Association of Quality of Life with Adherence to Medication, Exercise and Diabetes-related Self-care Activities, and its Relationship with Glycaemic Profile in Patients with Type 2 Diabetes Mellitus: A Cross-sectional Observational Study

Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic condition with a profound impact on health-related quality of life (HRQoL). Poor adherence to medication, exercise prescriptions and self-care activities remains a significant barrier to glycaemic control and optimal patient outcomes. However, the multidimensional associations between adherence behaviours and quality of life (QoL) domains remain underexplored in Indian urban populations. Objectives: This study aimed to assess adherence to medication, exercise and diabetes-related self-care activities, and to examine their associations with health-related QoL across four domains—physical health, psychological health, social relationships and environment—in T2DM patients. Methods: A cross-sectional observational study was conducted among 193 T2DM patients recruited from diabetic clinics in Surat, Gujarat, India. Adherence to medication was measured using the Iraqi Anti-Diabetic Medication Adherence Scale (IADMAS), exercise adherence using the Exercise Adherence Rating Scale (EARS) and self-care activities using the Diabetes Self-Management Questionnaire (DSMQ). QoL was assessed using the Gujarati version of the World Health Organization Quality of Life instrument, brief version (WHOQOL-BREF). Glycaemic control was evaluated through glycated haemoglobin (HbA1c). Spearman’s correlation coefficient was used for statistical analysis. Results: The mean age of participants was 49.78 ± 13.21 years; 59.07% were female. The mean medication adherence score was 7.11 ± 1.77; exercise adherence was 15.75 ± 5.50. Physical health QoL was low in 45.6% of participants. At the nominal level, medication adherence showed significant positive correlations with physical health QoL ( r = 0.22, P = .009) and social relationship QoL ( r = 0.304, P = .019); exercise adherence was significantly associated with physical health ( r = 0.25, P = .029), psychological health ( r = 0.49, P = .010) and general health satisfaction ( r = 0.554, P = .001); and multiple DSMQ subscales—including glucose management (GM), dietary control (DC) and physical activity (PA)—demonstrated significant correlations across QoL domains. After Benjamini-Hochberg false discovery rate (BH-FDR) correction for the 54 correlations tested, only the associations between DSMQ-GM and environmental QoL ( r = 0.581, P < .001) and between exercise adherence and general health satisfaction ( r = 0.554, P = .001) remained significant. Conclusion: Adherence to medication, exercise and diabetes-related self-care activities showed nominally significant associations with HRQoL in T2DM patients, of which the associations of diabetes self-management (GM) with environmental QoL and of exercise adherence with general health satisfaction remained robust after correction for multiple testing. Targeted interventions to improve adherence across these domains may benefit patient outcomes and well-being, though confirmatory studies are warranted.