As the world’s highest incidence of chronic non-communicable diseases, diabetes is the leading cause of major complications, such as end-stage renal disease and lower extremity amputations [19]. The findings of our study revealed the poor overall living quality of T2DM patients in China, and the incidence of hypoglycemia in Chinese T2DM patients was 32.18% which was higher than the proportion of patients reporting hypoglycemic symptoms in Thailand (30.65%) [20] and lower than that in the United States (63%) [21]. There were 167 diabetics with hypoglycemia with the specific quality of life score being 61.56 ± 17.50 and 352 diabetics without hypoglycemia with the specific quality of life score being 57.33 ± 15.36, which both were in a relatively high score level.
Through statistical analysis, we found the living quality of those elderly, low education, low income, divorced or widowed, living alone, long duration of diabetes were worse and lower which was consistent with the findings of India and Nepal [22, 23]. As the population ages and the chronic disease progresses, the number of elderly diabetics will continue to rise. Besides, due to the declines in body functions, vulnerabilities from comorbidities, psychological factors and geriatric syndromes such as frailty and cognitive impairment, the heavy multidimensional burden seriously diminished those elderly diabetics’ living quality [24]. Moreover, with the progression of the diabetes, the large physical, psychological and financial burden deriving from diabetes’ complications and treatment also increased. So the long duration of diabetes prominently diminished the specific quality of life [25]. Studies found that in those with diabetes, improvement in physical activity levels offers cardiometabolic, kidney, and cognitive benefits [24]. Exercise could enhance cardiovascular system function and physical feeling, improve insulin sensitivity, relieve blood pressure, blood lipids, and hence improve the effect of treatment. Therefore, nowadays, most expert guidelines have recommended or adopted a comprehensive chronic care model and precision diabetes medicine to optimize the diagnosis, prediction, prevention and treatment of diabetes by integrating multidimensional evaluation and multidisciplinary panel [26–28].
The results of t-test in Table 2 showed that compared with those without hypoglycemia, the score of specific quality of life in diabetes with hypoglycemia was higher (P < 0.001). Besides, the variable of hypoglycemia also was included in the model 3 of hierarchical regression analysis in Table 5 which indicated that hypoglycemia could impaired the specific quality of life. Hypoglycemia is potentially one of the most severe acute adverse effects of therapies for diabetes. Elliott L [29] reported that the incidence rates of severe hypoglycemia in T2DM patients the incidence rates ranged from 0 to 20 per 100 person-years. There is no doubt that hypoglycemia puts patients at risk for falls, fall-related injuries [30], dementia and death. Non-severe hypoglycemia events usually generate autonomic and neuroglycopenic symptoms which enable the individual to identify the onset, and to treat the falling blood glucose without requiring assistance while severe hypoglycemia is associated with impaired cognitive and physical functioning and the progressive neuroglycopenia interferes with the ability to self-treat [31]. Hypoglycemia and fear of hypoglycemia may further reduce adherence to glucose-lowering regimens, contributing to the further aggravation of diabetes-related complications. Therefore, it has a significant adverse impact on quality-of-life measures in diabetes [32, 33], which also supported our study’s finding. Psychologically, patients with recurrent hypoglycemia have been found to have chronic mood disorders including depression and anxiety; nocturnal hypoglycemia in particular may impact one’s sense of well-being on the following day because of its impact on sleep quantity and quality [27]. In the realistic scene, when diabetics have hypoglycemia, they will have a sense of near death in serious cases and if they are not treated in a short time, they will cause irreversible brain damage or even death, which scary them severely [34, 35]. Most of the time, the occurrence of hypoglycemia is not easy to detect, namely asymptomatic hypoglycemia [36]. Diabetics who have suffered from hypoglycemia will always worry that they will get hypoglycemia again [37].In the future blood glucose management, diabetics dare not make their blood glucose too low, causing a vicious circle of poor management of blood glucose and thus damage their quality of life[20, 38, 39].