The document summarizes a study on sleep quality and quality of life in adults with type 2 diabetes in Bangladesh. It provides background on the increasing prevalence of diabetes, poorer quality of life and sleep quality in those with diabetes compared to those without. The study aims to assess sleep quality and quality of life using validated scales in 180 adults with type 2 diabetes receiving care at a hospital in Dhaka, Bangladesh. It describes the methodology used, including a cross-sectional design, convenience sampling, and data collection using questionnaires to measure sleep quality, quality of life, and participant demographics. Preliminary results on the socio-demographic characteristics of participants are also presented.

1. Dr.Dr. S. M. Niaz MowlaS. M. Niaz Mowla
ID NOID NO:: 14-98060-314-98060-3
Department of Public HealthDepartment of Public Health
American International University- Bangladesh (AIUB)American International University- Bangladesh (AIUB)
Banani, Dhaka- 1213Banani, Dhaka- 1213
Sleep Quality and Quality of Life in Adults with Type 2Sleep Quality and Quality of Life in Adults with Type 2
DiabetesDiabetes
Sleep Quality and Quality of Life in Adults with Type 2Sleep Quality and Quality of Life in Adults with Type 2
DiabetesDiabetes

2. 2014 2035
Diabetes is a huge and growing problem…
Intersects with all dimensions of
development
BACKGROUND
Among these, type 2 diabetes constitutes about 85-95% of all
diabetes.

3. BACKGROUND
Prevalence and rate ratios of self-reported health as
"fair" or "poor" among individuals aged 20 years and
older, by age group and diabetes status, Canada,
2009-2010
How people perceive their
general health provides a good
indication of their quality of
life.
How people perceive their
general health provides a good
indication of their quality of
life.
In 2009-2010, nearly two-fifths
(39.1%) of Canadians aged 20
years and older who reported
having diabetes rated their
health as "fair" or "poor",
compared to a tenth of the
adult population without
diabetes (10.3%).
In 2009-2010, nearly two-fifths
(39.1%) of Canadians aged 20
years and older who reported
having diabetes rated their
health as "fair" or "poor",
compared to a tenth of the
adult population without
diabetes (10.3%).
Source: Public Health Agency of Canada (2011)

4. BACKGROUND
HRQOL is an important outcome- To evaluate the impact of the disease and its
treatment on individuals and health care costs.
People with type 2 diabetes have a worse quality of life than people with no
diabetes.
Poor sleep is prevalent in T2DM and inversely associated with quality of life.
Sleep quality is an important clinical consideration for two major reasons.
1.Complaints about sleep quality are common.
2.Poor sleep quality can be an important symptom of many sleep and medical chronic
disorders.

5. BACKGROUND
This study was a baseline survey which will-
Initiate further specific study and explore new idea for the policy makers and
service providers and diabetes educators,
--- to play a key role in assessing sleep and providing easy to improve sleep
hygiene and quality of life,
---to emphasize of screening new patients for sleep problems, making a
suggesting sleep hygiene strategies as part of diabetes management.

6. JUSTIFICATION OF THE STUDY
Studies showed- T2DM adversely affect both well being and physical functioning,
contributing to decrease HRQOL as well as sleep quality.
These studies were carried out in Europe, the USA and Japan.
Do not represent population across the globe. Particularly those from Indian
subcontinent.
Not clear whether the results are applicable to the Bangladeshi population.
About 80% of T2DM occur in developing world.
9th
leading cause of death in Bangladesh. (CDC in Bangladesh factsheet, 2014)
In 2030- BD will hold the 8th position according to the total cases of DM in adult
population.
Time to determine the sleep quality and quality of life in adults with T2DM
patients in BD for a more comprehensive and intensive approach to diabetic care as
diabetes depends on ethnicity.

7. RESEARCH QUESTIONS
How is the sleep quality in adults with type 2 diabetes?
How is the quality of life in adults with type 2 diabetes?

8. OBJECTIVES
General ObjectivesGeneral Objectives
To find out the sleep quality and quality of life in adults with Type 2
Diabetes.
Specific ObjectivesSpecific Objectives
To assess the sleep quality in adults with type 2 diabetes using Pittsburg
Sleep Quality Index.
To assess quality of life of the respondents using SF-36 v2TM
.
To determine the association between sleep quality and quality of life
among the respondents.

9. Independent VariablesIndependent VariablesIndependent VariablesIndependent Variables Dependent VariablesDependent VariablesDependent VariablesDependent Variables
• Age
• Sex
• Religion
• Marital status
• Educational qualification
• Occupation
• Monthly family income
• Duration of diabetes
• Present treatment
profile
• Number of diabetic
complication
• Presence of co-
morbidities
DemographicDemographic Diabetes MellitusDiabetes Mellitus
• Sleep latency
• Sleep duration
• Habitual sleep
efficiency
• Sleep disturbances
• Use of sleeping
medication
• Day time dysfunction
Physical functioning
Role physical
Bodily pain
General health
Mental health
Vitality
Social functioning
Role emotional
Sleep QualitySleep Quality Quality of LifeQuality of Life
STUDY VARIABLES

10. Diabetes related variable
Duration of diabetes, Treatment status
(Insulin), Complications of diabetes,
Presence of co-morbidities
Patient’s characteristics
Age, Sex, Marital status, Education,
Occupation, Family income
Sleep quality
Sleep latency, Sleep duration, Habitual
sleep efficiency, Sleep disturbance,
Use of sleeping medication, Day time
dysfunction
Sleep quality
Sleep latency, Sleep duration, Habitual
sleep efficiency, Sleep disturbance,
Use of sleeping medication, Day time
dysfunction
Quality of life
Physical functioning, Role physical,
Bodily pain, General health, Mental
health, Vitality, Social functioning,
Role emotional
Quality of life
Physical functioning, Role physical,
Bodily pain, General health, Mental
health, Vitality, Social functioning,
Role emotional
CONCEPTUAL FRAMEWORK

11. METHODOLOGY
Study DesignStudy Design
A cross sectional study.
Study TimeStudy Time
The total study period was six months, commencing from July, 2015.

12. Study PlaceStudy Place
Out Patient Department
(OPD) of National Health Care
Network, Mirpur.
- Branch of BIRDEM
- Easy approachability.
- Availability of the patients.
METHODOLOGY

13. Inclusion CriteriaInclusion Criteria
 Age – (25 - 60 years).
 Duration of Diabetes more than 1 years.
Attending the National Healthcare Network, Mirpur hospital.
Exclusion CriteriaExclusion Criteria
Type 1 diabetes.
 Diagnosed sleep disorder prior to diabetes.
 Diabetes with pregnancy.
 Inability to communicate due to physical and mental health.
METHODOLOGY

14. Sampling Method and Sampling SizeSampling Method and Sampling Size
Due to time and resource constrains, my study participants were 180.
Convenient sampling was followed for selection of study sample due to
scarcity of cases.
METHODOLOGY

15. Data Collection InstrumentsData Collection Instruments
 A semi- structured questionnaire and checklist was used to collect data.
The questionnaire was prepared by following SF-36 version 2 to assess the
HRQOL and PSQI to assess the sleep quality.
It was prepared in English and then translated to Bangla.
Data Collection ProcedureData Collection Procedure
Face to face interview.
Record review.
METHODOLOGY

16. Data Processing and Analysis PlanData Processing and Analysis Plan
 At the end of each day of data collection each questionnaire was checked to
see whether the questionnaire is filled completely and consistently.
Then they were stored after giving appropriate identification number.
The data were analyzed in computer with SPSS 20.0 version.
After meticulous cleaning and editing of the data, an analysis plan was
structured with relevance to study objective.
METHODOLOGY

17. Data Processing and Analysis Plan (Cont…)Data Processing and Analysis Plan (Cont…)
For descriptive statistics- means, medians, standard deviations, ranges for
continuous data and frequencies and proportion for categorical data were
calculated.
For inferential statistics- one way ANOVA, t test, χ2 test and Pearson’s
correlation were calculated.
Linear regression analysis was used to examine the relationships between
PSQI and HRQOL.
In all the tests, p 0.05 was considered to be statistically significant.˂
METHODOLOGY

18. Data Quality ManagementData Quality Management
Pre testing of questionnaire was made to assess the validity in out of the study
area.
On spot-check & review of the filled up questionnaires on daily bases to
ensure completeness and consistency.
Ethical IssuesEthical Issues
Ethical Approval was obtained from Research Committee of AIUB.
Verbal consent of the study participants was obtained.
Study has done through collection of data using questionnaire and neither any
intervention nor any invasive procedures has undertaken.
Privacy and highest confidentiality of the participant was maintained strictly.
All other ethical issues were handled properly.
METHODOLOGY

19. Limitation of the StudyLimitation of the Study
Limited number of research works on sleep quality in adults with T2DM of
BD.
Sampling technique- convenient method- result might not be generalized for
other population.
Possibility of recall bias of the respondents.
Did not include a control group.
Sample size limited to 180.
METHODOLOGY

21. Highest proportion of the
respondent (48.9%) was ≥ 50
years age group followed by
40-49 years age group
(30%). Mean (SD) age of the
respondents were 48.31
(±9.02) years.
Highest proportion of the
respondent (48.9%) was ≥ 50
years age group followed by
40-49 years age group
(30%). Mean (SD) age of the
respondents were 48.31
(±9.02) years.
SOCIO-DEMOGRAPHIC CHARACTER-AGE

22. 35%
65%
Gender distribution of the respondents
Male Female
SOCIO-DEMOGRAPHIC CHARACTER-GENDER

23. Secondary
16%
Higher
secondary
27%
Graduate
15%
Post
graduate
17%
Illiterate
1%
Can sign
only
7%
Primary
17%
Upto
primary
[25%]
Major proportion of respondents (43.3%) were in the educational level of S.S.C and H.S.C, up to
primary level there were 25% patients, the rest were graduates and above.
Major proportion of respondents (43.3%) were in the educational level of S.S.C and H.S.C, up to
primary level there were 25% patients, the rest were graduates and above.
SOCIO-DEMOGRAPHIC CHARACTER-EDUCATIONAL
QUALIFICATION

24. SOCIO-DEMOGRAPHIC CHARACTER-RELIGION AND
MARITAL STATUS

25. SOCIO-DEMOGRAPHIC CHARACTER-OCCUPATION

26. Characteristics Frequency Percent
Monthly family income
<20000
20000 to 29000
30000 to 39000
40000 to 49000
50000 to 59000
≥60000
62
13
33
14
22
36
34.4
7.2
18.3
7.8
12.3
20.0
Family size
<5
5 – 6
7 – 8
>8
121
21
24
14
67.2
11.7
13.3
7.8
Ownership of house
No
Yes
96
84
53.3
46.7
Type of house
Pacca building
Semi- pacca building
155
25
86.1
13.9
Area of residence
Urban
Rural
153
27
85.0
15.0
SOCIO-DEMOGRAPHIC CHARACTER-OTHERS

27. PERCENT DISTRIBUTION OF RESPONDENTS BY DURATION
OF DIABETES

28. PERCENT DISTRIBUTION OF RESPONDENTS BY VARIOUS
COMPLICATIONS DUE TO DIABETES

29. PERCENT DISTRIBUTION OF RESPONDENTS BY SELF
REPORTED HEALTH STATUS

30. PERCENT DISTRIBUTION OF RESPONDENTS BY PHYSICAL
ACTIVITIES

31. PERCENT DISTRIBUTION OF RESPONDENTS BY PHYSICAL
EMOTIONAL PROBLEMS DURING PAST 4 WEEKS

32. PERCENT DISTRIBUTION OF RESPONDENTS BY CAUSES OF
TROUBLE SLEEPING

33. Characteristics Possible maximum
score
Mean (SD) Median Range
Overall sleep quality 21 7.28(±3.06) 7 3-15
Subjective sleep quality 3 1.60(±0.68) 2 0-3
Sleep latency 3 1.66(±0.87) 2 0-3
Sleep duration 3 1.42(±0.89) 1 0-3
Habitual sleep efficiency 3 1.00(±1.07) 1 0-3
Sleep disturbance 3 1.02(±0.14) 1 1-2
Use of sleep medication 3 0.93(±1.01) 1 0-3
Day time dysfunction 3 1.06(±0.46) 1 0-3
SLEEP QUALITY

34. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30-39
40-49
≥50
5
33
54
88
4.20
6.15
7.00
8.00
1.30
2.69
2.78
3.19
5.671 0.001 0.345 <0.001
Occupation Service
Business
Housewife
Retired
Day laborer
44
23
87
20
6
6.50
8.39
6.89
8.65
10.00
2.45
3.71
2.94
2.81
3.89
4.77 0.003
Diabetes duration
(Years)
<5
5 – 9
10 – 14
≥15
63
59
33
25
6.20
7.32
8.30
8.60
2.75
3.10
2.73
3.11
5.774 0.001
BMI Normal weight
Over weight
Obese
48
86
46
6.54
7.20
8.21
2.73
3.03
3.27
3.669 0.027
Diabetic complications Yes
No
111
69
8.09
6.00
3.26
2.19
t = 5.135 <0.001
Hypertension Yes
No
96
84
7.79
6.71
3.09
2.94
t = 2.382 0.018
Coronary heart disease Yes
No
27
153
9.21
6.93
3.16
2.92
t = 3.745 <0.001
OVERALL SLEEP QUALITY

35. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30-39
40-49
≥50
5
33
54
88
1.20
1.42
1.53
1.73
0.44
0.56
0.60
0.75
2.752 0.044 0.291 <0.001
Marital status Married
Others
143
37
1.52
1.91
0.62
0.79
t = -3.222 0.002
Glycemic control
level
r = 0.759 <0.001
Diabetic
complications
Yes
No
111
69
1.78
1.31
0.70
0.52
t = 5.033 <0.001
Hypertension Yes
No
96
84
1.70
1.48
0.69
0.64
t = 2.188 0.030
Coronary heart
disease
Yes
No
27
153
2.14
1.50
0.75
0.61
t = 4.817 0.018
SUBJECTIVE SLEEP QUALITY

36. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30-39
40-49
≥50
5
33
54
88
1.20
1.40
1.50
1.80
0.44
0.86
0.74
0.93
2.871 0.038 0.274 <0.001
Diabetes duration
(years)
<5
5 – 9
10 – 14
≥15
63
59
33
25
1.39
1.72
1.84
1.92
0.81
0.80
0.93
0.95
3.418 0.019
Diabetic
complications
Yes
No
111
69
1.84
1.36
0.90
0.72
t = 3.752 <0.001
Hypertension Yes
No
96
84
1.78
1.52
0.87
0.85
t = 1.991 0.048
SLEEP LATENCY

37. SOCIO-DEMOGRAPHICAL CHARACTERISTICS AND SLEEP
QUALITY
Characteristics Sleep quality Total n(%) χ2
P-value
Poor sleeper Good sleeper
n(%) n(%)
Sex
Male
Female
46(73.0)
71(60.7)
17(27.0)
46(39.3)
63
117
0.098 0.105
Marital status
Married
Others
87(60.8)
30(81.1)
56(39.2)
7(18.9)
143
37
0.021 0.022
Educational status
Up to primary
S.S.C to H.S.C
Graduates and above
30(66.7)
52(66.7)
35(61.4)
15(33.3)
26(33.3)
22(38.6)
45
78
57
0.427 0.789
Area of residence
Urban
Rural
103(67.3)
14(51.9)
50(32.7)
13(48.1)
153
27
2.414 0.120
Type of house
Pacca
Semi-pacca
104(67.1)
13(52.0)
51(32.9)
12(48.0)
155
25
2.157 0.142

38. DIABETES PROFILE OF THE RESPONDENTS AND SLEEP
QUALITY
Characteristics Sleep quality Total
n(%)
χ2
P-value OR with 95% CI
Poor sleeper Good sleeper
n(%) n (%)
Use of oral hypoglycemic agent
Yes
No
72(60.0)
45 (75.0)
48(40.0)
15(25.0)
120
60
3.956 0.049 2.00(1.0043.984)
Use of insulin
Yes
No
75(77.3)
42(50.6)
22(22.7)
41(49.4)
97
83
14.034 <0.001 0.30(0.158-0.570)
Presence of complications
Yes
No
80(72.1)
37(56.6)
31(27.9)
32(46.2)
111
69
6.366 0.016 2.23(1.190-4.187)
Hypertension
Yes
No
68(70.8)
49(58.3)
28(29.2)
35(41.7)
96
84
3.077 0.087 -
Coronary heart disease
Yes
No
24(85.7)
93(61.2)
4(14.3)
59(38.8)
28
152
6.254 0.016 3.80(1.257-11.52)

39. Characteristics Possible
maximum score
Mean (SD) Median Range
Overall quality
of life
3600 2044.80 (±512.75) 2220 914-2910
Physical health 2100 1261.19 (±334.14) 1370 415-1975
Mental health 1500 283.60 (±204.50) 829 325-1200
QUALITY OF LIFE

40. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30 – 39
40 – 49
≥50
5
33
54
88
2542.00
2378.00
2222.61
1782.14
230.500
241.500
368.990
536.790
21.678 <0.001 -0.599 <0.001
Occupation Service
Business
Housewife
Retired
Day laborer
44
23
87
20
6
2337.50
2114.65
2010.36
1687.05
1322.33
320.14
488.58
518.14
468.42
306.14
11.324 <0.001
Diabetes duration
(Years)
<5
5 – 9
10 – 14
≥15
63
59
33
25
2252.30
2177.92
1801.73
1528.60
383.54
401.67
528.46
534.40
20.917 <0.001
Insulin use Yes
No
97
83
2168.98
1938.53
554.55
430.03
t = 3.137 0.002
Hypertension Yes
No
96
84
1899.30
2211.08
498.57
479.61
t = -4.271 <0.001
Coronary heart disease Yes
No
27
153
1481.28
2148.60
508.52
442.38
t = -7.163 <0.001
OVERALL QUALITY OF LIFE

41. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30 – 39
40 – 49
≥50
5
33
54
88
1588.00
1489.24
1371.67
1089.32
143.248
187.517
241.496
342.048
22.324 <0.001 -0.603 <0.001
Diabetes duration
(Years)
<5
5 – 9
10 – 14
≥15
63
59
33
25
1415.24
1329.66
1097.42
927.60
267.43
258.21
347.24
315.40
21.934 <0.001
BMI Normal weight
Over weight
Obese
48
86
46
1414.89
1235.46
1148.91
239.12
324.01
383.08
8.604 <0.001 -0.316 <0.001
Insulin use Yes
No
97
83
1348.12
1186.80
286.70
354.75
t = 3.373 0.001
Hypertension Yes
No
96
84
1171.87
1363.27
314.49
328.35
t = -3.979 <0.001
Coronary heart disease Yes
No
27
153
877.85
1331.80
326.05
282.74
t = -7.575 <0.001
PHYSICAL HEALTH

42. Characteristics Categories N Mean score SD F p r©
P-value
Age in years <30
30 – 39
40 – 49
≥50
5
33
54
88
954.00
889.67
850.94
692.83
97.301
103.460
161.773
220.554
14.536 <0.001 -0.516 <0.001
Diabetes duration
(Years)
<5
5 – 9
10 – 14
≥15
63
59
33
25
837.06
848.25
707.30
601.00
145.55
182.38
215.03
232.35
14.308 <0.001
BMI Normal weight
Over weight
Obese
48
86
46
896.29
765.02
700.76
138.88
195.70
229.44
12.945 <0.001 -0.352 <0.001
Insulin use Yes
No
97
83
820.85
751.73
174.41
223.87
t = 2.331 0.021
Hypertension Yes
No
96
84
727.42
847.80
210.22
178.29
t = -4.111 <0.001
Coronary heart disease Yes
No
27
153
603.42
816.79
208.78
186.15
t = -5.469 <0.001
MENTAL HEALTH

43. Sleep quality Quality of life
Overall Physical health Mental health
r©
P-value r©
P-value r©
P-value
Overall quality of sleep -0.530 <0.001 -0.540 <0.001 -0.447 <0.001
Subjective sleep quality -0.539 <0.001 -0.535 <0.001 -0.474 <0.001
Sleep latency -0.462 <0.001 -0.472 <0.001 -0.387 <0.001
Sleep duration -0.322 <0.001 -0.329 <0.001 -0.270 <0.001
Habitual sleep efficiency -0.281 <0.001 -0.288 <0.001 -0.234 0.002
Sleep disturbance -0.180 0.015 -0.186 0.012 -0.148 0.048
Use of sleep medication -0.284 <0.001 -0.312 <0.001 -0.201 0.007
Day time dysfunction -0.529 <0.001 -0.499 <0.001 -0.511 <0.001
Sleep quality score in overall sleep quality and all domains were inversely correlated with overall quality of life, physical and
mental health score. There were strong significant correlation of overall sleep quality (r= -0.530, p<0.001), subjective sleep
quality(r= -0.539, p< 0.001) and day time dysfunction (r= -0.529, p<0.001) with overall quality of life.
Sleep quality score in overall sleep quality and all domains were inversely correlated with overall quality of life, physical and
mental health score. There were strong significant correlation of overall sleep quality (r= -0.530, p<0.001), subjective sleep
quality(r= -0.539, p< 0.001) and day time dysfunction (r= -0.529, p<0.001) with overall quality of life.
CORRELATION BETWEEN SLEEP QUALITY SCORE AND
QUALITY OF LIFE

44. Overall sleep quality was categorized into two groups good sleepers (score ≤5) and poor sleepers (score >5).
Relationship between the sleep quality with the overall quality of life, physical health and mental health was
significant (p>0.001). Average score in overall quality of life, physical and mental health domains were lower in
poor sleeper than good sleeper.
Overall sleep quality was categorized into two groups good sleepers (score ≤5) and poor sleepers (score >5).
Relationship between the sleep quality with the overall quality of life, physical health and mental health was
significant (p>0.001). Average score in overall quality of life, physical and mental health domains were lower in
poor sleeper than good sleeper.
Characteristics Sleep quality N Mean score SD t P-value
Overall quality of
life
Poor sleeper
Good sleeper
117
63
1905.48
2303.52
541.17
326.29
6.147 <0.001
Physical health Poor sleeper
Good sleeper
117
63
1169.31
1431.82
351.58
213.46
6.222 <0.001
Mental health Poor sleeper
Good sleeper
117
63
136.17
871.69
213.33
153.15
4.912 <0.001
OVERALL SLEEP QUALITY AND QUALITY OF LIFE

45. Linear regression analysis showed that duration of diabetes explains 26.1%, 15.3% and 8.6%
of the variability of physical and mental health components of SF-36 and PSQI respectively.
Linear regression analysis showed that duration of diabetes explains 26.1%, 15.3% and 8.6%
of the variability of physical and mental health components of SF-36 and PSQI respectively.
Duration of
Diabetes
R R Square Adjusted R Square Std. Error of the Estimate
Physical health
(PCS)
0.511 0.261 0.257 288.06804
Mental health
(MCS)
0.397 0.157 0.153 188.23365
Sleep quality
(PSQI) 0.293 0.086 0.081 2.94011
CRRELATION BETWEEN DURATION OF DIABETES WITH PCS,
MCS AND PSQI

46. On the other hand, linear regression analysis also showed that sleep quality explains
29.2% and 20.0% of the variability of physical health and mental health of the health
related quality of life.
On the other hand, linear regression analysis also showed that sleep quality explains
29.2% and 20.0% of the variability of physical health and mental health of the health
related quality of life.
Sleep Quality R R Square Adjusted R Square Std. Error of the Estimate
Physical health
(PCS)
0.540 0.292 0.288 282.00904
Mental health
(MCS) 0.447 0.200 0.196 183.40262
CORRELATION BETWEEN SLEEP QUALITY WITH PCS
AND MCS

47. The purpose of this study was to examine the relationship between
sleep quality and health-related of life in adults with type 2 diabetes.
To our knowledge, this is the first systematic investigation to find
out the association between poor sleep and quality of life in T2DM
in Bangladesh.
For this purpose, we interviewed one eighty individuals with type 2
diabetes through a semi-structured questionnaires and check list
assessing sleep quality, health-related quality of life, comorbidities.
CONCLUSION

48. 117 participants (65%) were poor sleepers (global PSQI >5).
(Comparatively, previous studies have identified between 45% and 67% of persons with type 2
diabetes to have poor sleep quality and/or difficulty initiating or maintaining sleep.)
Poor sleeper had significantly poorer SF-36 PCS and MCS and
poorer functioning on each of the 8 domains of the SF-36 (all
p<0.001).
Poor sleeper tended to be aged, to be female, and to have more
comorbidities.
CONCLUSION

49. Overall quality of life is better in females than male but they are mentally
compromised.
Both sleep quality and quality of life were better in married persons than
others.
HRQOL was associated with age, years since diabetes diagnosis, number
of comorbidities, number of diabetic complications, insulin use.
On an average, the respondents who were suffering from diabetes ≥15
years had lower score in overall quality of life, physical and mental health.
Overall quality of life was highest in younger (15-29 years) and lowest in
elderly subjects (over 50 years). Life quality decreased with increasing
age.
CONCLUSION

50. These results suggest that poor sleep is common among persons with type
2 diabetes and that poor sleep quality is associated with HRQOL and
diabetes-related quality of life, in particular satisfaction with and impact of
treatment.
This study suggested that adequate sleep quality and quantity should be
considered a fundamental component of a healthy lifestyle, like weight
control and physical activity.
CONCLUSION

51. Ensure sleep hygiene strategies as part of diabetes management.
Ensure control blood sugar level with appropriate treatment for every type
2 diabetes patients.
Strategies should be designed to early diagnosis of diabetes and
aggressive management of blood pressure, hyperlipidaemia and
albuminuria should be ensured.
A comprehensive nationwide study about sleep quality and quality of life
of type 2 diabetes patients should be conducted.
RECOMMENDATION

52. My Supervisor
All respected faculties of MPH, AIUB
All my wonderful batch-mates of MPH
NHN, MIRPUR
ICDDR,B
My lovely family
&
Finally, American International University-
Bangladesh (AIUB)
ACKNOWLEDGEMENT