title: Living with diabetes: quality of care and quality of life.
abstract: BACKGROUND
  The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients' opinions of the quality of care received and the results of interventions.
  
  
  METHODS
  A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed.
  
  
  RESULTS
  Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system.
  
  
  CONCLUSIONS
  The bureaucratic circuits of the health care system impair patients' quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials.
authors.affiliation: Department of Public Health Nursing, Mental and Mother and Child Health, University of Barcelona, Spain.
authors.forename: Pilar Isla
authors.initials: PI
authors.lastname: Pera