Meta-Analysis: The Effect of Neuropatic Complications and Depression Commorbidity on the Quality of Life of Patients with Type 2 Diabetes

Rofana Aghniya, Bhisma Murti, Didik Gunawan Tamtomo


Background: Diabetes mellitus is a metabolic disease that results from insulin insufficiency and often causes complications. DM patients are prone to depression. Depression is one aspect that affects the quality of life. Measuring the quality of life in DM patients is done as a measure of the success of the intervention. This study aims to estimate the influence of neuro­pathic complications and comorbid depression on the quality of life of type 2 DM patients based on the results of previous studies.

Subjects and Method: Meta-analysis studies and systematic studies were applied to this research with electronic data sources PubMed, ProQuest, Science Direct, Scopus, Spinger Link and Google Scholar. The key words used were as follows: Comorbidity depression and DM, depression and quality of life and DM and cross sectional study, neuropathy and quality of life and DM and adjusted odd ratio, neuropathy or diabetes, depression or quality of life or DM or adjusted. odd ratio. The article used is a full-text article with a cross-sectional study design and the results are reported in adjusted odds ratio (aOR). Articles were analyzed using the Review Manager 5.3 application with fixed effect models.

Results: Fifteen articles reviewed in this study originated from 5 continents. 6 studies came from the Asian continent (Japan, Iran, Singa­pore, Korea, China and Nepal), 4 studies from the European continent (Norway and 3 United Kingdom), 2 studies from the African continent (Uganda and Nigeria), 2 studies from the North American continent (Brazil) and 1 study from the continent of South America (USA). The results of the forest plot interpre­tation showed that patients with type 2 diabetes mellitus with neuropathy complications had 0.78 times the chance of having a good quality of life com­pared to type 2 DM patients with­out neuro­pa­thic complications (aOR= 0.78; 95% CI= 0.69 to 0.89; p= 0.001). Patients with type 2 DM with comorbid depression had a 0.45 times chance of having a good quality of life com­pared to type 2 DM patients without co­morbid depression (aOR= 0.45; 95% CI= 0.28 to 0.73; p = 0.001).

Conclusion: Patients with type 2 DM without complications of neuropathy and without co­morbid depression have a better quality of life than patients with type 2 DM with complica­tions of neuropathy and comorbid depression.

Keywords: diabetes melitus, diabetic neuro­pathy, depresssion, quality of life

Correspondence: Rofana Aghniya. Masters Program in Public Health, Universitas Sebelas Maret. Jl.Ir. Sutami 36A, Surakarta 57126, Central Java. Email: Mobile:0855­23528340.

Journal of Epidemiology and Public Health (2020), 05(03): 359-371



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Adriaanse MC, Drewes HW, Van Der Heide I, Struijs JN, Baan C (2016). The impact of comorbid chronic conditions on quality of life in type 2 diabetes patients. Qual Life Res, 25: 175–182.

Anderson RJ, Freedland KE, Clouse RE, Lustman PJ (2001). The prevalence of comorbid depression in adults with diabetes: A meta-analysis. Diabetes Care, 24(6): 1069–1078.

Anulus A, Murti B, Prasetya H (2019). Risk Factors of HIV among Male Military Personnels: A Meta Analysis. J Health Promot and Behav, 4(3): 178–188. doi:10.26911/thejhpb.2019.04.03.03.

Benbow SJ, Wallymahmed ME, Macfarlane IA (1998). Diabetic peripheral neuro-pathy and quality of life. QJM, 91(11), 733–737.

Chew BH, Mohd-Sidik S, Shariff-Ghazali S (2015). Negative effects of diabetes-related distress on health related quality of life: An evaluation among the adult patients with type 2 diabetes mellitus in three primary healthcare clinics in Malaysia. Health Qual. Life Outcomes, 13(1).

Danaei G, Finucane MM, Lu Y, Singh GM, Cowan MJ, Paciorek CJ, Lin JK, Farzadfar F, Khang YH, Stevens GA, Rao M, Ali MK, Riley LM, Robinson CA, Ezzati M (2011). National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2·7 million participants. The Lancet, 378(9785): 31–40.

Danhauer SC, Brenes GA, Levine BJ, Young L, Tindle HA, Addington EL, Wallace RB, Naughton MJ, et al. (2019). Variability in sleep disturbance, physical activity and quality of life by level of depressive symptoms in women with Type 2 diabetes. Diabetic Medicine, 36(9), 1149–1157.

Derakhshanpour F, Vakili MA, Farsinia M, Mirkarimi K (2015). Depression and quality of life in patients with type 2 diabetes. Iran Red Crescent Med J. 17(5): e27676.

Egede LE, Grubaugh AL, Ellis C (2010). The effect of major depression on pre-ventive care and quality of life among adults with diabetes. Gen Hosp. Psychiatry, 32(6): 563–569.

Gerontoukou EI, Michaelidoy S, Rekleiti M, Saridi M, Souliotis K (2015). Investigation of anxiety and depression in patients with chronic diseases. Health Psychol, 3(2).

Grandy S, Fox KM (2008). EQ-5D visual analog scale and utility index values in individuals with diabetes and at risk for diabetes: Findings from the Study to Help Improve Early evaluation and management of risk factors Leading to Diabetes (SHIELD). Health Qual. Life Outcomes, 6: 18.

Habtewold TD, Alemu SM, Haile YG (2016). Sociodemographic, clinical, and psychosocial factors associated with depression among type 2 diabetic outpatients in Black Lion General Specialized Hospital, Addis Ababa, Ethiopia: A cross-sectional study. BMC Psychiatry, 16(1): 1–7.

Happich M, Breitscheidel L, Meisinger C, Ulbig M, Falkenstein P, Benter U, Watkins J (2007). Cross-sectional analysis of adult diabetes type 1 and type 2 patients with diabetic micro-vascular complications from a German retrospective observational study. Curr Med Res Opin. 23(6): 1367–1374.

Happich M, John J, Stamenitis S, Clouth J, Polnau D (2008). The quality of life and economic burden of neuropathy in diabetic patients in Germany in 2002 Results from the diabetic microvascular complications (DIMICO) study. Diabetes Res. Clin. Pract. 81(2): 223–230.

Hutter N, Scheidt-Nave C, Baumeister H (2009). Health care utilisation and quality of life in individuals with diabetes and comorbid mental disorders. Gen. Hosp. Psychiatry. 31(1), 33–35.

Iglay K, Hannachi H, Howie PJ, Xu J, Li X, Engel SS, Moore LM, Rajpathak S (2016). Prevalence and co-prevalence of comorbidities among patients with type 2 diabetes mellitus. Curr Med Res Opin. 32(7): 1243–1252.

Landman GWD, Van Hateren KJJ, Kleef-stra N, Groenier KH, Gans ROB, Bilo HJG (2010). Health-related quality of life and mortality in a general and elderly population of patients with type 2 diabetes (ZODIAC18). Diabetes Care, 33(11): 2378–2382.

Lyrakos GN, Papazafiropoulou AK, Batistaki C, Xatziagelaki E, Damigos D, Tinas C, Mpakomitrou F, Bousboulas S, Spinaris V (2013). 1412 – Differences in depression anxiety and stress among men and women with diabetes mellitus. European Psychiatry, 28(1): 1.

Murti B (2018). Prinsip dan Metode Riset Epidemiologi (Edisi V). Program Pascasarjana, Universitas Sebelas Maret. Surakarta: Bintang Fajar Offset.

Nouwen A, Winkley K, Twisk J, Lloyd CE, Peyrot M, Ismail K, Pouwer F (2010). Type 2 diabetes mellitus as a risk factor for the onset of depression: A systematic review and meta-analysis. Diabetologia, 53(12), 2480–2486.

Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, Cavan D, Shaw JE, Maka-roff LE (2017). IDF Diabetes Atlas: Global estimates for the prevalence of diabetes for 2015 and 2040. Diabe-tes Res Clin Pract. 128: 40–50.

Papadopoulos AA, Kontodimopoulos N, Frydas A, Ikonomakis E, Niakas D (2007). Predictors of health related quality of life in type II diabetic pati-ents in Greece. BMC Public Health, 7(1): 1–9.

Papelbaum M, Lemos HM, Duchesne M, Kupfer R, Moreira RO, Coutinho WF (2010). The association between quality of life, depressive symptoms and glycemic control in a group of type 2 diabetes patients. Diabetes Res. Clin. Pract. 89(3): 227–230.

Park M, Katon WJ, Wolf FM (2013). Depression and risk of mortality in individuals with diabetes: A meta-analysis and systematic review. Gen. Hosp. Psychiatry. 35(3): 217–225.

Penckofer S, Quinn L, Byrn M, Ferrans C, Miller M, Strange P (2012). Does glycemic variability impact mood and quality of life? Diabetes Technol. Ther. 14(4): 303–310.

Schram M, Baan C, Pouwer F (2009). Depression and quality of life in patients with diabetes: a systematic review from the European depression in diabetes (EDID) research consortium. Curr Diabetes Rev. 5(2): 112-9.

Smith BH, Torrance N (2012). Epidemiology of neuropathic pain and its impact on quality of life. Curr Pain Headache Rep. 16(3): 191–198.

Solli O, Stavem K, Kristiansen IS (2010). Health-related quality of life in diabetes: The associations of complications with EQ-5D scores. Health Qual. Life Outcomes. 8: 18.

Sterne JAC, Sutton AJ, Ioannidis JPA, Terrin N, Jones DR, Lau J, Carpenter J, Rücker G (2011). Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ. 343(7818).

Unützer J, Patrick DL, Diehr P, Simon G, Grembowski D, Katon W (2000). Quality adjusted life years in older adults with depressive symptoms and chronic medical disorders. International Psychogeriatrics, 12(1): 15–33.

Van Acker K, Bouhassira D, De Bacquer D, Weiss S, Matthys K, Raemen H, Mathieu C, Colin IM (2009). Preva-lence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics. Diabetes and Metabolism. 35(3): 206–213.

Venkataraman K, Wee HL, Leow MKS, Tai ES, Lee J, Lim SC, Tavintharan S, Wong TY, Ma S, Heng D, Thumboo J (2013). Associations between compli-cations and health-related quality of life in individuals with diabetes. Clin Endocrinol (Oxf). 78(6): 865-73.

Wexler DJ, Grant RW, Wittenberg E, Bosch JL, Cagliero E, Delahanty L, Blais MA, Meigs JB (2006). Correlates of health-related quality of life in type 2 diabetes. Diabetologia, 49(7): 1489–1497.

Zhou B, Lu Y, Hajifathalian K, Bentham J, Di Cesare M, Danaei G, Bixby H, Cowan M, et al. (2016). Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants. Lancet. 387(10027): 1513–1530.


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