Determinants and impacts of glycemic control on quality of life among type 2 diabetes mellitus patients in Palestine: a cross-sectional study

Abstract

Introduction: Type 2 Diabetes Mellitus (T2DM) imposes a profound global health burden, significantly impairing patients' Health-Related Quality of Life (HRQoL), particularly in low- and middle-income, conflict-affected settings like Palestine. Aim: This study aims to investigate the determinants and impacts of glycemic control on QoL among T2DM patients in Palestine, focusing on the satisfaction, impact, and worry domains. Methods: A cross-sectional study was conducted among 249 adult patients with T2DM recruited from diabetes outpatient clinics in Palestine. Data were collected using a structured questionnaire encompassing demographic/clinical variables and the Arabic version of the Revised Diabetes Quality of Life Questionnaire (RVDQOL-13). Glycemic control was categorized by HbA1c (≤7% controlled, >7% uncontrolled). Non-parametric tests (Mann–Whitney U, Kruskal–Wallis H) and Spearman correlations were utilized to identify associated factors and the impact of glycemic control on QoL. Results: The sample had a mean age of 61.17 years, with 54.2% exhibiting uncontrolled glycemia. QoL was moderately impaired (Mean = 3.31), with the "Impact" domain (fatigue and pain) being the most severely affected. Uncontrolled glycemia was a significant independent predictor of worse QoL (Mean Rank = 136.17 vs. 111.78, p = 0.008), corroborated by a positive correlation between HbA1c and QoL scores (rho = 0.209, p = 0.001). Additionally, female gender, physical inactivity, and low monthly income were significantly associated with poorer QoL. Conclusion: Poor glycemic control, female gender, physical inactivity, and low income significantly diminish QoL among Palestinian T2DM patients. Interventions must transcend pharmacological prescriptions to include structured diabetes self-management education, gender-sensitive support, and strategies that overcome contextual barriers to physical activity and self-efficacy.