Quality of Life and Associated Factors in Indonesian Diabetic Patients with Foot Ulcers

DOI: https://doi.org/10.14710/nmjn.v8i1.16815

Article Metrics: (Click on the Metric tab below to see the detail)

Article Info
Published: 06-06-2018
Section: Articles
Fulltext PDF Tell your colleagues Email the author

Background: Diabetic foot ulcer will cause a reduction in quality of life (QOL), high care burden, and even mortality. An assessment of QOL and associated factors in patients with diabetic foot ulcer is important to provide evidence for establishing a care plan program for such patients. However, up to the present, there is no evidence of a published study that investigates the QOL and its associated factors in patients with diabetic foot ulcer in Indonesia.
: The purpose of this study was to investigate the QOL in patients with diabetic foot ulcer in each domain and investigate the factors associated with this condition.
: The design of this study was a cross-sectional study. The total sample for this study was 55 patients. The QOL data were collected using a Diabetic Foot Ulcer Scale questionnaire. Statistical analyses were conducted using Mann-Whitney U-test and Kruskal-Wallis test.
s: The result showed that the QOL in the domains of emotions, positive compliance, family life, and friend were high, while the QOL in the domains of daily activities, physical health, leisure, finances, positive attitude, and treatment ranged from low to average. Significant differences were found between income (p=0.004), grade of the wound (p=0.047), number of wounds (p=0.029), and blood glucose (p=0.013) with QOL of patients. Other variables did not have a significant relationship with QOL, but marital status had a significant correlation with the domain of leisure (p=0.004) and duration of the ulcer had a significant correlation with the domain of emotions (p=0.001)
: There is a correlation between income, grade of the wound, the number of wounds, and blood glucose with QOL of patients with a diabetic foot ulcer. This study recommends to take into account economic status, grade and number of wound, and blood glucose level in order to improve the QOL of patients for an effective patient care plan.


Diabetic; foot ulcer; quality of life

  1. Yunita Sari  Scholar
    Nursing Program, Faculty of Health Science, Jenderal Soedirman University, Indonesia
    Ini dari Panitia International Conference of Health Science Unsoed. Konferensi internasional yang bekerja sama dengan NMJN untuk publikasi artikel terpilih
  2. Iwan Purnawan 
    Faculty of Health Science, Jenderal Soedirman University, Indonesia
  3. Agis Taufik 
    , Indonesia
  4. Annas Sumeru 
    , Indonesia
  1. Abetz, L., Sutton, M., Brady, L., McNulty, P., & Gagnon, D. D. (2002). The diabetic foot ulcer scale (DFS): a quality of life instrument for use in clinical trials. Practical Diabetes International, 19(6), 167–175. https://doi.org/10.1002/pdi.356
  2. Aklima, A., Kritpracha, C., & Thaniwattananon, P. (2012). Development of family-based dietary self-management support program on dietary behaviors in patients with type 2 diabetes mellitus in Indonesia: A literature review. Nurse Media Journal of Nursing, 2,(2). Retrieved from https://ejournal.undip.ac.id/index.php/medianers/article/view/3969
  3. Aklima, A., Kritpracha, C., & Thaniwattananon, P. (2013). Dietary behaviors among patients with type 2 diabetes mellitus in Indonesia. Nurse Media Journal of Nursing, 3(1). https://doi.org/10.14710/nmjn.v3i1.4453
  4. Al-Rubeaan, K., Al Derwish, M., Ouizi, S., Youssef, A. M., Subhani, S. N., Ibrahim, H. M., & Alamri, B. N. (2015). Diabetic foot complications and their risk factors from a large retrospective cohort study. PloS One, 10(5), e0124446. https://doi.org/10.1371/journal.pone.0124446
  5. Almeida, S.A., Silveira, M. M., Santo, P.F.E., Pereira, R.C., & Salomé, G M. (2013). Assessment of the quality of life of patients with diabetes mellitus and foot ulcers. Rev Bras Cir Plást, 28(1), 142–146.
  6. Bann, C. M., Fehnel, S. E., & Gagnon, D. D. (2003). Development and validation of the diabetic foot ulcer scale-short form (DFS-SF). PharmacoEconomics, 21(17), 1277–1290.
  7. Bouhassira, D., Letanoux, M., & Hartemann, A. (2013). Chronic pain with neuropathic characteristics in diabetic patients: a French cross-sectional study. PloS One, 8(9), e74195. https://doi.org/10.1371/journal.pone.0074195
  8. de Jesus Pereira, M. T., Magela S. G., Guimaraes O. D., Cunha E. V. H., Almeida, S.A., & Masako F. L. (2014). Feelings of powerlessness in patients with diabetic foot ulcers. Wounds : A Compendium of Clinical Research and Practice, 26(6), 172–177.
  9. Deshpande, A.D., Harris-Hayes, M., & Schootman, M. (2008). Epidemiology of diabetes and diabetes-related complications. Physical Therapy, 88(11), 1254–1264. https://doi.org/10.2522/ptj.20080020
  10. Driver, V. R., Fabbi, M., Lavery, L.A., & Gibbons, G. (2010). The costs of diabetic foot: the economic case for the limb salvage team. Journal of Vascular Surgery, 52(3 Suppl), 17S–22S. https://doi.org/10.1016/j.jvs.2010.06.003
  11. Gilpin, H., & Lagan, K. (2008). Quality of life aspects associated with diabetic foot ulcers : A review. The Diabetic Foot Journal, 11(2), 56–62.
  12. Gonzalez de la Torre, H., Quintana-Lorenzo, M. L., Perdomo-Perez, E., & Verdu, J. (2017). Correlation between health-related quality of life and venous leg ulcer’s severity and characteristics: a cross-sectional study. International Wound Journal, 14(2), 360–368. https://doi.org/10.1111/iwj.12610
  13. Jin, J., Sklar, G.E., Oh, V.M.S., Li, S.C. (2008). Factors affecting therapeutic compliance: a review from the patient’s perspective. Therapeutics and Clinical Risk Management, 4(1). 269-286.
  14. Leon, B.M., & Maddox, T.M. (2015). Diabetes and cardiovascular disease: Epidemiology, biological mechanisms, treatment recommendations and future research. World Journal of Diabetes, 6(13), 1246–1258. https://doi.org/10.4239/wjd.v6.i13.1246
  15. Macioch, T., Sobol, E., Krakowiecki, A., Mrozikiewicz-Rakowska, B., Kasprowicz, M., & Hermanowski, T. (2017). Health-related quality of life in patients with diabetic foot ulceration - translation and Polish adaptation of diabetic foot ulcer scale-short form. Health and Quality of Life Outcomes, 15(1), 15. https://doi.org/10.1186/s12955-017-0587-y
  16. Mathur, R. K., Sahu, K., Saraf, S., Patheja, P., Khan, F., & Gupta, P. K. (2017). Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers. Lasers in Medical Science, 32(2), 275–282. https://doi.org/10.1007/s10103-016-2109-2
  17. Prazeres, F., & Figueiredo, D. (2014). Measuring quality of life of old type 2 diabetic patients in primary care in Portugal: a cross-sectional study. Journal of Diabetes and Metabolic Disorders, 13, 68. https://doi.org/10.1186/2251-6581-13-68
  18. Primanda, Y., Kritpracha, C., & Thaniwattananon, P. (2011). Dietary behaviors among patients with type 2 diabetes mellitus in Yogyakarta, Indonesia. Nurse Media Journal of Nursing, 1(2). Retrieved from https://ejournal.undip.ac.id/index.php/medianers/article/view/975
  19. Ribu, L., Hanestad, B.R., Moum, T., Birkeland, K., & Rustoen, T. (2007). A comparison of the health-related quality of life in patients with diabetic foot ulcers, with a diabetes group and a nondiabetes group from the general population. Quality of Life Research : An International Journal of Quality of Life Aspects of Treatment, Care and Rehabilitation, 16(2), 179–189. https://doi.org/10.1007/s11136-006-0031-y
  20. Salome, G.M., Blanes, L., & Ferreira, L.M. (2011). Assessment of depressive symptoms in people with diabetes mellitus and foot ulcers. Revista Do Colegio Brasileiro de Cirurgioes, 38(5), 327–333.
  21. Santos, I.C.R.V., Carvalho, E. F., Souza, W. V., & Albuquerque, E. C. (2015). Factors associated with diabetic foot amputations . Jornal Vascular Brasileiro, 14(1). 37-45. http://dx.doi.org/10.1590/1677-5449.20140049
  22. Sekhar, M. S., Thomas, R. R., Unnikrishnan, M. K., Vijayanarayana, K., & Rodrigues, G. S. (2015). Impact of diabetic foot ulcer on health-related quality of life: a cross-sectional study. Seminars in Vascular Surgery, 28(3), 165–171. https://doi.org/https://doi.org/10.1053/j.semvascsurg.2015.12.001
  23. Shaw, J. E., Sicree, R. A., & Zimmet, P. Z. (2010). Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Research and Clinical Practice, 87(1), 4–14. https://doi.org/10.1016/j.diabres.2009.10.007
  24. Spanos, K., Saleptsis, V., Athanasoulas, A., Karathanos, C., Bargiota, A., Chan, P., & Giannoukas, A. D. (2017). Factors associated with ulcer healing and quality of life in patients with diabetic foot ulcer. Angiology, 68(3), 242–250. https://doi.org/10.1177/0003319716651166
  25. Steel, A., Reece, J., & Daw, A.M. (2016). Understanding the relationship between depression and diabetic foot ulcers. Journal of Social Health and Diabetes, 4(1), 17–24. https://doi.org/10.4103/2321-0656.164792
  26. Syarif, H. (2013). Kualitas hidup pasien ulkus diabetes di poliklinik endokrin RSUD, Banda Aceh [The quality of life of patients with diabetic ulcers in endocrine polyclinic in RSUD Banda Aceh]. Idea Nursing Journal, IV(1), 1–7.
  27. Tuttolomondo, A., Maida, C., & Pinto, A. (2015). Diabetic foot syndrome as a possible cardiovascular marker in diabetic patients. Journal of Diabetes Research, 2015, 268390. https://doi.org/10.1155/2015/268390
  28. Valensi, P., Girod, I., Baron, F., Moreau-Defarges, T., & Guillon, P. (2005). Quality of life and clinical correlates in patients with diabetic foot ulcers. Diabetes & Metabolism, 31(3 Pt 1), 263–271.
  29. Vymětalová, R., & Zeleníková, R. (2016). Painful ulceration and QOL of patients with the diabetic foot syndrome. Cent Eur J Nurs Midw, 7(4), 512–517. https://doi.org/10.15452/CEJNM.2016.07.0023
  30. Wagner, F. W. J. (1981). The dysvascular foot: a system for diagnosis and treatment. Foot & Ankle, 2(2), 64–122.
  31. Yusuf, S., Okuwa, M., Irwan, M., Rassa, S., Laitung, B., Thalib, A., … Sugama, J. (2016). Prevalence and risk factor of diabetic foot ulcers in a regional hospital, Eastern Indonesia. Open Journal of Nursing, 6(January), 1–10. https://doi.org/10.4236/ojn.2016.61001