The quality of life of diabetes mellitus patients with diabetic retinopathy complications: A descriptive cross-sectional study
DOI:
https://doi.org/10.63868/npjn.v1i02.30Keywords:
Diabetes mellitus; Diabetic retinopatyhy; quality of lifeAbstract
Background: Diabetic Retinopathy (DR) imposes a profound multidimensional burden on patients, extending beyond physiological visual loss to compromise daily functioning and psychosocial well-being. While the clinical progression of DR is well-documented, empirical evidence regarding its specific impact on quality of life (QoL) domains in developing regions remains limited
Objective: This study aimed to describe the quality of life and identify specific functional deficits among patients with diabetes mellitus complicated by diabetic retinopathy in West Sumatra, Indonesia.
Method: A quantitative descriptive cross-sectional study was conducted at the Eye Clinic of Ibnu Sina Yarsi Islamic Hospital, Bukittinggi. A total of 70 patients with confirmed diabetic retinopathy were recruited using purposive sampling. Data were collected using the validated Indonesian version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Descriptive statistical analysis was performed to determine demographic characteristics and domain-specific QoL scores.
Results: The study cohort was primarily female (61.4%) and elderly, with 64.3% of the participants being 60 years or older. Most participants had been living with diabetes for more than 10 years (68.6%). Overall, half of the participants (50.0%) reported a moderate quality of life, while 28.6% rated their quality of life as poor. Analysis of specific domains showed that "near activities" and "mental health" were the most significantly affected areas. In contrast, scores for "color vision" and "peripheral vision" were relatively well-preserved.
Conclusion: diabetic retinopathy severely impacts patients' quality of life, particularly affecting their independence in near-vision tasks and their psychological well-being. These findings underscore the pressing need for comprehensive nursing interventions that encompass routine psychosocial assessments and education on adaptive self-management, in conjunction with clinical management of glycemic levels, to enhance the overall well-being of this vulnerable population
References
American Diabetes Association. (2024). Standards of care in diabetes—2024. Diabetes Care, 47(Supplement_1), S1–S4. https://doi.org/10.2337/dc24-Sint
Antonetti, D. A., Silva, P. S., & Stitt, A. W. (2021). Current understanding of the molecular and cellular pathology of diabetic retinopathy. Nature Reviews Endocrinology, 17(4), 195–206. https://doi.org/10.1038/s41574-020-00451-4
Cheung, N., Mitchell, P., & Wong, T. Y. (2010). Diabetic retinopathy. The Lancet, 376(9735), 124–136. https://doi.org/10.1016/S0140-6736(09)62124-3
Cole, J. B., & Florez, J. C. (2020). Genetics of diabetes mellitus and diabetes complications. Nature Reviews Nephrology, 16(7), 377–390. https://doi.org/10.1038/s41581-020-0278-5
Dougherty, B. E., Trolinger, M. R., & Blaha, M. J. (2020). The burden of diabetic retinopathy: A review of the patient perspective. Clinical Ophthalmology, 14, 3423–3431. https://doi.org/10.2147/OPTH.S257318
Fenwick, E. K., Man, R. E. K., Gan, A. T. L., Kumari, N., Tan, G., Aravindhan, A., Gupta, P., Wong, T. Y., & Lamoureux, E. L. (2020). Diabetic retinopathy and macular edema are associated with poorer diabetes self-care behavior. Acta Diabetologica, 57(1), 57–64. https://doi.org/10.1007/s00592-019-01363-4
Fitriani, A., & Miko, A. (2021). Education level and its relation to the incidence of diabetic retinopathy. Journal of Public Health Research, 10(2), 215-220.
Fitrina, Y., & Hidayat, R. (2023). Analysis of risk factors for diabetic retinopathy in type 2 diabetes mellitus patients. Jurnal Kesehatan Andalas, 12(1), 45-52.
Hirneiss, C., Neubauer, A. S., Welge-Luessen, U., Eibl, K., & Kampik, A. (2014). Visual quality of life in patients with diabetic retinopathy. Ophthalmologica, 231(3), 163–170. https://doi.org/10.1159/000357370
Hwu, Y. J., Coates, V. E., & Boore, J. R. P. (2020). The evolving role of the nurse in diabetes care: An international perspective. Journal of Nursing Management, 28(5), 1060–1069.
IBM Corp. (2019). IBM SPSS Statistics for Windows, Version 26.0. IBM Corp.
Khooshab, E., Soury, A., & Seyedbagheri, S. H. (2020). The impact of diabetic retinopathy on quality of life and self-care capabilities in elderly patients. Journal of Diabetes Nursing, 24(3), 112–119.
Lemeshow, S., Hosmer, D. W., Klar, J., & Lwanga, S. K. (1990). Adequacy of sample size in health studies. World Health Organization.
Lopez, C. M., & Yanez, B. (2022). Social support and health outcomes in chronic disease. Health Psychology Review, 16(3), 340–355
Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25-list-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology, 119(7), 1050–1058. https://doi.org/10.1001/archopht.119.7.1050
Mangione, C. M., Lee, P. P., Gutierrez, P. R., Spritzer, K., Berry, S., & Hays, R. D. (2001). Development of the 25-list-item National Eye Institute Visual Function Questionnaire. Archives of Ophthalmology, 119(7), 1050–1058. https://doi.org/10.1001/archopht.119.7.1050
Ministry of Health Republic of Indonesia. (2021). Laporan Nasional Riskesdas 2018 (National Report on Basic Health Research 2018). Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan.
Nusinovici, S., Rim, T. H., Yu, M., Zhang, G., & Cheng, C. Y. (2022). Validation of the NEI VFQ-25 in an Asian population with diabetic retinopathy. Scientific Reports, 12(1), 4589. https://doi.org/10.1038/s41598-022-08523-w
Nugraha, P., & Utami, S. (2020). Socioeconomic factors and adherence to diabetes treatment. Indonesian Journal of Nursing, 23(1), 12–19.
Polit, D. F., & Beck, C. T. (2020). Nursing research: Generating and assessing evidence for nursing practice (11th ed.). Wolters Kluwer.
Pusparini, A., Dahlan, A., & Santosa, A. (2023). Health-related quality of life in Indonesian type 2 diabetes mellitus outpatients: The role of complications and social support. Diabetes & Metabolic Syndrome: Clinical Research & Reviews, 17(2), 102732.
Rahmawati, R., Bajorek, B., & Michael, A. (2022). Quality of life in patients with diabetic retinopathy: A systematic review. Quality of Life Research, 31(3), 639–655. https://doi.org/10.1007/s11136-021-02958-z
Rees, G., Xie, J., Fenwick, E. K., Sturrock, B. A., Finger, R., Rogers, S. L., & Lamoureux, E. L. (2016). Association between diabetes-related eye complications and symptoms of anxiety and depression. JAMA Ophthalmology, 134(9), 1007–1014. https://doi.org/10.1001/jamaophthalmol.2016.2213
Saban, K. L., Penckofer, S. M., Androwich, I., & Bryant, F. B. (2018). Health-related quality of life in women with type 2 diabetes: The role of social support and self-efficacy. Journal of Advanced Nursing, 74(6), 1365–1375.
Saeedi, P., Petersohn, I., Salpea, P., Malanda, B., Karuranga, S., Unwin, N., Colagiuri, S., Guariguata, L., Motala, A. A., Ogurtsova, K., Shaw, J. E., & Bright, D. (2019). Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: Results from the International Diabetes Federation Diabetes Atlas. Diabetes Research and Clinical Practice, 157, 107843. https://doi.org/10.1016/j.diabres.2019.107843
Simó, R., Stitt, A. W., & Gardner, T. W. (2018). Neurodegeneration in diabetic retinopathy: Does it really matter? Diabetologia, 61(9), 1902–1912. https://doi.org/10.1007/s00125-018-4692-1
Speight, J., Reaney, M. D., & Barnard, K. D. (2020). Not all roads lead to Rome—a review of quality of life measurement in adults with diabetes. Diabetic Medicine, 26(7), 688–695.
Sun, H., Saeedi, P., Karuranga, S., Pinkepank, M., Ogurtsova, K., Duncan, B. B., Stein, C., Basit, A., Chan, J. C. N., Mbanya, J. C., Pavkov, M. E., Ramachandaran, A., Wild, S. H., James, S., Herman, W. H., Zhang, P., Bommer, C., Kuo, S., Boyko, E. J., & Magliano, D. J. (2022). IDF Diabetes Atlas: Global, regional and country-level diabetes prevalence estimates for 2021 and projections for 2045. Diabetes Research and Clinical Practice, 183, 109119. https://doi.org/10.1016/j.diabres.2021.109119
Teo, Z. L., Tham, Y. C., Yu, M., Chee, M. L., Rim, T. H., Cheung, N., Bikbov, M. M., Wang, Y. X., Tang, Y., Lu, Y., Wong, I. Y., Ting, D. S. W., Tan, G., Jonas, J. B., Sabanayagam, C., Wong, T. Y., & Cheng, C. Y. (2021). Global prevalence of diabetic retinopathy and projection of burden through 2045: Systematic review and meta-analysis. Ophthalmology, 128(11), 1580–1591. https://doi.org/10.1016/j.ophtha.2021.04.027
Visseren, F. L. J., Mach, F., Smulders, Y. M., Carballo, D., Koskinas, K. C., ... & Williams, B. (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 42(34), 3227–3337.
Wang, Y., Feng, L., Zeng, Y., Zhu, J., & Wang, J. (2023). The impact of diabetic retinopathy on the psychological well-being of patients with type 2 diabetes: A cross-sectional study. Journal of Advanced Nursing, 79(4), 1023–1034. https://doi.org/10.1111/jan.15088
Wardani, I. A., Widayanti, T. W., & Supanji, S. (2019). Validity and reliability of the Indonesian version of the National Eye Institute Visual Function Questionnaire-25 (NEI VFQ-25). Ophthalmologica Indonesiana, 45(1), 35–41.
Whitehead, L., Glass, C., & Wilson, L. (2016). The role of the nurse in the management of diabetic retinopathy: A systematic review. Journal of Clinical Nursing, 25(13-14), 1814–1825.
Wong, T. Y., & Sabanayagam, C. (2016). Strategies to tackle the global burden of diabetic retinopathy: From epidemiology to artificial intelligence. Ophthalmologica, 243(1), 9–20
Yau, J. W., Rogers, S. L., Kawasaki, R., ... & Wong, T. Y. (2012). Global prevalence and major risk factors of diabetic retinopathy. Diabetes Care, 35(3), 556–564
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Nurse Point: Journal of Nursing
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
