518 Annals of Saudi Medicine, Vol 19, No 6, 1999 Special Communication EFFECT OF DIABETES MELLITUS ON QUALITY OF LIFE: A REVIEW Mostafa A. Abolfotouh, MD, MPH, DrPH The term “quality of life” (QL), and more specifically “health-related quality of life” (HQOL), is a multi- dimensional concept that encompasses the physical, emotional, and social components associated with an illness or its treatment. 1 Quality of life deals with the individual’s perception of his or her life situation. 2 Hornquist defines QL as recognized need and functional satisfaction within different life domains. 3,4 More self-reported life satisfaction within such domains indicates higher levels of quality of life. Living With Diabetes Financial, social and psychological handicaps are integral to all chronic diseases, but diabetes differs in two important respects. In the first place, although it affects virtually every aspect of everyday life to a greater or lesser degree, the patient is encouraged to lead a “normal life” without any of the concessions usually made to a person with chronic illness. Secondly, although the treatment is demanding and often complex, the patient is expected to bear much of the responsibility for making decisions which may effect his health, both in the short and long term. This burden is absent in most other chronic illnesses, even in those which are equally invisible, such as epilepsy and mental illness. 5 Diversity People with diabetes make up the most diverse group imaginable, including members of both sexes, with all degrees of health, and in the different walks of life. This diversity, along with the fact that diabetes can occur at any time in the lifespan, accounts for the wide range of associated biopsychosocial issues. Similarity People with diabetes, from the three-year-old girl with From the Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia. Address reprint requests and correspondence to Prof. Abolfotouh: Department of Family and Community Medicine, College of Medicine and Health Sciences, King Khalid University, P.O. Box 641, Abha, Saudi Arabia. Accepted for publication 12 September 1999. Received 22 February 1999. insulin-dependent diabetes to the 65-year-old obese male with non-insulin-dependent diabetes, usually find it upsetting to learn and to be reminded daily that they have a serious, even life-threatening condition that will not go away. Multiple stresses, which range from insulin reactions to permanent physical complications, run in three phases of health and function. 6 The first phase is the year after onset of diabetes, with emotional upheaval attendant on diagnosis. The mid-phase of relative well-being and full function usually lasts several years, and occasionally several decades, and the third phase begins if and when the person needs to make allowances for one or more permanent physical complications. Coping with Diabetes at Onset The stress in the first phase of diabetes is the impact of the presenting symptoms, the diagnosis, and its implications for the individual and the family. Transient reactions range from mild to major adjustment disorders, with increased anxiety, depression, anger, withdrawal from others, diminished ability to feel intimate and playful, and impaired ability to learn and work. 7 Shock of Diagnosis It has been suggested that the mental trauma at diagnosis is greater in diabetes than in other chronic diseases. The newly diagnosed diabetic is confronted by a new vocabulary, a need to learn food values previously ignored, a new responsibility for administering his own treatment, the frightening immediate or remote responsibility of self-injection, and anxiety about the possibility of hypoglycemia (a word which he probably does not understand anyway), and apparently terrifying medical complications. 5 Parents who are informed that their child has diabetes often act with disbelief or shock. This is followed by bewilderment, anxiety, a sense of helplessness, and a deepening grief for the child whom they recently knew to be healthy. 8 To many whose diabetes is newly diagnosed, it seems that the world is fairly crammed with aunts, uncles, and acquaintances with amputations of feet or legs as a result of diabetes.