Assessment of Lifestyle Factors, Stress Levels, and Quality of Life among People with Type 2 Diabetes Mellitus

Assessment of Lifestyle Factors, Stress Levels, and Quality of Life among People with Type 2 Diabetes Mellitus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Assessment of Lifestyle Factors, Stress Levels, and Quality of Life among People with Type 2 Diabetes Mellitus Anu Mahajan, Arti Muley This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4399656/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 06 Aug, 2024 Read the published version in Discover Public Health → Version 1 posted 11 You are reading this latest preprint version Abstract Background India is deemed the “Diabetes Capital,” with over 100 million people suffering from this deadly disease. The disease is a lifestyle disorder and significantly impacts the quality of life. Thus, the study assesses the lifestyle factors and quality of life among people suffering from Type 2 Diabetes. Materials and Methods A cross-sectional study was conducted among 100 T2DM participants aged 18–65. Data were collected from Diabetic Clinics across Pune City using the Modified Diabetes Quality of Life Questionnaire, having seven domains with 17 questions. PSS and IPAQ Questionnaire were used to assess the Stress and Physical Activity. Results 60% of the participants were males with a mean age of 43.30 ± 10.89 years. The mean age of women was 50.17 ± 10.13 years. The mean HbA1c of males and females was 7.98 ± 1.41 and 7.83 ± 1.25, respectively. 83% have moderate stress, while 11% have low stress. Only 11% were found to be physically active. The average QoL score of the participants was 63.4 ± 11.2, non-significantly higher in males than in females (64.9 ± 11.03 vs 61.0 ± 11.22). Domain assessment of QoL showed statistical significance among general health (p = 0.002) and energy fatigue (p = 0.015), with males having better general health than women, and energy levels were better in females than males. However, no significance was seen between the genders in physical function, emotional well-being, and role limitation. A statistical significance for energy fatigue (p = 0.031) was observed when QoL was assessed across the disease duration. Conclusion Due to a sedentary lifestyle and increased stress, the glycemic profile of the participants was uncontrolled, which negatively impacted their quality of life. Thus, a holistic approach to managing diabetes will be more beneficial in improving the quality of life. Type 2 Diabetes Mellitus lifestyle stress gender Quality of life Figures Figure 1 Figure 2 Figure 3 Introduction India is deemed the Diabetes Capital of the world, with 101 million people suffering from the disease. The number of affected populations is more in urban than rural areas[ 1 ]. Diabetes is a chronic condition that increases the risk of co-morbidities like neuropathy, nephropathy, retinopathy, foot complications, and many more, leading to increased mortality, decreased productivity, and a financial burden [ 2 ]. The disease not only affects the physical state but has a significant impact on mental health and is a cause of mental illnesses like anxiety, depression, and stress [ 3 ]. Physical and mental health deterioration significantly impacts the patient’s overall quality of life. QoL describes how well a person leads his or her life. QoL is measured as “physical and social functioning, perceived physical and mental well-being,” as described by WHO[ 4 ]. It is a powerful tool to predict a patient’s capacity to manage the disease and maintain long-term health and well-being. QoL depends on several factors, including age, sex, occupation, socioeconomic status, dietary control, exercise regime, the medication used, number of complications, if any, and disease duration [ 5 ]. Besides these factors, a sedentary lifestyle and high-calorie and packaged food consumption significantly disturb the patients' glycemic profile and are also responsible for increasing obesity in these patients [ 6 ]. A recent meta-analysis from three cohort studies in the US shows that a 10% increase in ultra-processed food consumption results in a 12% higher risk of developing Type-2 Diabetes (T2D) [ 7 ]. Obesity in urban India is 39.6% [ 1 ] is fueled by increasing urbanization, purchase power, and easy availability of packaged and ready-to-eat food[ 8 ]. It has also been observed that after the pandemic, stress and anxiety levels in people have increased significantly among women [ 9 ]. A cross-sectional study conducted in various parts of India shows that 84% of participants have moderate to severe levels of perceived stress, and 88% have moderate to severe anxiety levels [ 10 ]. These factors negatively affect the QoL among diabetic patients. In the last decade, much attention has been given to QoL as it is considered an essential outcome for diabetes treatment and management. Assessing the QoL of patients at regular intervals at diabetic clinics helps improve health outcomes, identify overlooked problems, and help evaluate the therapeutic effects [ 11 ]. The QoL study helps evaluate the overall treatment and care of diabetes and the needs of the patients at different stages of the disease and helps to understand what more has to bring to improve the patient’s help. However, most studies on the Quality of Life showed that Diabetic people have poorer QoL than the healthy population, and the global trend shows that women have poorer QoL than men [ 12 ] Thus, considering all these factors, the study aimed to investigate the QoL of individuals suffering from Diabetes and assess the association across gender, duration of disease, and lifestyle factors affecting the glycemic profile. Materials and Methods This cross-sectional study was conducted from April to May 2023 after approval from the Institutional Ethics Committee. The subjects who meet the inclusion criteria of age 18–65 years, known cases of Type 2 Diabetes, HbA1c ≥ 6.5%, and oral hypoglycemic agents were included. Subjects with T1DM, GDM, or any recent surgery or hospitalization were excluded from the study. The participants were enrolled by purposive sampling technique from Diabetic Clinics across Pune City after obtaining informed consent. A pretested questionnaire was used to take the patient’s demographic profile and anthropometric variables, which include height, weight, body mass index (BMI), waist, and hip circumference. Information was also collected about their lifestyle, which included sleep patterns and dietary patterns, and consumption of packaged food. Self-reported biochemical parameters (tests conducted within the last month) were recorded, including fasting, postprandial blood sugar, and HbA1c levels. Physical activity levels were assessed by the standard short form of the WHO IPAQ questionnaire[ 13 ]. The volume of activity was computed by weighting each type of activity by its energy requirement defined in METS, which are multiples of resting metabolic rates to calculate the score in METS-min. The physical activity was categorized based on METS-min into inactive, minimally active, and HEPA (Health Enhancing Physical Active) active [ 14 ]. The PSS (Perceived Stress Scale) developed by Cohen[ 15 ] assessed stress levels, which has 10 questions. It is the most widely used physiological instrument for measuring the perception of stress. The question asks about the feeling and thoughts the participants experienced during the last month. Each question was given scores 0–4; the total score was calculated, and based on that, the individual was categorized as having low, moderate, and high stress. Data on Quality of Life was collected using the Modified Diabetes Quality of Questionnaire (MDQoL), which has already been used and validated in the Indian Diabetic Population [ 16 ] The questionnaire consists of seven domains and 17 questions on General Health, physical functioning, role limitations due to physical health, emotional well-being, role limitations due to emotional problems, social functioning, and energy fatigue. All the responses were scored 0-100, with 0 as the least and 100 as the maximum score. The average total score of all the questions was calculated and based on the QoL score; participants were categorized into low ( 70) [ 17 ] The participants were assessed in all the domains based on gender and the duration of the disease ( 5 years) The collected data was analyzed using IBM SPSS statistics software, version 23. Descriptive statistics were used to express demographic data. For assessing the means of various domains across the groups, Independent T-test was used, and comparing means for more than one group, one way ANOVA test was used. Correlations were performed between different variables using Pearson’s correlation coefficient. A p-value < 0.05 was considered to be significant. Results A total of 100 responses were recorded. There were 60% males and 40% females, with a mean age of 46.05 ± 11.07 years. The mean age of males was 43.30 ± 10.89 years, and of females was 50.17 ± 10.13 years. Most participants were above age 40 (60%). Most participants are educated, with 57% being graduates, 29% being post-graduates, and 3% doctorate. Most participants are obese with a mean BMI of 27.53 ± 3.67 kg/m 2 , and are found to have abdominal obesity as the mean waist-to-hip ratio was 0.91 ± 0.05. There was no significant difference in the BMI of males and females. Further analysis revealed that only 8% of participants had normal BMI, 17% were Overweight, and 64% were obese (Table 1 a & 1 b). 91% of the participants were on diabetic medicine, while 9% were not taking medicine. 70% of patients have a history of diabetes less than 5 years, and 30% have Diabetes more than 5 years. The mean Fasting Blood Sugar (FBS) was 138.41 ± 48.80 mg/dL, and mean postprandial blood sugar (PPBS) was 202.32 ± 77.52 mg/dL, and the mean HbA1c was 7.92 ± 1.34. There was no significant difference in FBS and PPBS in both genders. The same pattern was observed with HbA1c as the mean HbA1c of males was 7.98 ± 1.41, and the mean HbA1c of females was 7.83 ± 1.25 mg/dL, respectively. 93% of the participants were aware that Diabetes can cause further complications. Table 1 a. Demographics of Participants (n = 100) Sr no. Variable Category % 1. Gender Male 60 Females 40 2. Age (years) Less than 40 39 More than 40 61 3. BMI (kg/m 2 ) Normal, 18.5–22.9 8 Overweight, 23-24.9 17 Obese I, 25-29.9 57 Obese II, > 30 17 4. Education Higher Secondary 11 Graduate 57 Post Graduate 29 Doctorate 3 5. Diabetic Medicine Yes 91 No 9 6. Diabetic complications awareness Yes 93 No 7 7. Duration of Diabetes Less than 5 years 70 More than 5 years 30 Table 1 b. Gender-wise demographics and glycemic profile of the Participants (n = 100) Parameters Male Females Independent t-test p-value Number 60 40 Mean Age (years) 43.30 ± 10.89 50.17 ± 10.13 0.002* BMI (kg/m 2 ) 27.27 ± 4.05 27.93 ± 3.07 0.386 Waist to Hip ratio 0.9134 ± 0.055 0.9045 ± 0.043 0.395 FBS 141.73 ± 47.95 135.94 ± 53.47 0.681 PPBS 207.68 ± 83.69 194.28 ± 67.43 0.400 HbA1c 7.98 ± 1.41 7.83 ± 1.25 0.571 *p-value significant at level < 0.05 The lifestyle factors of all the participants are assessed in terms of their eating patterns, sleep cycle, physical activity, and stress levels. It was found that most participants prefer non-vegetarian meal types (53%) compared to vegetarian meals (47%). About 68% had their breakfast daily, 21% did not prefer to have breakfast, and 11% missed once or twice a week. The majority (72%) prefer to have lunch from home, while 26% either order outside or from home. Packaged food consumption was also observed among the participants, and consumption was statistically significant for the frequency of having it once a week (51%). Among the participants, 63% tend to eat at a restaurant once a week, and 20% do not prefer to go outside and prefer homemade food (Table 2 ). Most of the participants (93%) reported irregular sleep. Most participants (66%) had good sleep for 7–8 hours, 27% reported having inadequate sleep, less than 7 hours, and only 7% slept for more than 8 hours. Most participants (93%) are in the habit of watching TV and mobile before 1 hour of going to sleep. Physical Activity is assessed with the WHO IPAQ Scale, and it was found that 39% were inactive, 50% were minimally active, and only 11% were found to be physically active (Fig. 1 ). Most participants (83%) had moderate stress, 2% had high stress, and 15% had low stress as assessed by the Perceived Stress Scale (Fig. 2 ). Table 2 Lifestyle Factors of the Participants (n = 100) Lifestyle Factors Sr. no. Factors % Chi-square p-value 1. Eating Preference Vegetarian 47 0.011* Non-Vegetarian 53 2. Breakfast Don’t prefer breakfast 21 0.983 Miss once or twice a week 11 Have breakfast daily 68 3. Lunch Lunch from home 72 0.001* Eating or ordering outside 2 Both 26 4. Packaged food Eat daily 26 0.002* Once a week 51 More than once a week 13 Never 10 5. Eating at restaurant Daily 4 0.422 Once a week 63 More than twice a week 13 Never 20 6. Sleep Regular 7 0.522 Irregular 93 7. Duration of sleep Less than 7 hours 27 0.520 7–8 hours 66 > 8 hours 7 8. Watch TV, and mobile before 1 hour of sleep Yes 93 0.522 No 7 9. Stress Level Low 15 0.043* Moderate 83 High 2 10. Physical Activity Inactive 39 0.009* Minimally Active 50 HEPA Active 11 *p-value significant at level < 0.05 The mean QoL score of participants was 63.37 ± 11.21. Males have a slightly better score of 64.93 ± 11.03 than females, 61.02 ± 11.22. About 63% of participants had a moderate score, 27% had a high score, and only 10% were found to have a low score, as shown in Fig. 3 . When the QoL score was assessed domain-wise across genders, a statistical significance was found between energy fatigue and general health with p values 0.015 and 0.002, respectively. However, no significance was observed in the other domains like physical function, role limitations due to physical functioning, emotional well-being & role limitations due to emotional functioning, and social functioning. The average QoL score has a negative correlation with HbA1c (p = 0.002). The detailed domain-specific across the gender is given in Table 3 Table 3 Domain-wise assessment of QoL across the gender of participants (n = 100) Factors Gender Mean ± SD Independent t-test p-value Physical Function Male 67.49 ± 25.56 0.091 Female 58.53 ± 25.84 Role limitation due to physical functioning Male 74.58 ± 14.90 0.065 Female 68.12 ± 19.60 Emotional Role Limitation Male 66.00 ± 19.67 0.323 Female 61.25 ± 18.83 Energy Fatigue Male 37.33 ± 18.21 0.015* Female 48.00 ± 24.72 Emotional Wellbeing Male 68.27 ± 22.75 0.233 Female 62.66 ± 23.10 Social Function Male 81.29 ± 14.15 0.494 Female 79.25 ± 15.26 General Health Male 59.58 ± 12.44 0.002* Female 49.37 ± 19.82 *p-value significant at level < 0.05 When QoL scores were analyzed across the duration of Diabetes (less than 5 years and more than 5 years), a statistical significance was found in the Energy fatigue Domain (p = 0.031). The detailed domain-specific across the gender is given in Table 4 . Table 4 Domain-wise assessment of QoL across the duration of the disease Factors Duration of diabetes Mean ± SD Independent t-test p-value Physical Function 5 years 66.10 ± 25.32 Role limitation due to physical functioning 5 years 72.50 ± 18.97 Emotional Role Limitation 5 years 65.00 ± 22.39 Energy Fatigue 5 years 48.66 ± 25.01 Emotional Wellbeing 5 years 64.31 ± 29.58 Social Function 5 years 79.66 ± 17.80 General Health 5 years 54.72 ± 16.67 *p-value significant at level < 0.05 Discussion The present study is aimed to assess the lifestyle factors and QoL in people with Diabetes in the urban areas of Pune City. A recent study reported that urban areas have a higher prevalence rate of obesity (40%) and Diabetes (16%) as compared to rural areas, wherein the prevalence of obesity was 23.1%, and Diabetes was 8.9% [ 1 ]. The present study also found the result in a similar context. The mean BMI of the participants in the study falls in the Obese category as per the cut-off for the Asian Population [ 18 ]. The abdominal obesity was found to be more in women than the cut-off value of 0.85, which is in reference to the global trend as women have fat deposited more on the abdomen area. Dietary habits also help manage blood sugar levels. Many studies favor the consumption of a plant-based diet, which helps effectively manage blood sugar levels. A systematic review of 20 randomized control trials (RCTs) with more than 6 months found that a vegetarian diet showed a more significant body reduction, improved glycemic control, and insulin sensitivity [ 19 ]. In our study, more than half of the population was found to eat an animal-based diet. literature suggests that animal protein intensifies insulin resistance, and people who consume animal diets are at more risk for developing Type 2 Diabetes[ 20 ]. Eating regularly during the whole day also helps maintain blood sugar levels. A systematic review comparing 14 cohort studies indicates that having breakfast at least 3 times per week has reduced the risk of Type 2 Diabetes Mellitus and Obesity [ 21 ]. In our study, 68% of participants had breakfast daily, and more than one-third of participants ate lunch at home. Consumption of ultra-processed food and eating outside food that is high in oil and, sugar, preservatives also increase the risk of Diabetes. A systematic review and meta-analysis involving 18 studies and 1.1 million individuals showed a 72% positive association between ultra-processed food and the risk of Diabetes [ 22 ]. We also found that consumption of processed food and eating out at restaurants was high among the participants either daily or on the weekly basis intensifying the risk of the disease. Diabetes is a chronic condition, and its management requires proper care and attention with dietary control and daily physical activity. Doing at least 150 minutes of moderate to vigorous-intensity activity weekly and not a gap of more than 2 days between the sessions for better glycemic control[ 23 ]. However, most participants were found to be physically inactive in our study, with only 11% being physically active. Stress also has a prominent role in affecting blood sugar levels. In a healthy individual, any stress releases cortisol, which increases the blood sugar level and is an adaptive response for survival; however, if the stress continues in the long run, it causes insulin resistance and leads to diabetes [ 24 ]. The present study also found that 83% of participants have moderate levels of stress. Similar results were found in the study held at a tertiary care hospital in Chennai, India [ 25 ]. Sleep is also essential for good health, and people with diabetes frequently struggle with sleep. However, the concept of sleep disturbances has yet to be clearly defined. In our study, 93% of participants reported having irregular sleep, and only 66% reported having adequate sleep of 7–8 hours per day. It has also been observed that increased dependency on digital devices resulting in increased screen time has severe adverse effects on physical and mental health. Constant exposure to smartphones, computers, and television affects mental health, increasing stress and anxiety and leading to sleep disorders in children and adults [ 26 ]. The study also found comparable results as 93% of participants watched mobile phones, laptops, and television before 1 hour of sleep, and 91% had irregular sleep. These all are the critical factors for the dysregulation of blood sugar levels, which in turn QoL of the patients. The average QoL scores were calculated, and it was found that the mean QoL score of the participants was 63.37 ± 11.21, which was similar to another study by [ 27 ]. However, few studies report high QoL Scores [ 28 ] and low QoL scores [ 29 ]. The variation in results may be attributed to different region participants and the tools used to measure QoL. The results also show that men have slightly better QoL scores than women, consistent with a study conducted across five countries, China, Ghana, India, Russia, and South Africa, with 33,019 participants showing that men have better QoL scores than women [ 30 ]. A negative correlation was observed between the QoL score and HbA1c values with p values of 0.002, which indicates that increasing sugar levels affect the quality of life. The questionnaire has seven domains, including various physical and mental health aspects. A domain-wise analysis between the gender showed that participants scored highest in Social functioning and least scores in Energy fatigue. Fatigue is a common condition in Diabetes and has a bidirectional relationship; both feed and worsen each other, creating a vicious cycle known as Diabetes Fatigue Syndrome [ 31 ]. Our results are consistent with the study by [ 32 ]which states that Low energy fatigue scores negatively impact QoL. Thus, it becomes essential for healthcare providers to address fatigue issues during the treatment and management of Diabetes. A statistical significance between the gender is observed, with men complaining that they get fatigued more quickly than women in our study. The reason could be multifactorial as they complain of poor nutritional status, busy work life, sleep irregularity, or mental stress. Statistical significance with a p-value of 0.002 is also observed in the Gender Health Domain, with men scoring (59.58 ± 12.44) better than women scoring (49.37 ± 19.82). General Health is a multi-dimensional domain that considers several factors affecting the QoL of the patient. Many recent studies have shown that the Diabetic population has poor QoL compared to healthy individuals. In most cases, men were observed to have better overall health than women[ 33 ], [ 34 ]. In the rest of the domains, like role limitation due to physical functioning, emotional well-being, and role limitations due to emotional functioning, there was no statistically significant difference between both genders, indicating that both genders are equally affected. When comparing the effect of diabetes on the disease duration, a statistical significance was found only in the Energy fatigue Domain. People who have Diabetes for less than 5 years get fatigued more rapidly than those with Diabetes duration of more than 5 years. The result could be due to fear of the progression of the disease, which affects their mental health, and they complain more of fatigue, whereas patients with chronic diabetes would have learned to live with it. Conclusion Due to increasing urbanization, the lifestyle of people has changed as their dietary pattern shifts from consumption of a balanced diet to easy, processed, ready-to-eat foods. They have become more sedentary due to changes in working culture, leading to increased stress. All these factors impact the quality of life, which deteriorates further as the disease progresses. The present study assesses the lifestyle factors and quality of life of Type 2 Diabetic Patients among the gender and duration of disease in various physical and mental health domains. It emphasizes which factors could be responsible for their elevated sugar levels, ultimately affecting their quality of life. However, the study has certain limitations, including samples from one region and limited sample size. The patients were taken only from the OPD-based clinics, and the study did not cover all lifestyle factors affecting blood sugar levels. Thus, to conclude, T2DM is a lifestyle disorder that can be managed by adopting a good eating pattern and regular exercise, focusing on physical and mental health. Diabetes is a multifactorial disease; it starts affecting the body's major organs with time. Based on the results obtained from our study, there is a need to educate people on lifestyle changes that will help them control their glycemic profiles and reduce related complications. Hence, a holistic approach will be vital, which includes team collaboration consisting of a physician, nutritionist, and physiatrist/ phycologist to improve the overall quality of life among people suffering from Diabetes. Declarations Acknowledgments The author would like to acknowledge the participants who took their time and provided detailed dietary histories. Also, thank Diabetic Clinics for allowing us to collect the data. Source of Support and Funding The study received no specific grant from any funding agency. Conflict of Interest None declared Author’s Contribution Both authors contributed equally to the study conception and design, data collection and analysis, results interpretation, and manuscript drafting. All authors read and approved the final manuscript. Ethical Approval The study was ethically approved by the independent ethics committee of Symbiosis International (Deemed University) (IEC-SIU Pune). The ethics approval number is IEC/SIU/556. 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Louzado et al. , “Gender Differences in the Quality of Life of Formal Workers.,” Int J Environ Res Public Health , vol. 18, no. 11, Jun. 2021, doi: 10.3390/ijerph18115951. K. H. Lee, H. Xu, and B. Wu, “Gender differences in quality of life among community-dwelling older adults in low- A nd middle-income countries: Results from the Study on global AGEing and adult health (SAGE),” BMC Public Health , vol. 20, no. 1, Jan. 2020, doi: 10.1186/s12889-020-8212-0. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 06 Aug, 2024 Read the published version in Discover Public Health → Version 1 posted Editorial decision: Revision requested 24 Jun, 2024 Reviews received at journal 24 Jun, 2024 Reviews received at journal 24 Jun, 2024 Reviews received at journal 21 Jun, 2024 Reviewers agreed at journal 17 Jun, 2024 Reviews received at journal 06 Jun, 2024 Reviewers agreed at journal 27 May, 2024 Reviewers invited by journal 25 May, 2024 Editor assigned by journal 23 May, 2024 Submission checks completed at journal 23 May, 2024 First submitted to journal 10 May, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4399656","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":309372892,"identity":"2bc4ff27-e94e-461b-8acf-3a56cc0d8d1a","order_by":0,"name":"Anu Mahajan","email":"","orcid":"","institution":"Symbiosis International (Deemed University)","correspondingAuthor":false,"prefix":"","firstName":"Anu","middleName":"","lastName":"Mahajan","suffix":""},{"id":309372894,"identity":"9e2e437a-c90a-412b-9981-fbc9f0f82c38","order_by":1,"name":"Arti Muley","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAx0lEQVRIiWNgGAWjYLCCBwwMciD6wAOitSQwMBiDtSSQoiWxAcogDPj7T6dJJFQcTp8fdvgh0BY7Od0GAlokbuRuk0g4czh34+00A6CWZGOzA4SsucG7TSKxDahldgJIy4HEbYS0yJ8/C9Ty73C64ez0D8RpMTgAdFhiw+EEeekcIm0xvJG72SLhWLrhBumcggMJBkT4Re782Y03PtRYy8vPTt/84UOFnRxh70NAM9CFYHcSpxwE6hjkG4hXPQpGwSgYBSMMAAAz3krha1UEiAAAAABJRU5ErkJggg==","orcid":"","institution":"Symbiosis International (Deemed University)","correspondingAuthor":true,"prefix":"","firstName":"Arti","middleName":"","lastName":"Muley","suffix":""}],"badges":[],"createdAt":"2024-05-10 09:24:01","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4399656/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4399656/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12982-024-00173-2","type":"published","date":"2024-08-06T15:56:59+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":57944166,"identity":"14bb72c6-e438-45d3-a6ac-de68571f3901","added_by":"auto","created_at":"2024-06-07 19:09:04","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":77621,"visible":true,"origin":"","legend":"\u003cp\u003ePhysical Activity assessed by WHO IPAQ scale\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4399656/v1/cfb534da517716efb05437e5.png"},{"id":57944145,"identity":"9e0fb0e6-e8f5-4e5b-a920-fefe0af2314f","added_by":"auto","created_at":"2024-06-07 19:08:57","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":73500,"visible":true,"origin":"","legend":"\u003cp\u003eStress level assessed by Perceived Stress Scale\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4399656/v1/dc3e1dcde1b26bda4407f24b.png"},{"id":57944158,"identity":"c7cc6b83-5baf-49c6-80c1-9cbb2cd75a00","added_by":"auto","created_at":"2024-06-07 19:09:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":19514,"visible":true,"origin":"","legend":"\u003cp\u003eGender-wise distribution of Quality of Life Score\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4399656/v1/a33ea21389d92b7c9348ac3b.png"},{"id":62298465,"identity":"fb33a032-fc46-43a5-8122-ca53611d99c0","added_by":"auto","created_at":"2024-08-12 16:13:41","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":657198,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4399656/v1/23152821-9ee0-421d-a29b-c0609211cf2f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessment of Lifestyle Factors, Stress Levels, and Quality of Life among People with Type 2 Diabetes Mellitus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eIndia is deemed the Diabetes Capital of the world, with 101\u0026nbsp;million people suffering from the disease. The number of affected populations is more in urban than rural areas[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Diabetes is a chronic condition that increases the risk of co-morbidities like neuropathy, nephropathy, retinopathy, foot complications, and many more, leading to increased mortality, decreased productivity, and a financial burden [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The disease not only affects the physical state but has a significant impact on mental health and is a cause of mental illnesses like anxiety, depression, and stress [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Physical and mental health deterioration significantly impacts the patient\u0026rsquo;s overall quality of life.\u003c/p\u003e \u003cp\u003eQoL describes how well a person leads his or her life. QoL is measured as \u0026ldquo;physical and social functioning, perceived physical and mental well-being,\u0026rdquo; as described by WHO[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. It is a powerful tool to predict a patient\u0026rsquo;s capacity to manage the disease and maintain long-term health and well-being. QoL depends on several factors, including age, sex, occupation, socioeconomic status, dietary control, exercise regime, the medication used, number of complications, if any, and disease duration [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Besides these factors, a sedentary lifestyle and high-calorie and packaged food consumption significantly disturb the patients' glycemic profile and are also responsible for increasing obesity in these patients [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. A recent meta-analysis from three cohort studies in the US shows that a 10% increase in ultra-processed food consumption results in a 12% higher risk of developing Type-2 Diabetes (T2D) [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Obesity in urban India is 39.6% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] is fueled by increasing urbanization, purchase power, and easy availability of packaged and ready-to-eat food[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. It has also been observed that after the pandemic, stress and anxiety levels in people have increased significantly among women [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A cross-sectional study conducted in various parts of India shows that 84% of participants have moderate to severe levels of perceived stress, and 88% have moderate to severe anxiety levels [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. These factors negatively affect the QoL among diabetic patients.\u003c/p\u003e \u003cp\u003eIn the last decade, much attention has been given to QoL as it is considered an essential outcome for diabetes treatment and management. Assessing the QoL of patients at regular intervals at diabetic clinics helps improve health outcomes, identify overlooked problems, and help evaluate the therapeutic effects [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The QoL study helps evaluate the overall treatment and care of diabetes and the needs of the patients at different stages of the disease and helps to understand what more has to bring to improve the patient\u0026rsquo;s help. However, most studies on the Quality of Life showed that Diabetic people have poorer QoL than the healthy population, and the global trend shows that women have poorer QoL than men [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] Thus, considering all these factors, the study aimed to investigate the QoL of individuals suffering from Diabetes and assess the association across gender, duration of disease, and lifestyle factors affecting the glycemic profile.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e This cross-sectional study was conducted from April to May 2023 after approval from the Institutional Ethics Committee. The subjects who meet the inclusion criteria of age 18\u0026ndash;65 years, known cases of Type 2 Diabetes, HbA1c\u0026thinsp;\u0026ge;\u0026thinsp;6.5%, and oral hypoglycemic agents were included. Subjects with T1DM, GDM, or any recent surgery or hospitalization were excluded from the study. The participants were enrolled by purposive sampling technique from Diabetic Clinics across Pune City after obtaining informed consent.\u003c/p\u003e \u003cp\u003eA pretested questionnaire was used to take the patient\u0026rsquo;s demographic profile and anthropometric variables, which include height, weight, body mass index (BMI), waist, and hip circumference. Information was also collected about their lifestyle, which included sleep patterns and dietary patterns, and consumption of packaged food. Self-reported biochemical parameters (tests conducted within the last month) were recorded, including fasting, postprandial blood sugar, and HbA1c levels.\u003c/p\u003e \u003cp\u003ePhysical activity levels were assessed by the standard short form of the WHO IPAQ questionnaire[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The volume of activity was computed by weighting each type of activity by its energy requirement defined in METS, which are multiples of resting metabolic rates to calculate the score in METS-min. The physical activity was categorized based on METS-min into inactive, minimally active, and HEPA (Health Enhancing Physical Active) active [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The PSS (Perceived Stress Scale) developed by Cohen[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e] assessed stress levels, which has 10 questions. It is the most widely used physiological instrument for measuring the perception of stress. The question asks about the feeling and thoughts the participants experienced during the last month. Each question was given scores 0\u0026ndash;4; the total score was calculated, and based on that, the individual was categorized as having low, moderate, and high stress.\u003c/p\u003e \u003cp\u003eData on Quality of Life was collected using the Modified Diabetes Quality of Questionnaire (MDQoL), which has already been used and validated in the Indian Diabetic Population [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e] The questionnaire consists of seven domains and 17 questions on General Health, physical functioning, role limitations due to physical health, emotional well-being, role limitations due to emotional problems, social functioning, and energy fatigue. All the responses were scored 0-100, with 0 as the least and 100 as the maximum score. The average total score of all the questions was calculated and based on the QoL score; participants were categorized into low (\u0026lt;\u0026thinsp;50), moderate (50\u0026ndash;70), and high (\u0026gt;\u0026thinsp;70) [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] The participants were assessed in all the domains based on gender and the duration of the disease (\u0026lt;\u0026thinsp;5 years and \u0026gt;\u0026thinsp;5 years)\u003c/p\u003e \u003cp\u003eThe collected data was analyzed using IBM SPSS statistics software, version 23. Descriptive statistics were used to express demographic data. For assessing the means of various domains across the groups, Independent T-test was used, and comparing means for more than one group, one way ANOVA test was used. Correlations were performed between different variables using Pearson\u0026rsquo;s correlation coefficient. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered to be significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 100 responses were recorded. There were 60% males and 40% females, with a mean age of 46.05\u0026thinsp;\u0026plusmn;\u0026thinsp;11.07 years. The mean age of males was 43.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89 years, and of females was 50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.13 years. Most participants were above age 40 (60%). Most participants are educated, with 57% being graduates, 29% being post-graduates, and 3% doctorate. Most participants are obese with a mean BMI of 27.53\u0026thinsp;\u0026plusmn;\u0026thinsp;3.67 kg/m\u003csup\u003e2\u003c/sup\u003e, and are found to have abdominal obesity as the mean waist-to-hip ratio was 0.91\u0026thinsp;\u0026plusmn;\u0026thinsp;0.05. There was no significant difference in the BMI of males and females. Further analysis revealed that only 8% of participants had normal BMI, 17% were Overweight, and 64% were obese (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003ea \u0026amp; \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003eb).\u003c/p\u003e \u003cp\u003e91% of the participants were on diabetic medicine, while 9% were not taking medicine. 70% of patients have a history of diabetes less than 5 years, and 30% have Diabetes more than 5 years. The mean Fasting Blood Sugar (FBS) was 138.41\u0026thinsp;\u0026plusmn;\u0026thinsp;48.80 mg/dL, and mean postprandial blood sugar (PPBS) was 202.32\u0026thinsp;\u0026plusmn;\u0026thinsp;77.52 mg/dL, and the mean HbA1c was 7.92\u0026thinsp;\u0026plusmn;\u0026thinsp;1.34. There was no significant difference in FBS and PPBS in both genders. The same pattern was observed with HbA1c as the mean HbA1c of males was 7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41, and the mean HbA1c of females was 7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25 mg/dL, respectively. 93% of the participants were aware that Diabetes can cause further complications.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ea. Demographics of Participants (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr no.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore than 40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNormal, 18.5\u0026ndash;22.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverweight, 23-24.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObese I, 25-29.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eObese II, \u0026gt;\u0026thinsp;30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigher Secondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003ePost Graduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e29\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDoctorate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetic Medicine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e91\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDiabetic complications awareness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eDuration of Diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e70\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore than 5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eb. Gender-wise demographics and glycemic profile of the Participants (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFemales\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndependent t-test p-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMean Age (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.27\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e27.93\u0026thinsp;\u0026plusmn;\u0026thinsp;3.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWaist to Hip ratio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.9134\u0026thinsp;\u0026plusmn;\u0026thinsp;0.055\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.9045\u0026thinsp;\u0026plusmn;\u0026thinsp;0.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.395\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e141.73\u0026thinsp;\u0026plusmn;\u0026thinsp;47.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135.94\u0026thinsp;\u0026plusmn;\u0026thinsp;53.47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.681\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPBS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e207.68\u0026thinsp;\u0026plusmn;\u0026thinsp;83.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e194.28\u0026thinsp;\u0026plusmn;\u0026thinsp;67.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.400\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHbA1c\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e0.571\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p-value significant at level\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe lifestyle factors of all the participants are assessed in terms of their eating patterns, sleep cycle, physical activity, and stress levels. It was found that most participants prefer non-vegetarian meal types (53%) compared to vegetarian meals (47%). About 68% had their breakfast daily, 21% did not prefer to have breakfast, and 11% missed once or twice a week. The majority (72%) prefer to have lunch from home, while 26% either order outside or from home. Packaged food consumption was also observed among the participants, and consumption was statistically significant for the frequency of having it once a week (51%). Among the participants, 63% tend to eat at a restaurant once a week, and 20% do not prefer to go outside and prefer homemade food (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMost of the participants (93%) reported irregular sleep. Most participants (66%) had good sleep for 7\u0026ndash;8 hours, 27% reported having inadequate sleep, less than 7 hours, and only 7% slept for more than 8 hours. Most participants (93%) are in the habit of watching TV and mobile before 1 hour of going to sleep. Physical Activity is assessed with the WHO IPAQ Scale, and it was found that 39% were inactive, 50% were minimally active, and only 11% were found to be physically active (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Most participants (83%) had moderate stress, 2% had high stress, and 15% had low stress as assessed by the Perceived Stress Scale (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLifestyle Factors of the Participants (n\u0026thinsp;=\u0026thinsp;100) Lifestyle Factors\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSr. no.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-square\u003c/p\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e1.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEating Preference\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eVegetarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.011*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNon-Vegetarian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e2.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eBreakfast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDon\u0026rsquo;t prefer breakfast\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.983\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMiss once or twice a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHave breakfast daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e3.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eLunch\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLunch from home\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e72\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.001*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEating or ordering outside\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eBoth\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e4.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003ePackaged food\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEat daily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e51\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore than once a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e5.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003eEating at restaurant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDaily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e0.422\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOnce a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMore than twice a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e6.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eRegular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eIrregular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eDuration of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLess than 7 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.520\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u0026ndash;8 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;8 hours\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWatch TV, and mobile before 1 hour of sleep\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.522\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e9.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003eStress Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLow\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.043*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eModerate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHigh\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e10.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003ePhysical Activity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eInactive\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e0.009*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMinimally Active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e50\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eHEPA Active\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003e*p-value significant at level\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe mean QoL score of participants was 63.37\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21. Males have a slightly better score of 64.93\u0026thinsp;\u0026plusmn;\u0026thinsp;11.03 than females, 61.02\u0026thinsp;\u0026plusmn;\u0026thinsp;11.22. About 63% of participants had a moderate score, 27% had a high score, and only 10% were found to have a low score, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. When the QoL score was assessed domain-wise across genders, a statistical significance was found between energy fatigue and general health with p values 0.015 and 0.002, respectively. However, no significance was observed in the other domains like physical function, role limitations due to physical functioning, emotional well-being \u0026amp; role limitations due to emotional functioning, and social functioning. The average QoL score has a negative correlation with HbA1c (p\u0026thinsp;=\u0026thinsp;0.002). The detailed domain-specific across the gender is given in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e3\u003c/span\u003e\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDomain-wise assessment of QoL across the gender of participants (n\u0026thinsp;=\u0026thinsp;100)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndependent t-test p-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e67.49\u0026thinsp;\u0026plusmn;\u0026thinsp;25.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e58.53\u0026thinsp;\u0026plusmn;\u0026thinsp;25.84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRole limitation due to physical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e74.58\u0026thinsp;\u0026plusmn;\u0026thinsp;14.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.065\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.12\u0026thinsp;\u0026plusmn;\u0026thinsp;19.60\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional Role Limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.00\u0026thinsp;\u0026plusmn;\u0026thinsp;19.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.323\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e61.25\u0026thinsp;\u0026plusmn;\u0026thinsp;18.83\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnergy Fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e37.33\u0026thinsp;\u0026plusmn;\u0026thinsp;18.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.015*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e48.00\u0026thinsp;\u0026plusmn;\u0026thinsp;24.72\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e68.27\u0026thinsp;\u0026plusmn;\u0026thinsp;22.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.233\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e62.66\u0026thinsp;\u0026plusmn;\u0026thinsp;23.10\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSocial Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e81.29\u0026thinsp;\u0026plusmn;\u0026thinsp;14.15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.494\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e79.25\u0026thinsp;\u0026plusmn;\u0026thinsp;15.26\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e59.58\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e49.37\u0026thinsp;\u0026plusmn;\u0026thinsp;19.82\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p-value significant at level\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eWhen QoL scores were analyzed across the duration of Diabetes (less than 5 years and more than 5 years), a statistical significance was found in the Energy fatigue Domain (p\u0026thinsp;=\u0026thinsp;0.031). The detailed domain-specific across the gender is given in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDomain-wise assessment of QoL across the duration of the disease\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\"\u0026plusmn;\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFactors\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of diabetes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eMean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eIndependent t-test p-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003ePhysical Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e62.97\u0026thinsp;\u0026plusmn;\u0026thinsp;26.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.582\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.10\u0026thinsp;\u0026plusmn;\u0026thinsp;25.32\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eRole limitation due to physical functioning\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e71.78\u0026thinsp;\u0026plusmn;\u0026thinsp;16.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e72.50\u0026thinsp;\u0026plusmn;\u0026thinsp;18.97\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional Role Limitation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e63.71\u0026thinsp;\u0026plusmn;\u0026thinsp;18.11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.763\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e65.00\u0026thinsp;\u0026plusmn;\u0026thinsp;22.39\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEnergy Fatigue\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e38.57\u0026thinsp;\u0026plusmn;\u0026thinsp;19.35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.031*\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e48.66\u0026thinsp;\u0026plusmn;\u0026thinsp;25.01\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eEmotional Wellbeing\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e66.75\u0026thinsp;\u0026plusmn;\u0026thinsp;19.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e64.31\u0026thinsp;\u0026plusmn;\u0026thinsp;29.58\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSocial Function\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e80.82\u0026thinsp;\u0026plusmn;\u0026thinsp;13.07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.717\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e79.66\u0026thinsp;\u0026plusmn;\u0026thinsp;17.80\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eGeneral Health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e55.83\u0026thinsp;\u0026plusmn;\u0026thinsp;16.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.760\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\"\u0026plusmn;\" colname=\"c3\"\u003e \u003cp\u003e54.72\u0026thinsp;\u0026plusmn;\u0026thinsp;16.67\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e*p-value significant at level\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThe present study is aimed to assess the lifestyle factors and QoL in people with Diabetes in the urban areas of Pune City. A recent study reported that urban areas have a higher prevalence rate of obesity (40%) and Diabetes (16%) as compared to rural areas, wherein the prevalence of obesity was 23.1%, and Diabetes was 8.9% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The present study also found the result in a similar context. The mean BMI of the participants in the study falls in the Obese category as per the cut-off for the Asian Population [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. The abdominal obesity was found to be more in women than the cut-off value of 0.85, which is in reference to the global trend as women have fat deposited more on the abdomen area.\u003c/p\u003e \u003cp\u003eDietary habits also help manage blood sugar levels. Many studies favor the consumption of a plant-based diet, which helps effectively manage blood sugar levels. A systematic review of 20 randomized control trials (RCTs) with more than 6 months found that a vegetarian diet showed a more significant body reduction, improved glycemic control, and insulin sensitivity [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. In our study, more than half of the population was found to eat an animal-based diet. literature suggests that animal protein intensifies insulin resistance, and people who consume animal diets are at more risk for developing Type 2 Diabetes[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Eating regularly during the whole day also helps maintain blood sugar levels. A systematic review comparing 14 cohort studies indicates that having breakfast at least 3 times per week has reduced the risk of Type 2 Diabetes Mellitus and Obesity [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. In our study, 68% of participants had breakfast daily, and more than one-third of participants ate lunch at home. Consumption of ultra-processed food and eating outside food that is high in oil and, sugar, preservatives also increase the risk of Diabetes. A systematic review and meta-analysis involving 18 studies and 1.1\u0026nbsp;million individuals showed a 72% positive association between ultra-processed food and the risk of Diabetes [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. We also found that consumption of processed food and eating out at restaurants was high among the participants either daily or on the weekly basis intensifying the risk of the disease.\u003c/p\u003e \u003cp\u003eDiabetes is a chronic condition, and its management requires proper care and attention with dietary control and daily physical activity. Doing at least 150 minutes of moderate to vigorous-intensity activity weekly and not a gap of more than 2 days between the sessions for better glycemic control[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. However, most participants were found to be physically inactive in our study, with only 11% being physically active. Stress also has a prominent role in affecting blood sugar levels. In a healthy individual, any stress releases cortisol, which increases the blood sugar level and is an adaptive response for survival; however, if the stress continues in the long run, it causes insulin resistance and leads to diabetes [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. The present study also found that 83% of participants have moderate levels of stress. Similar results were found in the study held at a tertiary care hospital in Chennai, India [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. Sleep is also essential for good health, and people with diabetes frequently struggle with sleep. However, the concept of sleep disturbances has yet to be clearly defined. In our study, 93% of participants reported having irregular sleep, and only 66% reported having adequate sleep of 7\u0026ndash;8 hours per day. It has also been observed that increased dependency on digital devices resulting in increased screen time has severe adverse effects on physical and mental health. Constant exposure to smartphones, computers, and television affects mental health, increasing stress and anxiety and leading to sleep disorders in children and adults [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. The study also found comparable results as 93% of participants watched mobile phones, laptops, and television before 1 hour of sleep, and 91% had irregular sleep. These all are the critical factors for the dysregulation of blood sugar levels, which in turn QoL of the patients.\u003c/p\u003e \u003cp\u003eThe average QoL scores were calculated, and it was found that the mean QoL score of the participants was 63.37\u0026thinsp;\u0026plusmn;\u0026thinsp;11.21, which was similar to another study by [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e]. However, few studies report high QoL Scores [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e] and low QoL scores [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]. The variation in results may be attributed to different region participants and the tools used to measure QoL. The results also show that men have slightly better QoL scores than women, consistent with a study conducted across five countries, China, Ghana, India, Russia, and South Africa, with 33,019 participants showing that men have better QoL scores than women [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. A negative correlation was observed between the QoL score and HbA1c values with p values of 0.002, which indicates that increasing sugar levels affect the quality of life.\u003c/p\u003e \u003cp\u003eThe questionnaire has seven domains, including various physical and mental health aspects. A domain-wise analysis between the gender showed that participants scored highest in Social functioning and least scores in Energy fatigue. Fatigue is a common condition in Diabetes and has a bidirectional relationship; both feed and worsen each other, creating a vicious cycle known as Diabetes Fatigue Syndrome [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. Our results are consistent with the study by [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e]which states that Low energy fatigue scores negatively impact QoL. Thus, it becomes essential for healthcare providers to address fatigue issues during the treatment and management of Diabetes. A statistical significance between the gender is observed, with men complaining that they get fatigued more quickly than women in our study. The reason could be multifactorial as they complain of poor nutritional status, busy work life, sleep irregularity, or mental stress. Statistical significance with a p-value of 0.002 is also observed in the Gender Health Domain, with men scoring (59.58\u0026thinsp;\u0026plusmn;\u0026thinsp;12.44) better than women scoring (49.37\u0026thinsp;\u0026plusmn;\u0026thinsp;19.82). General Health is a multi-dimensional domain that considers several factors affecting the QoL of the patient. Many recent studies have shown that the Diabetic population has poor QoL compared to healthy individuals. In most cases, men were observed to have better overall health than women[\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e], [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. In the rest of the domains, like role limitation due to physical functioning, emotional well-being, and role limitations due to emotional functioning, there was no statistically significant difference between both genders, indicating that both genders are equally affected.\u003c/p\u003e \u003cp\u003eWhen comparing the effect of diabetes on the disease duration, a statistical significance was found only in the Energy fatigue Domain. People who have Diabetes for less than 5 years get fatigued more rapidly than those with Diabetes duration of more than 5 years. The result could be due to fear of the progression of the disease, which affects their mental health, and they complain more of fatigue, whereas patients with chronic diabetes would have learned to live with it.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eDue to increasing urbanization, the lifestyle of people has changed as their dietary pattern shifts from consumption of a balanced diet to easy, processed, ready-to-eat foods. They have become more sedentary due to changes in working culture, leading to increased stress. All these factors impact the quality of life, which deteriorates further as the disease progresses. The present study assesses the lifestyle factors and quality of life of Type 2 Diabetic Patients among the gender and duration of disease in various physical and mental health domains. It emphasizes which factors could be responsible for their elevated sugar levels, ultimately affecting their quality of life. However, the study has certain limitations, including samples from one region and limited sample size. The patients were taken only from the OPD-based clinics, and the study did not cover all lifestyle factors affecting blood sugar levels.\u003c/p\u003e \u003cp\u003eThus, to conclude, T2DM is a lifestyle disorder that can be managed by adopting a good eating pattern and regular exercise, focusing on physical and mental health. Diabetes is a multifactorial disease; it starts affecting the body's major organs with time. Based on the results obtained from our study, there is a need to educate people on lifestyle changes that will help them control their glycemic profiles and reduce related complications. Hence, a holistic approach will be vital, which includes team collaboration consisting of a physician, nutritionist, and physiatrist/ phycologist to improve the overall quality of life among people suffering from Diabetes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe author would like to acknowledge the participants who took their time and provided detailed dietary histories. Also, thank Diabetic Clinics for allowing us to collect the data.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSource of Support and Funding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received no specific grant from any funding agency.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone declared\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor\u0026rsquo;s Contribution\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBoth authors contributed equally to the study conception and design, data collection and analysis, results interpretation, and manuscript drafting. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical Approval\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was ethically approved by the independent ethics committee of Symbiosis International (Deemed University) (IEC-SIU Pune). The ethics approval number is IEC/SIU/556.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe original data is available with the corresponding author and can be made available on request or demand.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eR. M. Anjana \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Metabolic non-communicable disease health report of India: the ICMR-INDIAB national cross-sectional study (ICMR-INDIAB-17),\u0026rdquo; \u003cem\u003eLancet Diabetes Endocrinol\u003c/em\u003e, vol. 11, no. 7, pp. 474\u0026ndash;489, Jul. 2023, doi: 10.1016/S2213-8587(23)00119-5.\u003c/li\u003e\n\u003cli\u003eJ. B. Cole and J. C. Florez, \u0026ldquo;Genetics of diabetes mellitus and diabetes complications,\u0026rdquo; \u003cem\u003eNature Reviews Nephrology\u003c/em\u003e, vol. 16, no. 7. 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Kluding, \u0026ldquo;Fatigue in type 2 diabetes: Impact on quality of life and predictors,\u0026rdquo; \u003cem\u003ePLoS One\u003c/em\u003e, vol. 11, no. 11, Nov. 2016, doi: 10.1371/journal.pone.0165652.\u003c/li\u003e\n\u003cli\u003eJ. A. Louzado \u003cem\u003eet al.\u003c/em\u003e, \u0026ldquo;Gender Differences in the Quality of Life of Formal Workers.,\u0026rdquo; \u003cem\u003eInt J Environ Res Public Health\u003c/em\u003e, vol. 18, no. 11, Jun. 2021, doi: 10.3390/ijerph18115951.\u003c/li\u003e\n\u003cli\u003eK. H. Lee, H. Xu, and B. Wu, \u0026ldquo;Gender differences in quality of life among community-dwelling older adults in low- A nd middle-income countries: Results from the Study on global AGEing and adult health (SAGE),\u0026rdquo; \u003cem\u003eBMC Public Health\u003c/em\u003e, vol. 20, no. 1, Jan. 2020, doi: 10.1186/s12889-020-8212-0.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Type 2 Diabetes Mellitus, lifestyle, stress, gender, Quality of life","lastPublishedDoi":"10.21203/rs.3.rs-4399656/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4399656/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eIndia is deemed the \u0026ldquo;Diabetes Capital,\u0026rdquo; with over 100\u0026nbsp;million people suffering from this deadly disease. The disease is a lifestyle disorder and significantly impacts the quality of life. Thus, the study assesses the lifestyle factors and quality of life among people suffering from Type 2 Diabetes.\u003c/p\u003e\u003ch2\u003eMaterials and Methods\u003c/h2\u003e \u003cp\u003eA cross-sectional study was conducted among 100 T2DM participants aged 18\u0026ndash;65. Data were collected from Diabetic Clinics across Pune City using the Modified Diabetes Quality of Life Questionnaire, having seven domains with 17 questions. PSS and IPAQ Questionnaire were used to assess the Stress and Physical Activity.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e60% of the participants were males with a mean age of 43.30\u0026thinsp;\u0026plusmn;\u0026thinsp;10.89 years. The mean age of women was 50.17\u0026thinsp;\u0026plusmn;\u0026thinsp;10.13 years. The mean HbA1c of males and females was 7.98\u0026thinsp;\u0026plusmn;\u0026thinsp;1.41 and 7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.25, respectively. 83% have moderate stress, while 11% have low stress. Only 11% were found to be physically active. The average QoL score of the participants was 63.4\u0026thinsp;\u0026plusmn;\u0026thinsp;11.2, non-significantly higher in males than in females (64.9\u0026thinsp;\u0026plusmn;\u0026thinsp;11.03 vs 61.0\u0026thinsp;\u0026plusmn;\u0026thinsp;11.22). Domain assessment of QoL showed statistical significance among general health (p\u0026thinsp;=\u0026thinsp;0.002) and energy fatigue (p\u0026thinsp;=\u0026thinsp;0.015), with males having better general health than women, and energy levels were better in females than males. However, no significance was seen between the genders in physical function, emotional well-being, and role limitation. A statistical significance for energy fatigue (p\u0026thinsp;=\u0026thinsp;0.031) was observed when QoL was assessed across the disease duration.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDue to a sedentary lifestyle and increased stress, the glycemic profile of the participants was uncontrolled, which negatively impacted their quality of life. Thus, a holistic approach to managing diabetes will be more beneficial in improving the quality of life.\u003c/p\u003e","manuscriptTitle":"Assessment of Lifestyle Factors, Stress Levels, and Quality of Life among People with Type 2 Diabetes Mellitus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-06-07 19:08:43","doi":"10.21203/rs.3.rs-4399656/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-06-24T11:39:32+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-24T11:38:35+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-24T11:38:31+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-21T14:39:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"168697415813688374347830704318115538475","date":"2024-06-17T10:09:05+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-06-06T07:03:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"153277707695678328011620996215222012354","date":"2024-05-27T10:15:49+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-25T09:22:01+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-23T11:04:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-05-23T11:02:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2024-05-10T09:22:11+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9bbee49f-b806-4c4d-873d-5352db69962d","owner":[],"postedDate":"June 7th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-08-12T16:04:54+00:00","versionOfRecord":{"articleIdentity":"rs-4399656","link":"https://doi.org/10.1186/s12982-024-00173-2","journal":{"identity":"discover-public-health","isVorOnly":false,"title":"Discover Public Health"},"publishedOn":"2024-08-06 15:56:59","publishedOnDateReadable":"August 6th, 2024"},"versionCreatedAt":"2024-06-07 19:08:43","video":"","vorDoi":"10.1186/s12982-024-00173-2","vorDoiUrl":"https://doi.org/10.1186/s12982-024-00173-2","workflowStages":[]},"version":"v1","identity":"rs-4399656","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4399656","identity":"rs-4399656","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}