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Original Research (Original Article) 


Saad T. Alboqami et al, 2020;4(3):722–729.

International Journal of Medicine in Developing Countries

The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study

Saad T. Alboqami1*, Abdulmalik Z. Alotaibi1, Wael S. Alotaibi1, Fehaid S. Almutalq1, Hamzah S. Alwadai1, Abdulrahman M. Al-Abdulmonem1, Mohammad J. Alharbi1

Correspondence to: Saad T. Alboqami

*Medical intern, College of Medicine, Majmaah University, Saudi Arabia.

Email: alboqami41 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 03 January 2020 | Accepted: 13 January 2020


ABSTRACT

Background:

Diabetes is one of the most prevalent chronic diseases in the Persian Gulf region, accounting for most of the cases that lead to a decrease in life quality in diabetic patients. This study aimed to evaluate the quality of life (QoL) in diabetic patients and the factors affecting it in patients of type 2 Diabetes Mellitus.


Methodology:

An observational cross-sectional study carried out in primary health care units and hospital of Majmaah from November 2017 to May 2018 to assess the QoL in randomly sampled diabetic patients aged 30–60 years in Majmaah City, Saudi Arabia. Patients with psychiatric illness, mental instability, physical and cognitive impairment, and gestational diabetes were excluded from the study.


Results:

The study included 179 resident patients. Almost half of the patients (49.2%) had a bachelor’s degree while near a quarter of diabetic participants had high school qualification (24%). There was no observed difference in the QoL between the groups, based on gender, in areas of functioning, except for the physical operation where a male had a vital superior physical functioning QoL compared to females (74.23 vs. 66.6, p = 0.037).


Conclusion:

The results of the survey showed a moderate global QoL among the surveyed diabetic patients, similarly average QoL was observed in the three domains of physical functioning, social functioning, and work functioning. Our findings revealed the necessity to institute appropriate measures and interventions by health authorities to ensure better management of diabetics and ameliorating the existing QoL of patients with diabetes in Saudi Arabia.


Keywords:

Diabetes mellitus, quality of life.


Introduction

The World Health Organization (WHO) estimated that there were 422 million adults living with diabetes mellitus (DM) in 2014 compared to only 108 million in 1980. Globally, the prevalence of diabetes has almost quadrupled, what it was in 1980 [1]. Diabetes prevalence is increasing rapidly; according to previous 2013 estimates from the International Diabetes Federation (IDF), there were 415 million people having diabetes in 2015, while it is expected to reach 642 million by the year 2040 [2]. Type 2 DM makes up about 85%–90% of all cases [3]. DM is a disease that is related to many complications that can affect a person’s quality of life (QoL), and in particular, a person’s mental and physical functioning [4].

The IDF reported that there were 3.8 million cases of diabetes in the Kingdom of Saudi Arabia (KSA) in 2017 with a prevalence reported at 18.5% [5]. Diabetes is the most common disease in KSA. Due to its local dietary customs and social traditions, limited success has been recorded with intervention programs [6]. The WHO expects that the number of people with DM in the KSA will triple from 890,000 in 2000 to 2,523,000 in 2030 [7].

Health-related quality of life (HRQoL) is a concept related to physical, mental, emotional, and social functioning. It goes directly to measure overall population health, average life expectancy, and causes of death and focuses mainly on the impact that health status has on QoL [8]. Today, studies have shown that HRQoL among diabetics is much lower than those reported among non-diabetics.


Subjects and Methods

An observational cross-sectional study carried out in the primary health care units and hospitals of Majmaah, Riyadh, Saudi Arabia from November 2017 to May 2018 to assess the QoL in a randomly sampled group of already diagnosed diabetic patients between the ages of 30 and 60 years. Patients with psychiatric illness, mental instability, physical and cognitive impairment, and gestational diabetes were excluded from the study.

A self-administered local modified questionnaire [an Arabic version of the Short-Form 36 item survey (SF-36)] was used in the evaluation of diabetic patients to assess their HRQoL. The SF-36 consisted of eight health aspects, including physical function, pain, role limitations due to physical health issues, role limitations due to personal/emotional problems, mental well-being, social function, energy/fatigue, and general health perceptions. We calculated the physical score which included four domains: physical functioning (PF), role physical (RP), body pain (BP), and general health (GH); the mental score which also included four domains: vitality (VT), social functioning (SF), role emotional (RE), and mental health (MH); and the work score which included three domains (PF, RP, and RE). The reliability (Cronbach’s alpha = 0.786) and validity of the SF-36 have been demonstrated for diabetes patients [9-13]. The patients were briefed regarding the questionnaire and given a copy to fill out.


Results

The socio-demographic characteristics are shown in Table 1.

Table 1. Demographic characteristics of the participants (n = 179).

n = 179 Percent (100%)
Gender Male 98 54.7
Female 81 45.3
Level of education Elementary 18 10.1
Middle school 13 7.3
High school 43 24.0
Bachelor 88 49.2
Master 12 6.7
Ph.D. 5 2.8

Our study included 179 residents’ patients in Majmaah city, Riyadh, Saudi Arabia. About 55% (n = 98) of subjects were of the male gender, and 45.3% (n = 81) were female. Almost half of the patients (49.2%) had a bachelor’s degree, while nearly a quarter of diabetic participants (24%) had a high school qualification.

Figure 1 shows that the majority of patients (67%) showed a high physical QoL, while more than a quarter (28.5%) showed a moderate physical QoL of life in relation to their disease, while 4.5% had a poor physical QoL. In terms of mental health, approximately half of the diabetic respondents (53.6%) had a high mental QoL, while 38% of patients had a moderate mental QoL, while 8.4% of respondents had a poor QoL (Figure 1). Concerning the social QoL, most diabetic subjects (65.9%) had a high QoL, followed by 30.7% of respondents with a moderate QoL, followed by a minority (3.4%) of respondents with poor QoL (Figure 2). In regard to work QoL, almost three-fifths of studied subjects (59.2%) had a high QoL, while near the quarter (24.6%) had a moderate QoL, while 16.2% of diabetic participants had a poor QoL (Figure 3).

Overall, diabetic participants had a moderate QoL in all three domains (physical functioning, social functioning, and work functioning). Patients with diabetes had significantly higher scores in social domains of QoL compared with physical functioning and work functioning (76.9 vs. 70.6 vs. 68.9, p ≤ 0.005). The biggest influence was on work domains (68.9, p = 0.000) followed with physical domains (70.5, p < 0.005) and social domain (76.8, p ≤ 0.005). Most of the patients had poor quality of work, which had a significant correlation with physical quality (0.836) and a lower correlation with social quality (0.643) (Tables 2 and 3).

We assessed the effect of gender of patients with diabetes on their QoL, resulting in that gender had a significant effect on the physical QoL where males had a significantly better or superior physical functioning QoL compared to females (74.23 vs. 66.6, p = 0.037). In other aspects of QoL, such as body pain, VT, social functioning, role emotional, and mental health, no statistically significant differences between the compared groups based on gender in areas of functioning were found. Therefore, gender had no significant effect on the QoL for patients with diabetics except for the physical QoL, where men had a better QoL (Table 4).

Both genders had near scores in physical total score (men = 71.1 ± 19.7, women = 69.9 ± 23.1), in social score (men = 76.9 ± 23.1, women = 76.9 ± 21.7), work score (men = 68.6 ± 29.3, women = 69.1 ± 26.3), mental score (men = 65.8 ± 23.5, women = 65.9 ± 21.1), and in total score (men = 67.4 ± 17.6, women = 65.6 ± 15.7). In summary, areas of physical, social domains, work, and mental functioning, no statistically significant differences were found between the groups according to gender (Table 5).

We assessed the effect of the education level of diabetic patients on their scores of QoL in different aspects. In considering physical functioning, patients with master’s degree had higher mean of the score (79.6 ± 15.7) followed by patients with a bachelor’s degree (73.2 ± 24.5) and lowest score was for patients with high school (64.3 ± 22.4); however, no significant relationship between education level and physical functioning was found (p = 0.296). In the aspect of role physical, patients with master’s degrees remain to have the highest score (91.67 ± 28.9) while patients with Ph.D. had the lowest score (60 ± 54.7) with no significant relationship between the education level of patients and role physical. The same results were remaining to appear in all other aspects; in summary, no statistically significant differences in QoL between the compared groups with the level of education in any of the areas of functioning were found.

Figure 1. Distribution of sample by the level of QoL.

Figure 2. Distribution of sample by the level of social QoL.

Figure 3. Distribution of sample by the level of work QoL.

In considering the relationship between total score and education level of patients with diabetics, areas of physical, mental functioning, and total scores of QoL showed that no statistically significant differences were found between the groups according to the level of education.

Mental health was mostly correlated with VT, which means feeling full of energy (p correlation =0.630) and least correlate with the emotional score (p correlation = 0.339). Physical score and emotional score were more correlated with social functioning of patients (p correlation = 0.633, 0.542, respectively) while the physical score was little correlated with the emotional score (p correlation = .406) and the emotional score was least correlate with VT (p correlation = 0.391). However, a significant relationship among physical score, VT, social, emotional, and mental health had been established (Table 6).

A significant correlation had been found between mental, body pain, physical functioning, role physical, and general health. The mental score was mostly correlated with the body pain score of patients (p correlation = 0.606) while it was least correlated with physical functioning (p correlation = 0.203). In addition, physical functioning gave the lowest correlation with other factors. The role of functioning was mostly correlated with the mental score (p correlation = 0.551). Moreover, general health was mostly correlated with pain score (p correlation = 0.527) (Table 7).

Table 2. Correlations between physical functioning, social functioning, and work functioning.

Physical functioning Social functioning Work functioning Total QoL score
Physical functioning X 1 0.633** 0.836** 0.906**
p 0.000 0.000 0.000 0.000
n 179 179 179 179
Social functioning X 0.633** 1 0.643** 0.705**
p 0.000 0.000 0.000 0.000
n 179 179 179 179
Work functioning X 0.836** 0.643** 1 0.889**
p 0.000 0.000 0.000 0.000
n 179 179 179 179
Total QoL score X 0.906** 0.705** 0.889** 1
p 0.000 0.000 0.000 0.000
n 179 179 179 179

**Correlation is significant at the 0.01 level (2-tailed).


Discussion

Diabetes is a chronic disease that alters the QoL. Several studies have provided information on the QoL of people with type 1 and 2 diabetes in order to improve their QoL [14,15]. Factors associated with the QoL of people with diabetes are multiple, related to socio-demographic and socioeconomic characteristics, the pathology itself, its microangiopathic and macroangiopathic complications and hypoglycemia, and the level of autonomy [14].

Among non-respondents to the SF-36 for the physical and mental component summary, most of the patients aged between 55 and 60 years. These subjects probably have a worse QoL than all the studied individuals. The consequences of this selection bias are probably an underestimate of the deterioration in the QoL of the survey population.

Table 3. Descriptive statistics.

Mean ± Standard Deviation n
Physical functioning 70.55 ± 19.04 179
Social functioning 76.89 ± 22.38 179
Work functioning 68.84 ± 27.95 179
Total QoL score 66.55 ± 16.73 179

Findings from our study revealed that diabetic patients had moderate global well-being and also the moderate QoL in the three domains (physical functioning, social functioning, and work functioning), whereas participants with diabetes had significantly higher scores in social domains of QoL compared with physical functioning and work functioning. Poor well-being was observed among patients in work domains.

Concerning the impact of demographic factors on diabetic patients’ QoL, the current study showed that gender had only an influence on physical functioning while educational level had no significant effect on any of the QoL domains. Contrary to our results, in the study conducted by Jayasinghe et al. [15], gender was found as a factor associated with diabetic individuals’ QoL by other studies [16,17].

Bosić-Zivanović et al. [18] reported that QoL was lower in the total of four domains (physical health, psychological health, social relations, and environment). DM affected mostly the physical domains and lower well-being was assessed in patients with comorbidity compared to those without comorbidity. In their work, the authors have also reported that physical and psychological domains were influenced by the educational level [19].

Using the WHOQoL-BREF Scale to assess physical, psychological, environmental health, and social relationships, Gholami et al. [19] revealed that more than half of the study patients from Neyshabur had a mean score of QoL of 12.18, suggesting moderate to low QoL among them, where the most superior score was discerned in the social relationships domain, and the poorest mean score was noticed in the psychological health domain.

Table 4. Results in the area of functioning in relation to gender.

Areas of functioning Gender n Mean ± Standard deviation p-value
Physical functioning Male 98 74.23 ± 22.945 0.037
Female 81 66.60 ± 25.566
Role physical Male 98 72.45 ± 44.907 0.535
Female 81 76.54 ± 42.637
Body pain Male 98 81.63 ± 24.493 0.514
Female 81 79.32 ± 22.287
General health Male 98 55.99 ± 12.972 0.510
Female 81 57.25 ± 12.339
VT Male 98 59.80 ± 22.290 0.662
Female 81 58.40 ± 20.091
Social functioning Male 98 76.91 ± 23.080 0.985
Female 81 76.85 ± 21.661
Role emotional Male 98 59.18 ± 49.402 0.495
Female 81 64.20 ± 48.241
Mental health Male 98 67.47 ± 21.179 0.245
Female 81 64.00 ± 18.044

Table 5. Summary of results of physical, social, and work functioning in relation to gender.

Areas of functioning Gender n Mean ± Standard deviation p-value
Physical total score Male 98 71.0778 ± 19.71754 0.689
Female 81 69.9306 ± 18.29681
Social score Male 98 76.91 ± 23.080 0.985
Female 81 76.85 ± 21.661
Work total score Male 98 68.6224 ± 29.36423 0.907
Female 81 69.1152 ± 26.33266
Total Male 98 67.3615 ± 17.55692 0.477
Female 81 65.5697 ± 15.74287
Mental Male 98 65.8406 ± 23.48536 0.995
Female 81 65.8611 ± 21.09411

The QoL was found better in patients with less duration of the disease (less than five years) and patients’ compliance with the treatment. The same trend was perceived by Al-Maskari et al. [20,21] among patients aged less than 40-years old. The results of the research by Al Hayek et al. [16] showed patients older than 50 years had a poor QoL. Using the SF-36 questionnaire, Weinberger et al. found no relationship between glycemic control and patients’ well-being [22]. Similarly, Testa et al. [23] found no association of higher HBA1C with reduced QoL. According to another study, people with diabetes with middle to high economic status had a higher QoL compared to patients with lower-economic status.

Table 6. Correlations.

Physical score VT Social functioning Role emotional Mental health
Physical score X 1 0.533** 0.633** 0.406** 0.512**
p 0.000 0.000 0.000 0.000 0.000
n 179 179 179 179 179
VT X 0.533** 1 0.522** 0.391** 0.630**
p 0.000 0.000 0.000 0.000 0.000
n 179 179 179 179 179
Social functioning X 0.633** 0.522** 1 0.542** 0.541**
p 0.000 0.000 0.000 0.000 0.000
n 179 179 179 179 179
Role emotional X 0.406** 0.391** 0.542** 1 0.399**
p 0.000 0.000 0.000 0.000 0.000
N 179 179 179 179 179
Mental health X 0.512** 0.630** 0.541** 0.399** 1
p 0.000 0.000 0.000 0.000 0.000
N 179 179 179 179 179

**Correlation is significant at the 0.05 level (2-tailed).

Table 7. Correlations.

Mental score Physical functioning Role physical Body pain General health
Mental score X 1 0.203** 0.511** 0.606** 0.448**
p 0.000 0.007 0.000 0.000 0.000
n 179 179 179 179 179
Physical functioning X 0.203** 1 0.174* 0.240** 0.331**
p 0.007 0.000 0.020 0.001 0.000
n 179 179 179 179 179
Role physical X 0.511** 0.174* 1 0.509** 0.327**
p 0.000 0.020 0.000 0.000 0.000
n 179 179 179 179 179
Body pain X 0.606** 0.240** 0.509** 1 0.527**
p 0.000 0.001 0.000 0.000 0.000
n 179 179 179 179 179
General Health X 0.448** 0.331** 0.327** 0.527** 1
p 0.000 0.000 0.000 0.000 0.000
n 179 179 179 179 179

**Correlation is significant at the 0.05 level (2-tailed).


Conclusions

The results of our survey showed a moderate global QoL among the surveyed diabetic patients, and moderate QoL in all the three domains (physical functioning, social functioning, and work functioning). Higher QoL scores were observed in social domains, while poorer well-being was observed among patients in work domains. Whereas gender was found significantly associated with physical functioning, the educational level had no significant effect on any of the QoL domains. We need to educate diabetic patients to improve the QoL to avoid complications.


List of Abbreviations

BP Body pain
DM Diabetes mellitus
GH General health
HRQoL Health-related quality of life
IDF International Diabetes Federation
KSA Kingdom of Saudi Arabia
MH Mental health
PF Physical functioning
QoL Quality of life
RP Role physical
SF Social functioning
WHO World Health Organization

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

Ethics Committee at Majmaah University approved the study via letter number MUREC-Mar.01/COM-2017/12.


Author details

Saad T. Alboqami1, Abdulmalik Z. Alotaibi1, Wael S. Alotaibi1, Fehaid S. Almutalq1, Hamzah S. Alwadai1, Abdulrahman M. Al-Abdulmonem1, Mohammad J. Alharbi1

  1. Medical Intern, College of Medicine, Majmaah University, Saudi Arabia

References

  1. Global Report on Diabetes; 2017 [cited 2019 Dec 24]. Available from: http://apps.who.int/iris/bitstream/handle/10665/204871/9789241565257_eng.pdf?sequence=1
  2. What is Diabetes; 2019 [cited 2019 Dec 24]. Available from: http://www.idf.org/aboutdiabetes/what-is-diabetes
  3. Williams RH, Wilson JD. Williams textbook of endocrinology. Philadelphia: Saunders; 2011. p 1371.
  4. Al Hayek AA, Robert AA, Al Saeed A, Alzaid AA, Al Sabaan FS. Factors associated with health-related quality of life among Saudi patients with type 2 diabetes mellitus: a cross-sectional survey. Diabetes Metab J. 2014;38:220–29. https://doi.org/10.4093/dmj.2014.38.3.220
  5. IDF MENA Members (Saudi Arabia); 2017 [cited 2019 Dec 24]. Available from: http://idf.org/our-network/regions-members/middle-east-and-north-africa/members/46-saudi-arabia.html
  6. Al Hayek AA, Robert AA, Al Dawish MA, Zamzami MM, Sam AE, Alzaid AA. Impact of an education program on patient anxiety, depression, glycemic control, and adherence to self-care and medication in Type 2 diabetes. J Family Community Med. 2013;20:77–82. https://doi.org/10.4103/2230-8229.114766
  7. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004;27:1047–53. https://doi.org/10.2337/diacare.27.5.1047
  8. Ferrans CE. Definitions and conceptual models of quality of life. In: Lipscomb J, Gotay CC, Snyder C, editors. Outcomes assessment in cancer: measures, methods, and applications. Cambridge, UK: Cambridge University Press; 2005. Available from: https://www.healthypeople.gov/sites/default/files/HRQoLWBFullReport.pdf:14-30. https://doi.org/10.1017/CBO9780511545856.002
  9. Walters SJ. Quality of Life Outcomes in Clinical Trials and Health-Care Evaluation. A practical guide to analysis and interpretation. John Wiley & Sons, Ltd, West Sussex, United Kingdom. 2009;p 380. https://doi.org/10.1002/9780470840481
  10. Richard R, Rubin CDE. Diabetes and Quality of Life. Diabetes Spectrum. 2000;13:1–21.
  11. Spasić A, Radovanović RV, Đorđević AC, Stefanović N, Cvetković T. Quality of life in type 2 diabetic patients. Acta Facultatis Medicae Naissensis. 2014;31(3):193–200. https://doi.org/10.2478/afmnai-2014-0024
  12. Al-Aboudi IS, Hassali MA, Shafie AA. Knowledge, attitudes, and quality of life of type 2 diabetes patients in Riyadh, Saudi Arabia. J Pharm Bioallied Sci. 2016;8(3):195–202. https://doi.org/10.4103/0975-7406.171683
  13. Mathew A, Anusree T, Mathew A, Archana S. Quality of life among type 2 diabetes mellitus patients in South India: a descriptive study. Am Int J Res Humanit Arts Soc Sci. 2014;215:197–200.
  14. Esin R, Khairullin I, Esin O, Abakumova A. Quality of life in patients with type 2 diabetes mellitus. BioNanoSci. 2016;6(4):502–7. https://doi.org/10.1007/s12668-016-0261-6
  15. Jayasinghe UW, Harris MF, Parker SM, Litt J, van Driel M, Mazza D, et al. Preventive Evidence into Practice (PEP) Partnership Group. The impact of health literacy and life style risk factors on health-related quality of life of Australian patients. Health Qual Life Outcomes. 2016;14(1):68. https://doi.org/10.1186/s12955-016-0471-1
  16. Al Hayek AA, Robert AA, Al Saeed A, Alzaid AA, Al Sabaan FS. Factors associated with health-related quality of life among Saudi patients with type 2 diabetes mellitus: a cross-sectional survey. Diabetes Metab J. 2014;38(3):220–9. https://doi.org/10.4093/dmj.2014.38.3.220
  17. Didarloo A, Alizadeh M. Health-related quality of life and its determinants among women with diabetes mellitus: a cross-sectional analysis. Nurs Midwifery Stud. 2016;5(1):e28937. https://doi.org/10.17795/nmsjournal28937
  18. Bosić-Zivanović D, Medić-Stojanoska M, Kovacev-Zavisić B. [The quality of life in patients with diabetes mellitus type 2]. Vojnosanit Pregl. 2012;69(10):858–63. https://doi.org/10.2298/VSP1210858B
  19. Gholami A, Azini M, Borji A, Shirazi F, Sharafi Z, Zarei E. Quality of life in patients with type 2 diabetes: application of WHOQOL-BREF scale. Shiraz E Med J. 2013;14:162–71.
  20. Kalda R, Rätsep A, Lember M. Predictors of quality of life of patients with type 2 diabetes. Patient Prefer Adherence. 2008;2:21–6.
  21. Al-Maskari MY, Al-Shookri AO, Al-Adawi SH, Lin KG. Assessment of quality of life in patients with type 2 diabetes mellitus in Oman. Saudi Med J. 2011;32(12):1285–90.
  22. Weinberger M, Kirkman MS, Samsa GP, Cowper PA, Shortliffe EA, Simel DL, et al. The relationship between glycemic control and health-related quality of life in patients with non-insulin-dependent diabetes mellitus. Med Care. 1994;32(12):1173–81. https://doi.org/10.1097/00005650-199412000-00002
  23. Testa MA, Simonson DC. Health economic benefits and quality of life during improved glycemic control in patients with type 2 diabetes mellitus: a randomized, controlled, double-blind trial. JAMA. 1998;280(17):1490–6. https://doi.org/10.1001/jama.280.17.1490


How to Cite this Article
Pubmed Style

Alboqami ST, Alotaibi AZ, Alotaibi WS, Almutalq FS, Alwadai HS, Al-Abdulmonem AM, Alharbi MJ. The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. IJMDC. 2020; 4(3): 722-729. doi:10.24911/IJMDC.51-1578840077


Web Style

Alboqami ST, Alotaibi AZ, Alotaibi WS, Almutalq FS, Alwadai HS, Al-Abdulmonem AM, Alharbi MJ. The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. http://www.ijmdc.com/?mno=81665 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1578840077


AMA (American Medical Association) Style

Alboqami ST, Alotaibi AZ, Alotaibi WS, Almutalq FS, Alwadai HS, Al-Abdulmonem AM, Alharbi MJ. The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. IJMDC. 2020; 4(3): 722-729. doi:10.24911/IJMDC.51-1578840077



Vancouver/ICMJE Style

Alboqami ST, Alotaibi AZ, Alotaibi WS, Almutalq FS, Alwadai HS, Al-Abdulmonem AM, Alharbi MJ. The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. IJMDC. (2020), [cited March 29, 2020]; 4(3): 722-729. doi:10.24911/IJMDC.51-1578840077



Harvard Style

Alboqami, S. T., Alotaibi, . A. Z., Alotaibi, . W. S., Almutalq, . F. S., Alwadai, . H. S., Al-Abdulmonem, . A. M. & Alharbi, . M. J. (2020) The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. IJMDC, 4 (3), 722-729. doi:10.24911/IJMDC.51-1578840077



Turabian Style

Alboqami, Saad T., Abdulmalik Z. Alotaibi, Wael S. Alotaibi, Fehaid S. Almutalq, Hamzah S. Alwadai, Abdulrahman M. Al-Abdulmonem, and Mohammad J. Alharbi. 2020. The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. International Journal of Medicine in Developing Countries, 4 (3), 722-729. doi:10.24911/IJMDC.51-1578840077



Chicago Style

Alboqami, Saad T., Abdulmalik Z. Alotaibi, Wael S. Alotaibi, Fehaid S. Almutalq, Hamzah S. Alwadai, Abdulrahman M. Al-Abdulmonem, and Mohammad J. Alharbi. "The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study." International Journal of Medicine in Developing Countries 4 (2020), 722-729. doi:10.24911/IJMDC.51-1578840077



MLA (The Modern Language Association) Style

Alboqami, Saad T., Abdulmalik Z. Alotaibi, Wael S. Alotaibi, Fehaid S. Almutalq, Hamzah S. Alwadai, Abdulrahman M. Al-Abdulmonem, and Mohammad J. Alharbi. "The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study." International Journal of Medicine in Developing Countries 4.3 (2020), 722-729. Print. doi:10.24911/IJMDC.51-1578840077



APA (American Psychological Association) Style

Alboqami, S. T., Alotaibi, . A. Z., Alotaibi, . W. S., Almutalq, . F. S., Alwadai, . H. S., Al-Abdulmonem, . A. M. & Alharbi, . M. J. (2020) The quality of life among patients with Diabetes mellitus in Majmaah city, Riyadh, Saudi Arabia: a cross-sectional study. International Journal of Medicine in Developing Countries, 4 (3), 722-729. doi:10.24911/IJMDC.51-1578840077