Fatigue and peripheral neuropathy are prominent and distressing concerns in patients with chronic diabetes, and they can make it difficult to accomplish everyday chores. In comparison to patients with T2DM and healthy control groups, the current study found that QoL, specifically Physical Component Summary (PCS) and fatigability, is considerably impacted in patients with T2DMPN. This could be attributed to the obvious clinical symptoms of DPN, such as a high MNDS score in T2DMPN patients. Our findings corroborate a previous study that found widespread DPN damage, notably in sensorimotor polyneuropathy, which is connected to pain, a worse QoL, poor outcome, and higher healthcare costs . Patients with DPN and peripheral artery disease (PAD) causes muscle atrophy, particularly in the lower limb's distal segment, due to their effects on motor nerve impairment and reduced muscle blood flow . Furthermore, DPN and fatigue limit movement, limit everyday activities, and create challenges in family, social, and professional duties. DPN also raises the chance of falling and losing individual's balance while standing or walking [18, 19, 20].
Diabetes mellitus is one of the most difficult diseases to manage since a variety of factors such as physical activity, glucose testing, findings, time from diagnosis, and depression have all been demonstrated to have a significant impact on QoL . Previous research has found that elderly and chronic T2DM patients have a moderate QoL in connection to co-morbidities, as well as limitations in physical functions and the strongest negative relationships with physical score . T2DMPN is a condition that develops as a result of uncontrolled or poorly controlled T2DM for an extended period of time, culminating in the patient becoming a T2DMPN patient. T2DMPN patients with complications had a lower PCS in QoL, which might be attributed to T2DMPN consequences like neuropathy, retinopathy, and cardiovascular disease, which were the three most potent factors linked to poor QoL . Long-term diabetes has been connected to a lower quality of life in previous studies; the PCS was linked to the time since diagnosis, while the MCS was linked to anxiety and depressive symptoms but not to diabetes duration or metabolic control . Because QoL is described as an individual's impression of their place in life in the context of the culture and value systems in which they live, and in relation to their goals, expectations, standards, and fears [1,2], it's probable that the MCS component was unaffected. The outcomes of this study suggest that the healthcare system should focus more on physical activity adjustments for patients with T2DMPN in order to lessen the impact of comorbidities on their QoL.
Fatigue is a typical symptom of hyperglycemia in diabetic patients, and it is likely impacted by disease physiology, psychological stress, and lifestyle factors [18,24]. In people with diabetes, fatigue, particularly central weariness, is an uncomfortable condition . Fatigue in skeletal muscle in diabetic individuals is caused by a combination of neurological, musculoskeletal, and metabolic abnormalities, such as decreased hepatic or muscular glycogen storage and reduced oxygen consumption during activity . Furthermore, muscle weakness in the distal (ankle plantar and dorsiflexors) and proximal (knee extensors and flexors) muscles of the lower extremities, as well as muscle size reduction in the proximal muscles of the lower extremity as a result of DPN , could explain the significant increase in fatigability among patients with T2DMPN. T2DMPN causes increased muscle fatigability, which can affect various muscular groups in the lower limb during both isometric and dynamic tasks .Furthermore, increased accumulation of intramuscular non-contractile tissue within muscular tissue due to neuropathy has been linked to decrease muscle strength in the calf and thigh muscles among patients with DPN , which is another possible explanation for increased fatigue in patients with T2DMPN. This could explain why patients with T2DMPN had a substantial influence on the physical component of QoL in the current study. Fatigue has also been noted as an impediment to diabetes patients' daily self-care management . The mechanisms underlying the increased muscle fatigue associated with diabetes are unknown . It has been suggested that this diabetes complication is linked to a failure of neuromuscular transmission.
Secondly, the current research found that T2DM had no effect on social health. This could imply that some T2DM or T2DMPN patients can cope socially with the disease's challenges. This is substantiated by the fact that the typical large size of Arab communities and the inherent close proximity of extended family are always associated with stronger social support; and the favorable relationship between social support and general health is widely documented . Furthermore, glycemic management has been shown to improve psychological well-being in T2DM patients . Furthermore, people with T2DM are well-known for being active and capable of self-care within their sociocultural background . Social support perceptions may be influenced by race and ethnicity, as well as sociodemographic and sociocultural determinants . As a result, more research is needed to understand more about the influence of T2DM on social dimension of QoL. Financial status, education level, family support, efficient healthcare management and follow-up, sociocultural and home care services are all factors that may have an impact on the social components of QoL in patients with T2DM and should be thoroughly investigated. Physical and social components of QoL are related through racial disparities, socioeconomic determinants, the built environment, and clinical issues [30, 31]. As a result, it's conceivable that interventions for patients with T2DM should be tailored to particular race or ethnicity in order to improve QoL.
The most important, independent risk factors for T2DM-associated DPN, according to a recent review of T2DM patients with DPN from 14 countries, were duration of diabetes, poor glycemic control, history of hypertension, cardiovascular disease, and depressive symptoms . Depressive symptoms have been have been identified as a significant risk factor for patients with T2DMPN. The study's claimed 14 countries, however, did not include any Arab nations. As a result, our findings on QoL, particularly the relevance of PCS and MCS components, will have considerable implications for the development of T2DM healthcare and therapy in Saudi Arabia. Prior to health management and policymaking, it is recommended that each territory recognize the functioning of physical and psychosocial components of QoL.
This is also the only study we are aware of that looked into the relationship between fatigue and QoL in Saudi Arabian diabetics. Several limitations, however, limit the interpretation of our findings. For example, the majority of data was self-reported, which could lead to under- or over-reporting of medical problems, complications, and comorbidities. Although current evidence is not fully understood, it has been suggested that these changes in PCs and MCS in QoL T2DMPN may be due to possible neurovascular damage in musculoskeletal components. As a result, more research is needed to identify the relevent factors that influence QoL in T2DM patients.