assorted complications can develop in diabetic patients. These complications include micro- and macro- vascular events which can do end- organ failure and may be a beginning of long- term physical and mental enervation for the patients. Most normally happening complications are Diabetic retinopathy, Nephropathy and Neuropathy. Diabetes Mellitus occurs as two chief types: type I DM and type II DM. [ 18 ]
Type I DM refers to development of an autoimmune status directed against the beta cells of the pancreas which are chiefly responsible for the production of insulin. Consequently, this leads to inability of the organic structure to bring forth equal sums of insulin. Type I DM has an onset at a younger age, occurs in persons with a comparatively low to normal BMI and is managed by day-to-day injections of insulin. Furthermore, the incidence of development of micro and macro- vascular complications is higher and earlier in patients with Type I DM. [ 18 ]
Type II Diabetes Mellitus occurs due to development of opposition to the effects of insulin in the organic structure. The oncoming of this type is normally subsequently in life, with bulk of the affected population with BMIs in the higher scope. Although this type of Diabetes Mellitus is ab initio sooner managed with unwritten hypoglycaemic medicines, the usage of insulin is going progressively common particularly as with clip the unwritten hypoglycemics fail to accomplish equal glycemic control. Progression towards complications is less common as compared to Type I DM and normally occurs at a ulterior phase of the disease. [ 18 ]
In international guidelines, the overall end for the intervention of all diabetes is to forestall ague and chronic complications, while continuing a good quality of life for the patient. Since, diabetics need to modify their life style once they are diagnosed, they frequently feel confronted with jobs on a day-to-day footing which in the long tally might take to poorer quality of life. [ 2, 3 ] Thus, cognition refering Health related Quality of life in diabetic patients, every bit good as the determiners of this, is important.
Over the last two decennaries, work has been done sing the impact of Diabetess on the quality of life of patients inflicted with this unwellness. [ 1, 2, 3, 6, 8, 9 ] It has been demonstrated that due to the chronic nature of the disease and the subsequent complications associated with it, it is a cause of anxiousness and major depression in these patients and a quality of life which is slightly decreased. [ 15-17 ] Clinically, this information is important since the presence of these psychiatric conditions could necessitate active psycho-therapeutic intercessions, with the engagement of clinical psychologists and head-shrinkers.
Ware et Al. published informations based on responses to the 1990 National Health Survey of Functional Status. In their study they found that patients with diabetes reported quality of life which was inferior to the general population peculiarly with respect to steps of physical public presentation and general wellness perceptual experience were taken into history, but these differences were non important on graduated tables mensurating societal operation and psychological wellness. [ 7 ] Research research workers have by and big found that depression is more prevailing among those with diabetes than among non-diabetics [ 8, 9, 10 ] . A survey reported that rates of distribution for depression ( 41 % ) and anxiousness ( 49 % ) were occurred with a higher frequence in diabetics than those in non-diabetics ( & A ; lt ; 10 % ) . [ 11 ] However, they besides found that the chance of perturbation was strongly associated with the figure of diabetes-related complications and with certain demographic variables, particularly gender and degree of instruction. These findings suggested that some disease and demographic variables may hold a strong impact on the quality of life in people with diabetes.
Designation of factors which affect the wellness related quality of life in Diabetic patients has been the mark of many Diabetologists. Factors which have been proposed to be associated with a poorer quality of life include demographic variables such as age of oncoming, present age, gender, socioeconomic position, functional category and presence of any other co-morbid unwellnesss or history of antecedently diagnosed psychiatric unwellness. Besides of import is the support system that the patient has in order to ease his intervention financially every bit good as morally. Second, disease-specific variables like type of diabetes, continuance of diabetes, manner of intervention, intervention regimen and development of complications as a consequence of intervention or micro- and macro- vascular complications of diabetes. Most conspicuously associated factor suggested in such a state of affairs is the adequateness of glycemic control [ 12, 13 ] . It can be evaluated by hebdomadal to monthly fasting and random blood glucose degrees, three monthly HbA1c degrees, and daily self monitored blood glucose degrees at place. It has been established that glycemic control and presence of complications significantly deteriorates the quality of life in diabetics. It has been efficaciously associated to development of depression and therefore has a considerable impact on forecast and wellness related result [ 2, 12, 13 ] . In a reappraisal, Rubin et Al. concluded that continuance and type of diabetes are non systematically associated with quality of life [ 2 ] . They besides found out that strict intervention does non impair quality of life. However, holding better a better glycemic control is associated with better quality of life. However, their most consistent determination was that complications related to diabetes were the most systematically agreed upon factor impacting quality of life in diabetic patients. [ 2 ]
Literature is available which suggests a high prevalence of major Depression and anxiousness upsets in diabetic patients. One multicentre cross-sectional survey late conducted in Karachi aimed to measure the prevalence of anxiousness and depression and place associated factors among people with type 2 diabetes. From among the 889 grownups enrolled in this survey, a high proportion was found to be affected ; 57.9 % ( 95 % CI = 54.7 % , 61.2 % ) and 43.5 % ( 95 % CI = 40.3 % , 46.8 % ) had anxiousness and depression severally. [ 15 ]
A rare cohort survey conducted in United States of America enrolled 57,880 participants who were followed up every two old ages from the twelvemonth 1996 to 2006. [ 16 ] This survey showed that the association between depression and diabetes is bi-directional such that diabetes increases the hazard of incident depression and depression increases the hazard of diabetes. The relationship between diabetes and depression is hence a complex one where one disease province deteriorates the other. Another survey determined that grownup patients with Type II Diabetes who have depression were more likely to hold hapless glycemic control and lower conformity to self-care activities. [ 17 ]
Harmonizing to our cognition informations sing the relation between the types of diabetes and the comparing of the quality of life in these two populations is limited. Even though the implicit in intervention scheme is the same in both type I DM and type II DM, that is equal control of blood glucose degrees, these are two separate diseases with basically different patho-physiologies. The patient population affected and class of disease differ well. Patients with Type I DM have an earlier oncoming of disease and the manner of intervention is injectable insulin. They are besides more apt to develop complications such as hypoglycaemic episodes and diabetic keto-acidosis every bit good as vasucular complications earlier than those inflicted with type II DM. Furthermore, the option of unwritten hypoglycaemic therapy in Type II DM greatly increases patient conformity and does non hold every bit large an impact as thrice or even four clip day-to-day insulin injections. Comparison between these two populations will let us to hold some elucidation as to the quality of life that is experienced by these patients and besides estimate the likeliness of development of depression in this patient population. This would hence enable us to take effectual steps to invent intercessions and guarantee a healthier result.
Purposes and Aims:
To find the quality of life of patients with type I and type II Diabetes Mellitus sing the outpatient clinics ( OPD ) in Karachi.
To find the prevalence of depression in type I and type II diabetic patients sing the OPD in Karachi.
To place whether type of diabetes, continuance of diabetes and manner of intervention have an impact on the quality of life and prevalence of depression in these diabetic patients.
To place assorted demographic factors which influence quality of life in these diabetic patients.