Glycemic Control and Health-Related Quality of Life in Palestinian Adults with Type 2 Diabetes: a cross-sectional analysis of satisfaction, impact, and worry

Abstract

Introduction: Type 2 Diabetes Mellitus (T2DM) represents a substantial and expanding global health burden, with well-documented impairment of Health-Related Quality of Life (HRQoL) — an effect that is often amplified in low- and middle-income, conflict-affected settings such as Palestine. Aim: This study set out to characterize the determinants and consequences of glycemic control for quality of life among Palestinian adults with T2DM, with particular attention to the satisfaction, impact, and worry dimensions of the disease experience. Methods: A cross-sectional survey enrolled 249 adult T2DM patients drawn from diabetes outpatient clinics across Palestine. A structured, self-administered questionnaire captured demographic and clinical information alongside the Arabic-language Revised Diabetes Quality of Life Questionnaire (RVDQOL-13). Patients were classified as glycemically controlled (HbA1c ≤ 7%) or uncontrolled (HbA1c > 7%). Group comparisons relied on non-parametric procedures (Mann–Whitney U, Kruskal–Wallis H), and Spearman correlations examined continuous associations with QoL. Results: Participants averaged 61.17 years of age, and just over half (54.2%) had uncontrolled glycemia. Overall QoL was moderately compromised (M = 3.31), driven mainly by the Impact domain, which captures fatigue and pain. Uncontrolled glycemia emerged as an independent predictor of poorer QoL (Mean Rank 136.17 vs. 111.78, p = 0.008), a pattern reinforced by a positive correlation between HbA1c and QoL scores (rho = 0.209, p = 0.001). Female sex, physical inactivity, and low monthly income were likewise linked to diminished QoL. Conclusion: Among Palestinian adults with T2DM, quality of life is meaningfully eroded by poor glycemic control together with being female, physically inactive, and of limited income. Improving outcomes will require care that extends beyond medication management to structured self-management education, gender-responsive support, and strategies that address practical barriers to physical activity and self-efficacy in this setting.