A Cross-sectional Study of Health-related Quality of Life among Adults with Type 2 Diabetes on Treatment with Herbal and Conventional Glucose-lowering Agents in Nairobi, Kenya

Abstract

Background: Patients with type 2 diabetes often seek care from herbal clinics for glycemic control. The impact of herbal glucose-lowering therapies on quality of life in this patient population has not been studied adequately. Aim: The study determined and compared health-related quality of life in patients with type 2 diabetes on treatment with herbal and conventional blood glucose-lowering agents in Nairobi, Kenya. Methods: A cross-sectional study was conducted among 80 patients with type 2 diabetes attending a conventional clinic at Kenyatta National Hospital and 37 patients receiving care at New Life Herbal Clinic in Nairobi City County, Kenya. A general questionnaire was used to collect sociodemographic and clinical information from the study participants. The World Health Organization Quality of Life Brief Version questionnaire was used to assess the health-related quality of life in both groups. Descriptive data analysis was performed on all variables.  The health-related quality of life scores were compared using the non-parametric Mann-Whitney test.  Multiple linear regression analyses were used to identify the determinants of health-related quality of life. P-values equal to or less than 0.05 were considered to be statistically significant. Results: Health-related quality of life scores in all the domains were significantly higher among the patients treated with conventional drugs compared to those treated at the herbal clinic (p<0.001).  Patients in both groups had the highest scores in the social domain (median score: 66.67 [33.33-75] for herbal and 75 [75-97.92] for the conventional group). Among patients on herbal therapies, the lowest scores were on psychological aspect of HRQoL (45.83 [33.33-54.17]). Regarding overall quality of life, patients at Kenyatta National Hospital had significantly higher median scores (75 [75-100]) compared to those at the herbal clinic (50 [25-75], p< 0.001). Treatment with conventional glucose-lowering agents was associated with significantly higher HRQoL scores on all the domains (p< 0.001).  Other factors associated with higher health-related quality of life scores were higher levels of education (p=0.010) and engagement in physical activity (p=0.001) for the physical domain; microvascular complications for the psychological domain (p=0.010) and male gender for the social domain (p=0.037).Additional factors associated with better environmental domain scores were male gender (p=0.033),  older age (p=0.004), urban residence ( p=0.026) and  alcohol intake (p=0.048). Conclusions: Patients on treatment with conventional therapies for type 2 diabetes had higher health-related quality of life scores compared to those on herbal treatments. We identified modifiable factors that can be enhanced to improve the quality of life of individuals with type 2 diabetes in both conventional and herbal treatment settings.