Diabetes-related quality of life (DR-QoL) reflects how living with diabetes affects daily functioning and well-being. The authors frame DR-QoL as the product of interacting biological and psychological processes—specifically cardiometabolic dysfunction and psychological stress—and note that these mechanisms are infrequently examined together within a unified analytic framework.
The study aimed to evaluate the independent, interactive, and mediating effects of cardiometabolic factors and stress on obstacles to DR-QoL. The design was cross-sectional, using validated instruments to assess stress and DR-QoL obstacles and a combination of logistic regression and path (mediation) analysis to test relationships among variables.
The sample comprised 1,815 adults with type 2 diabetes recruited from 15 Indonesian provinces during 2023–2024. Further sampling details, inclusion/exclusion criteria, and recruitment procedures are not reported in the abstract and should be consulted in the full text for study-level appraisal.
Stress and DR-QoL obstacles were measured with validated instruments (specific instrument names and scoring details are not provided in the abstract). Cardiometabolic variables reported include overweight and obesity, stage 2 systolic hypertension, and fasting blood glucose (FBG) abnormalities. Outcomes of interest were high stress and the presence of obstacles to DR-QoL.
Independent and synergistic effects were assessed with logistic regression models producing adjusted odds ratios (AORs). Mediation was tested via path analysis to estimate direct and indirect effects and standardized coefficients (β) for key pathways.
Overweight, obesity, stage 2 systolic hypertension, and abnormal fasting blood glucose (FBG) were significant predictors of high stress. Reported AORs for these predictors ranged from 1.982 to 20.889 (p < 0.001). The authors also identified synergistic interactions among cardiometabolic abnormalities that markedly increased the likelihood of high stress, with interaction AORs reported up to 53.972 for particular combinations.
Obstacles to DR-QoL were strongly associated with cardiometabolic abnormalities (AORs reported between 1.352 and 18.420) and with high stress (AOR = 18.930). Participants presenting multiple concurrent cardiometabolic abnormalities had the greatest risk of DR-QoL obstacles, with an observed AOR of 52.097 for the highest-risk group.
Path (mediation) analysis identified FBG and stress as primary mediators in the pathway from cardiometabolic dysfunction to DR-QoL obstacles. Among mediators, psychological stress exhibited the strongest direct effect on DR-QoL obstacles, with a standardized coefficient of β = 0.397. The abstract highlights FBG and stress as central mechanistic targets based on these mediation results.
Based on the reported findings, the authors suggest prioritizing interventions that address FBG control and psychological stress to reduce obstacles to DR-QoL among adults with type 2 diabetes. The combined influence of multiple cardiometabolic abnormalities and their interaction with stress underscores the need for integrated biological and psychosocial approaches in clinical care and self-management support.
The abstract does not provide detailed methodological information such as the names of validated instruments used, full covariate adjustment sets, sampling strategy, response rates, or potential biases. Effect estimates and statistical significance are reported in summary form; readers should consult the full text for complete methods, model specifications, and discussion of limitations.
In this large cross-sectional sample of adults with type 2 diabetes in Indonesia, cardiometabolic abnormalities—particularly abnormal fasting blood glucose—and psychological stress were strongly associated with obstacles to DR-QoL. Interactions among cardiometabolic factors substantially amplified risk, and mediation analysis positioned FBG and stress as central mechanistic targets, with stress exerting the strongest direct effect on DR-QoL obstacles (β = 0.397). The authors recommend focusing interventions on glucose control and stress reduction to mitigate barriers to DR-QoL.
(Conflict of interest: the authors declared no conflicts of interest as reported.)