Study of eating behavior and quality of life in patients with type 2 diabetes mellitus

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RELEVANCE. DM affects about 6% of people in the world. This is an extremely common disease. Patients with diabetes are unable to lead a fulfilling lifestyle. Their level of performance decreases, due to which the quality of life and social activity are reduced. According to the forecasts of the International Diabetes Federation, by 2035 half a billion people will suffer from diabetes [1]. Naturally, for a patient suffering from any ailment, it is important to what extent his condition may affect his physical and emotional state and position in society. According to the WHO definition, QOL is defined as people's sense of their place in their environment in connection with its value system and concept, satisfaction with their goals and expectations [2]. QOL indicators of patients with diabetes reflect their state of health.
PURPOSE to study the eating behavior and quality of life of patients with type 2 diabetes mellitus.
METHODS. 1. Study design
We examined 20 patients with type 2 diabetes mellitus who were hospitalized in the endocrinology department of the city clinical hospital. The average age was 64.3 ± 3.1 years. Eating behavior was assessed using the Dutch DEBQ questionnaire. The quality of life was assessed using the SF-36 questionnaire. The SF-36 scales were processed using SF-36 (Health Survey Manuel and Interpretation Guide). The questionnaires were filled in by the respondents themselves, after explaining the purpose of the survey.
2. Eligibility criteria
The criterion for inclusion in the study is the presence of diabetes mellitus.
3. Conditions
The study was carried out on the basis of the regional clinical hospital No. 1 in Voronezh. To participate in the survey, not only city dwellers were involved, but also regions, the way of life and socio-economic living conditions of which may differ significantly.
4. Duration of research
The distribution of questionnaires to patients took about a month. This period was significantly lengthened as we visited the hospital several times in order to recruit a sufficient number of patients. The processing of the obtained data and their statistical evaluation took about 2 weeks.
5. Description of the medical intervention
All study participants were given the SF-36 questionnaire to determine the quality of life, and the Dutch eating behavior questionnaire. Most of them completed the questionnaires on their own, some with our help (due to vision problems).
6. The main outcome of the study
Quality of life scores are the surrogate endpoint of our study. Without processing these results, the purpose of our research cannot be disclosed.
7. Additional study outcomes
With the help of the DEBQ questionnaire, the average value was revealed for the questions of emotiogenic, restrictive, external eating behavior. This allows us to conclude that, in general, there is no excessive strictness in dietary restrictions. This indicates a tendency for the dependence of food on the emotional state and "seizing" stress.
8. Analysis in subgroups
Subgroups of men and women of about the same age have been formed. Single patients constituted a group of people with severe diabetes symptoms.
9. Methods of registration of outcomes
To calculate the research results, online calculators were used for the corresponding questionnaires.
10. Statistical analysis
The calculation of QOL criteria was made by the method of summing Likert ratings based on the recoded raw scores expressed as a percentage. Statistical processing of the data was carried out using the Excel program using the Student's t-test.
RESULTS. One of the most widely used general questionnaires for assessing QoL is the Short Form Medical Outcomes Study (SF-36). Being general, it allows assessing the quality of life of patients with various nosologies and comparing this indicator with that of a healthy population. The Russian version of SF-36 has been revised by the International Center for the Study of QOL in St. Petersburg [3]. 36 items of the questionnaire are combined into eight scales, the indicators of each scale are reference in values ​​from 0 to 100, where 100 represents complete health. The scales form the physical and psychological indicators of health.
The main results of the study:
QOL criteria according to SF-36 are:
1. Physical activity. The assessment of the volume of physical activity, not constrained by the state of health, is currently being carried out. The average indicator among the respondents is 36. The criterion describing the state of the organism as a whole depends on the lifestyle and the possibilities of functioning of all systems of the organism, which have developed as a result of the lifestyle and social conditions.
2. The role of physical disorders in limiting life activity. The respondent expresses his opinion on how such problems affect his life.
The average indicator is 56. Such dramatic differences indicate a different degree of severity of diseases present in patients.
3. Pain. The patient characterizes his painful sensations, which have limited him in daily activities for the last 4 weeks.
The average is 51.
4. General health. The interviewee gives a subjective assessment the general state of their health at present. It is worth emphasizing that this estimate is sufficient
subjective, because it is very psychologically colored. The average indicator is 41. It is worth noting that none of the respondents has a general health indicator above 50, which reflects a rather low level of his life.
5. Vitality. The respondent assesses his activity (cheerfulness, energy, etc.) for the last 4 weeks. The average is -42. This indicator also does not rise above 50 among the respondents. Concomitant illnesses, family environment, lifestyle that does not correspond to desires lead to such low numbers.
6. Social activity. It reflects the satisfaction from communication with friends, relatives, work colleagues, etc. in the last 4 weeks. The average is 61. It has a very large difference in terms of indicators, it is more a manifestation of character traits.
7. The role of emotions and their influence on limiting life activity. The patient describes his emotional state for the last 4 weeks.
The average indicator is 30. Some of the respondents do not connect emotions and limitation of life activity in any way, that is, the indicator is 0, some consider emotions a decisive criterion for making certain decisions (the indicator is 100) Depends on the type of nervous system, reactivity developed in the process of life reactions to certain situations.
8. Mental health. To identify indicators of this characteristic, we ask the patient to rate their mood for the last 4 weeks. The average is 51. It allows one to judge the degree of influence of the disease on the patient, his satisfaction with the circumstances of his life.
After determining the body parameters in a group of patients, we found the following values: the average waist circumference is 104 ± 7.8 cm for women and 113.8 ± 5.7 cm for men. BMI corresponds to the values ​​of II and III degrees of obesity. Based on the values ​​obtained by the formula that we used to determine the ratio of waist circumference to height, it was found that among women all have metabolic syndrome (ratio above 63 - extreme obesity); in men, 40% are extremely overweight (ratio 58-63), 20% are extremely overweight (ratio 53-58) and 40% are extremely obese (ratio above 63).
Additional research results: the results obtained in the analysis of the DEBQ questionnaire revealed: average values ​​of indicators of emotiogenic eating behavior - 1.8; restrictive - 2.4; external - 2.7 points. Only the value of restrictive behavior corresponds to the norm, that is, there is no excessive strictness in limiting oneself in nutrition in patients. The average value of emotiogenic behavior is underestimated (1.6 with a mean value of 1.8). This indicates a tendency towards dependence of nutrition on the emotional state and "seizing" of stress. This can be attributed to the unstable economic and social conditions of life and the peculiarities of the mentality. The average value of external eating behavior corresponds to the average value (2.7).
DISCUSSION. It is very important for people with diabetes to control their weight, because being overweight further increases the resistance of cells to insulin and aggravates diabetic complications. The technique we use allows us to identify the presence of the so-called metabolic syndrome. Why is it important to use the waist size? Belly fat is considered metabolically active: it is capable of producing various hormones. Their effect on the body increases the risk of stroke, heart attack and, of course, diabetes. The findings showed that diabetic patients do not overeat because of hunger. It is caused by extreme instability to external circumstances associated with food, for example, food temptations.
A decrease in the level of QoL of patients with diabetes on the scales "physical functioning" and "general health" reflect the fatigue of sick people, a decrease in their vital activity. This can be due to a variety of factors. One of the most indicative is overweight as a manifestation of metabolic disorders. It partially interferes with an active lifestyle. Dietary restrictions affect the emotional state of the patient, and can lead to a depressive state. Do not forget about social factors: life activity in older people can be reduced due to the high level of stress associated with loneliness, fear of death, the pressure of stereotypes about old age and illness.
CONCLUSION. Based on the above, we can conclude that diabetes mellitus significantly worsens overall health and affects many aspects of life: from eating disorders to depressive conditions. This reduces the quality of life of people over 50, who make up a very large part of the population of our country. This emphasizes the importance of preventing diabetes mellitus and introducing educational measures, in particular for relatives of patients or in families with hereditary risk of developing diabetes.

About the authors

YUliya Pavlovna Korchagina

Воронежский государственный университет им Н.Н. Бурденко, кафедра общей хирургии

Author for correspondence.
Email: yulies-kk@mail.ru
ORCID iD: 0000-0002-9255-3862
SPIN-code: 3090-7621
Russian Federation

M. V. YAkovleva

Воронежский государственный университет им Н.Н. Бурденко, кафедра общей хирургии

Email: ritokt@yandex.ru
ORCID iD: 0000-0002-2545-8793
SPIN-code: 2922-5758
Russian Federation

References