# Quality of Life, Treatment Satisfaction, and Perceived Stress Among Adults with Type 2 Diabetes Attending Clinics in Conflict-Affected Syria: A Cross-Sectional Study

## TL;DR

This study found that adults with type 2 diabetes in conflict-affected Syria face poor quality of life, moderate treatment satisfaction, and high stress due to disrupted healthcare.

## Contribution

The study provides new insights into diabetes care challenges in conflict zones and identifies predictors of psychosocial outcomes in this population.

## Key findings

- Participants reported significant quality-of-life impairment and high perceived stress levels.
- Rural residence and comorbidities like depression and retinopathy were linked to poorer outcomes.
- Treatment satisfaction was moderate despite frequent hyperglycemia reports.

## Abstract

Background: The protracted Syrian conflict has severely disrupted healthcare services, compromising the continuity and quality of care for individuals with type 2 diabetes mellitus (T2DM). This study evaluated diabetes-related quality of life, treatment satisfaction, and perceived stress among adults with T2DM receiving care in selected clinics within conflict-affected Syrian regions and examined predictors of these outcomes. Methods: A cross-sectional survey was conducted in July 2024 among 200 adults with T2DM recruited from outpatient clinics, primary healthcare centers, and diagnostic laboratories in Homs and Damascus. Participants completed validated Arabic versions of the Audit of Diabetes-Dependent Quality of Life (ADDQoL), Diabetes Treatment Satisfaction Questionnaire (DTSQs), and Perceived Stress Scale (PSS-10), alongside the collection of sociodemographic and clinical data. Descriptive statistics, univariate analyses, and multivariable linear regression models were applied. As this study used a facility-based purposive sample, its findings may not be generalizable to all individuals with diabetes in Syria. Results: Participants had a mean age of 57.6 ± 11.8 years, and 59.5% were male. Hypertension (70.5%) and obesity (35.5%) were the most common comorbidities, while retinopathy (21.5%), nephropathy (23.5%), and neuropathy (19.5%) were the most frequent complications. The mean ADDQoL Average Weighted Impact score was −3.1 ± 1.3, indicating substantial quality-of-life impairment. The mean DTSQs total score was 30.4 ± 5.6, suggesting moderate satisfaction with treatment despite frequent perceived hyperglycemia. The mean PSS-10 score was 18.8 ± 3.4, with 92.5% of respondents experiencing moderate stress. In multivariable models, poorer quality of life was predicted by older age, rural residence, higher BMI, and depression. Lower treatment satisfaction was associated with rural residence and retinopathy, while higher perceived stress was linked to lower education, obesity, and obstructive sleep apnea. Conclusions: Adults with T2DM attending selected healthcare facilities in conflict-affected Syria experience marked reductions in quality of life, moderate treatment satisfaction, and elevated psychosocial stress. These findings highlight the need for strengthened medication supply chains, improved rural service coverage, and integration of psychosocial support within diabetes care in fragile health systems.