title: Non-adherence to self-care practices & medication and health related quality of life among patients with type 2 diabetes: a cross-sectional study.
abstract: BACKGROUND
  Non-adherence to lifestyle modification among diabetic patients develops the short-term risks and the long-term complications as well as declines the quality of life. This study aimed to find out the association between non-adherence to self-care practices, medication and health related quality of life (HR-QoL) among type 2 diabetic patients.
  
  
  METHODS
  At least 1 year diagnosed patients with type 2 diabetes (N = 500), age>25 years were conveniently selected from the Out-Patient Department of Bangladesh Institute of Health Sciences Hospital. Patients' self-care practices were assessed via interviewer-administered questionnaires using an analytical cross-sectional design. HRQoL was assessed by an adapted and validated Bangla version of the EQ-5D (EuroQol Group, 2009) questionnaire which has five domains- mobility, self-care, usual activities, pain/discomfort and anxiety/depression and two levels on each dimension. EQ-5D responses were further translated into single summery EQ-5D index using UK TTO value set. Patients' were considered as non-adhered to self-care practices according to the guidelines of Diabetic Association of Bangladesh. Multivariable linear regression was used to assess the association between non-adherence towards self-care practices and HRQoL.
  
  
  RESULTS
  Among the study patients, 50.2% were females and mean ± SD age was 54.2 (±11.2) years. Non-adherence rate were assessed for: blood glucose monitoring (37%), diet (44.8%), foot care (43.2%), exercise (33.2%) and smoking (37.2%). About 50.4% patients had problem in mobility, 28.2% in self-care, 47.6% in usual activities, 72.8% in pain/discomfort and 73.6% in anxiety/depression. On chi-squared test, significant association was found between non adherence to foot care and problem with mobility, self-care and usual activities (p < 0.05). Significant association was also found between non-adherence to exercise and poor mobility, self- care, usual activities, pain and anxiety (p < 0.05). Non-adherence to diet was associated with poor mobility (p < 0.05). In multivariable linear regression non-adherence to foot care (p = 0.0001), exercise (p = 0.0001), and smoking (p = 0.047) showed significant association with EQ-5D index after adjusting co-variates.
  
  
  CONCLUSIONS
  In this study, patients who have a non-adherence rate also have a lower quality of life.
authors.affiliation: Department of Community Nutrition, Bangladesh University of Health Sciences (BUHS), 125/1 Darussalam Mirpur-1, Dhaka-1216, Bangladesh. farzanasaleh_sumona@yahoo.com.
authors.forename: Farzana
authors.initials: F
authors.lastname: Saleh
authors.forename: Shirin J
authors.initials: SJ
authors.lastname: Mumu
authors.forename: Ferdous
authors.initials: F
authors.lastname: Ara
authors.forename: Md Abdul
authors.initials: MA
authors.lastname: Hafez
authors.forename: Liaquat
authors.initials: L
authors.lastname: Ali
mesh_terms: D001294:Attitude to Health; D001459:Bangladesh / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000523:psychology*; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance / Q000523:psychology / Q000706:statistics & numerical data*; D011788:Quality of Life / Q000523:psychology*; D012648:Self Care / Q000379:methods / Q000523:psychology / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires