Interdisciplinary Educative Structured Diabetes Program Effect on Health-Related Quality of Life and Anxiety/Depression Perception in Patients Attending a Primary Care Diabetes Clinic in Mexico City

Quality of life(QoL) is an important health outcome and diabetes affects major components of QoL, including physical, psychological and social. There is limited evidence about the effect of Diabetes Self-Management Education (DSME) on QoL in primary care urban population of low- and middle-income countries. This study evaluated the effect on Health-Related Quality of Life (HRQoL) in patients who attended an interdisciplinary educative structured program at Clínica Especializada en el Manejo de la diabetes in México City-Iztapalapa in 2017. Intervention lasted 5 months and included individual and group sessions in a shared medical appointments model aimed at promoting self-care. In 252 patients with type 2 diabetes, HRQoL was assessed from the EuroQoL 5D-5L, which is a generic instrument for this purpose including 5 dimensions: mobility, self-care, daily activities, pain/discomfort, and anxiety/depression. It reports an indexed score and a visual analogue scale (VAS) score, and highest scores obtainable are of 1 and 100, respectively. Women represented 67%, and 59.6% had elementary or less education. Mean age was 55±10 years old, and mean duration of diabetes was 13±8 years. Indexed score and VAS score increased from 0.76±0.14 to 0.87±0.14 (mean variation 0.1±0.14; p=<0.001) and from 62.6±24 to 88.4±11 (mean variation 25.7±26; p=<0.001), respectively. The highest improvement in a HRQoL dimension was the decreased proportion of patients without problems perception related to anxiety/depression from 63.2% to 26% (p=<0.001). This non-pharmacological therapeutic approach focused on DSME improved HRQoL. Our findings suggest the role of DSME in this population beyond the traditional physical component impact, since it favors the fulfillment of multiple interrelated objectives through different mechanisms, generating a diversity of positive results, including HRQoL.