Cumulative burden of diabetes-related complications and health-related quality of life in primary care: a cross-sectional study from Mexico

Background: Understanding the coexistence of diabetes-related complications and their impact on quality of life can help guide healthcare strategies. Aim: The purpose of this study was to assess the prevalence and coexistence of diabetes-related complications and their association with health-related quality of life (HRQoL) in patients with type 2 diabetes (T2D). Methods: We conducted a cross-sectional study of 1,703 patients with T2D receiving standard care in primary healthcare units in Mexico. Diabetes-related complications assessed included peripheral neuropathy, retinopathy, chronic kidney disease, cardiovascular disease, and amputation history. HRQoL was measured using the EuroQol 5-Dimension 5-Level questionnaire. Multivariable regression analyses were used to adjust for confounders and assess associations with HRQoL. Results: Complications were present in 70.5% of patients, predominantly peripheral neuropathy. The most affected HRQoL dimensions were pain/discomfort (53.8%) and anxiety/depression (53.4%), followed by mobility (34.2%), self-care (34%), and usual activities (24.2%). Multivariable analysis showed female sex was independently associated with a higher likelihoodof reporting problems across all dimensions. Having at least one complication was also associated with impairment, except for anxiety/depression, where risk increased with two or more complications. Hypertension and use of insulin were associated with a higher risk of problems in mobility, selfcare, and usual activities. Longer diabetes duration and use of insulin were risk factors for pain/discomfort, while higher body mass index was associated with anxiety/depression. Conclusion: Diabetes-related complications are highly prevalent and affect HRQoL domains in primary care, with a greater burden as complications accumulate.