Jamil A Malik, Azra Batool, Abida Nawaz.
Feedback loop between diabetes management and quality of life: a synthesis of direct and indirect effects.
Pak J Med Res Jan ;55(4):103-8.

Objectives: To address the feedback loop between glycemic control and quality of life and to see the direct and indirect effect of self regulation through resilience on the quality of life. Study design, settings and duration: A cross-sectional questionnaire based survey design was used to collect data from outpatient departments of various hospitals in Rawalpindi and Islamabad during October-November, 2012. Patients and Methods: Patients taking treatment for type 2 diabetes on outdoor basis were included in the study. Patients having major diabetic complication causing or coexisting with a physical disability, medical condition or psychiatric co morbidity were excluded. Informed consent was taken from all patients before filling of questionnaires. Quality of Life was assessed using the Murphy et al tool while resilience was measured using State-Trait Resilience Inventory, developed by Hiew et al and for self-regulation the scale translated by Sawar was used. Self-regulation was defined as the cognitive ability of an individual to manage with adverse life events and to continue with a proactive life13 while resilience was the quality of an individual that allowed him to face adversities of life and come back even stronger. Statistical analyses were conducted using SPSS and AMOS version 21. Results: Overall patients with higher glucose levels had poor quality of life (r = -.16, p < .05) but the relationship was not significant in the feedback loop. Whereas along with direct and indirect effect of self-regulation (β = .45, and β = .26 respectively; p < .05) and direct effect of resilience (β = .33, p < .05) on quality of life, Model 2 (without feedback loop) suggested that current glucose level is directly predicted by quality of life (β = -.13, p < .05) and indirectly by resilience and self-regulation through quality of life (β = -.09, and β = -.04 respectively; p <.05). Conclusion: Self-regulation has a significant direct and indirect effect through resilience on quality of life. Life style change is a stable indicator of glycemic control than glycemic control changing life style. Key words: Feedback loop, self-regulation, resilience, quality of life, direct and indirect effect.

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