Evaluation of the Influence of Quality of Life on Work Performance in the Population with Diabetes Mellitus

To evaluate the influence of quality of life on work performance in Type II Diabetes Mellitus, determining the main factors and dimensions that make up the study variables. This research has a quantitative approach and a correlational scope through an instrument designed to estimate the quality of life and work performance. 387 surveys were obtained as a result of Cronbach’s alpha of 0.88, and the results of the exploratory factor analysis showed an adequacy of KMO of 0.869. For the Bartlett sphericity test, a significant value p < 0.001 was obtained. This confirms that the 8 dimensions indicate that the instrument adequately evaluates the construct in the population studied. Little is known about the influence of quality of life on work performance in diabetes mellitus; in this research, it was found that there is a statistically significant relationship between the variable quality of life and work performance in a population with Type II Diabetes Mellitus, the better the quality of life, the greater the work performance. An interest in employees with diabetes mellitus (DM) should be shown in companies by making the subject’s own well-being part of goal 3, “Health and well-being,” and target 3.4 of reducing premature mortality from this type of disease by one-third, which aims to ensure a healthy life and promote well-being for all at all ages, through prevention and treatment and promoting mental health as one of the company’s sustainable development goals, carry out an annual survey to evaluate the quality of life and work performance and in this way the organization can carry out programs to detect early employees diagnosed and not diagnosed with DM. This research provides data and information that has been little studied on the influence on the variables of quality of life and work performance in Type II Diabetes Mellitus, given that this disease is the second leading cause of death in the country.

Introduction

The prevalence of Type II Diabetes Mellitus (T2DM) has been increasing in recent years and is one of the leading causes of death and disability. According to data from the National Health and Nutrition Survey (National Institute of Public Health, 2022), in Mexico, 14.6 million people suffer from T2DM, which represents a significant social and economic burden. It is essential to develop strategies that involve lifestyle changes with a comprehensive approach that considers the work environment of the individual who suffers from it, according to Basto-Abreuet al. (2023).

In addition to the above, according to data from the World Health Organization (2023), there are more than 420 million people in the world with this condition, which means that cases of diabetes and prevalence have increased steadily since 1980, which has caused a global emergency due to excessive expenses due to complications. In Mexico, more than 80% of expenditure is for hospital medical care and 20% for outpatient care for renal, cardiovascular, and ocular complications, amputations, disability, and disabilities which causes disability (Velasco-Contreras, 2016).

According to data from the National Institute of Public Health. INSP (2023), diabetes mellitus in Mexico is the first cause of death in women and the second in men. Around 12.4 million people have DM, and if not controlled, it can cause irreversible damage to the health of the individual. The lack of medical check-ups, an inadequate diet, and little or no physical activity can lead to the development of important conditions such as vision loss, decreased kidney function, amputations, major cardiovascular events, neuropathies, and chronic pain.

Because the present work focuses on the quality of life of patients with Type II Diabetes (T2DM) and work performance, Menonet al. (2021) highlight in their work that T2DM represents a considerable burden on both health and productivity. In their study conducted in Australia, they evaluated the potential productivity gains associated with the prevention of this disease over the next 10 years. They expressed the need to consider effective prevention strategies as an investment, not as an expense, as there are potential benefits for the health and economy of this country. However, additional cost-effectiveness analyses are required to assess the cost-effectiveness of these strategies and thus confirm these conclusions.

On the other hand, Nieuwenhuizenet al. (2014) used the Canadian Occupational Performance Measure Performance Scale (COPM) in 87 subjects. The correlation of the Pain Disability Index (PDI) and the 36-item RAND Health Survey (RAND-36) was carried out. Its proposed dimensions are physical functioning, social functioning, role limitation (physical), role limitation (emotional), mental health, vitality, pain, and general perception of health.

Another author who makes contributions to work performance is Kantrowitzet al. (2012), who indicate that the relationship that can occur between work performance and performing several tasks at the same time (polychronicity) was carried out by carrying out a study in which three dimensions are defined: preference in the use of time, the context and tangibility of time. Regarding the job performance rating, the areas of achievement, service orientation, strategy, vision, integrity, teamwork, judgment/problem-solving, influence, and motivation were included. The results obtained showed that several functions at the same time are significantly related to personality dimensions, health problems, and personal issues of the individual are often ignored since more importance is given to the multiple tasks assigned within the organization, and this translates into frequent changes of activities, uncertainty, and time pressure to fulfill the established tasks.

In a paper published on diabetes and employment by Ghoshet al. (2018), it is mentioned that workers suffering from diabetes must be medically evaluated and assigned a medical fitness for the work they intend to perform, so workers with controlled and uncomplicated diabetes do not need special accommodations to perform their work. The same author points out that in people with complications, evaluations of the efficacy and safety of the activities carried out within the organization should be carried out. In addition, it recommends routine measurements of the health of workers with diabetes in order to support the maintenance of their health.

This manuscript contains three sections on the development of the research, firstly an overview of the dimensions that make up the quality of life and work performance in the population with diabetes focusing on the information found in the current literature. Secondly, the multiple regression model is presented, which estimates the effect of the quality of life variable on work performance, determining the impact and statistical significance of the independent variable on the dependent variable. Finally, the article culminates with conclusions and recommendations for future research.

The main objective of this research is to evaluate the influence of quality of life on the work performance of people suffering from Type II Diabetes Mellitus. Quality of life is made up of aspects that are defined as objective, subjective, and social that define the perception of the individual about his or her position in life within a cultural concept. physiological state, social relationships, and the relationship with their environment (WHO, 2002), it is thought that there is a direct relationship with the work performance of the individual with this condition, and four dimensions are considered for each of the two variables for quality of life: physical health, psychological health, satisfaction, and social relationships (social environment) and for work performance: absenteeism, motivation, layoffs, and productivity (United Nations, 2023).

Materials and Methods

Methods

Multiple Regression Model

The analysis of the data obtained from the survey was carried out, and the viability of the instrument was reported through a multiple regression model, determining the statistical significance of the independent variable in the dependent variable, as well as its impact, testing the following (Table I) statistical hypothesis:

where

(1) $$\begin{array}{r}{Y}_1={\beta }_0+{\beta }_1{X}_1+{\beta }_2{X}_2+{\beta }_3{X}_3+{\beta }_4{X}_4+e_1\end{array}$$

(2) $$\begin{array}{r}{H}_0:{\beta }_k=0vs{H}_a:{\beta }_k\ne 0,k=0,1,2,3y4\end{array}$$

$Y$ – work performance (1: absenteeism, 2: layoffs, 3: motivation, and 4: productivity).

X₁ – physical health (X₂: Psychological Health, X₃: Satisfaction, and X₄: Social Relationships).

$e_{ij}$ – model error.

The formulas describing the variables for quality of life (3) and work performance (4) are described below:

(3) $$\begin{array}{rcl}& & Qualityoflife\\ & & =\{SocialRelationships+physicalhealth\\ & & +psychologicalhealth+Satisfaction\}/4\end{array}$$

(4) $$\begin{array}{rcl}& & Workperformance\\ & & =\{absenteeism+layoffs\\ & & +motivation+productivity\}/4\end{array}$$

Table I. Model Hypothesis

Ho: βx = 0	Ho: β0 = 0	Ho: β1 = 0	Ho: β2 = 0	Ho: β3 = 0	Ho: β4 = 0
Ha: βx ≠ 0	Ha: β 0 ≠ 0	Ha: β1 ≠ 0	Ha: β2 ≠ 0	Ha: β3 ≠ 0	Ha: β4 ≠ 0

As we can see, there is a relationship between the variables motivation-satisfaction-productivity that considers the physical and psychological needs of the individual and is part of Maslow’s hierarchy theory in such a way that these dimensions were evaluated in the measurement instrument of this study.

The hypotheses are described theoretically:

• The quality of life of people with Type II Diabetes Mellitus is directly related to their work performance.
• The main factors and dimensions that make up the quality of life of people with Type II Diabetes Mellitus will influence their work performance.
• Strategies that improve the quality of life of people with Type II Diabetes Mellitus will contribute to the improvement of work performance.

Materials

This research has a quantitative, correlational, cross-sectional, prospective approach, focusing on quality of life and work performance, collecting data in fieldwork at a specific time from December 2022 to August 2023 to test the research hypothesis through the development and application of an instrument.

In relation to the sample of 387, in this research, there are inclusion criteria to apply the instrument to a group of people who suffer from Type II Diabetes Mellitus, are aged between 18 and 80 years, are active population, and who answer all the questions of the survey, there are sites to apply the survey in different locations in Mexico City and in the metropolitan area. In this research, non-probabilistic convenience sampling was performed.

Instrument Reliability

Cronbach’s alpha statistic was used to obtain the reliability of the quality of life and work performance survey in the population with T2DM. The results are Cronbach’s alpha 0.883 and Number of elements 40.

The result is 88.3% reliability, which indicates that the instrument is reliable according to Tavakol and Dennick (2011) Cronbach’s alpha coefficient, the closer it is to its maximum value of 1, the higher the reliability of the scale, alpha values above 0.7 are considered acceptable, greater than 0.8 is good and above 0.9 is excellent.

The reliability results for each construct of the studied population are described below in Table II.

Table II. Cronbach’s Alpha Reliability Results for all Dimensions

Variable	Dimension	Cronbach’s alpha	Percentage
Quality of life and work performance	All	0.883	88.30%
Quality of life	Physical health	0.742	74.20%
	Psychological health	0.667	66.70%
	Satisfaction	0.771	77.10%
	Social relationships	0.781	78.10%
Work performance	Absenteeism	0.727	72.70%
	Dismissals	0.873	87.30%
	Motivation	0.811	81.10%
	Productivity	0.802	80.20%

Validity of the Instrument

For construct validation, exploratory factor analysis (EFA) by principal components, Promax rotation method with Kaiser normalization were used, and the assumptions of application of factor analysis were tested with the Kaiser-Meyer-Olkin index (KMO) and Bartlett’s sphericity test.

The results obtained for the 40 Likert-type questions of the studied population obtained the KMO index close to 1 (KMO = 0.869), and the Bartlett sphericity test is significant with a p < 0.05 (significance level (sig.) is <0.001), that is, the exploratory factor analysis is suitable to be used in the data obtained from the 387 respondents. This confirms that the factorial model is adequate to explain the data obtained from the Quality of Life and Work Performance Survey in the Population with Type II Diabetes Mellitus (Table III).

Table III. KMO and Bartlett Test

Kaiser-Meyer-Olkin measure of sampling adequacy		0.869
Bartlett’s sphericity test	Approx. Chi-square	7508.194
	Gl	780
	Gis.	<0.001

The variables that were analyzed for the studied sample are described in the following table, and the dimensions (latent variables) for quality of life and work performance are included. These constructs take into account the physical and psychological state, work environment, and social relationships that define the individual’s perception of his or her position in life as stated by the World Health Organization (2010) considers that there is a direct relationship with the work performance of the individual with this condition (Table IV).

Table IV. Latent Variables and Observable Instrument Variables

Variables	Latent variable	Observable variables
Quality of life	Social relationships	6, 17, 22, 39 and 40
	Physical health	1, 2, 3, 5, 7 and 8
	Psychological health	9, 10, 11, 12 and 38
	Satisfaction	13, 14, 15 and 16
Work performance	Absenteeism	4, 18, 19, 21 and 25
	Dismissals	23, 24, 26 and 32
	Motivation	27, 28, 29, 30 and 33
	Productivity	20, 31, 34, 35, 36 and 37

Exploratory Factor Analysis (EFA)

Data analysis is carried out to summarize through a minimum number of factors (or dimensions) the information obtained on the influence of quality of life on work performance in employees with Type II Diabetes Mellitus. For the analysis, the following were carried out:

1. Calculating the variability between variables.
2. Obtaining the total variance explained to define the number of factors.
3. Quantify each dimension (latent variable).

Commonalities

It is the degree to which each variable managed to capture the theoretical concept; we can also have variations that are influenced by the procedure itself. The commonality of a variable is the value of the variance of the data, which can be explained by the factorial model obtained.

By analyzing the commonalities of extraction, we can assess which variables (questions) explain the model the worst; in this case, it is observed that the variable that explains the model the worst is question 7. How often do you take time to prepare your food? The model is only capable of reproducing 39.4% (0.394) of its original variability.

Total Variance Explained

This analysis tells us that with six factors, we can explain 58.0% of the reliability of the data of the analyzed sample. Likewise, the matrix of components a (or standard matrix) measures the behavior that the individual perceives with the question; in this case, question 4 has a value of 0.162, included in component 6; it is the only one with the smallest value of the rest of the items. Given the cross-factorial load, it indicates that this question can be eliminated later.

Results

In accordance with the general objective of this research, to evaluate the influence of quality of life on the work performance of people suffering from Type II Diabetes Mellitus, an instrument was developed that was used to collect data from the target population; the instrument contains 51 questions of which 11 are demographic and 40 Likert. The survey application showed an average application time of seven to ten minutes both via online platform and face-to-face.

Age

In the present study, 387 surveys (385 cases analyzed and two cases lost for this analysis) were analyzed as an instrument for the evaluation of the quality of life and work performance of people with T2DM, with an age range of 20 to 80 years, and an average of 51.08 ± 11.41.

Gender

Distribution of the study sample by gender: 48.8% (188/385) of the participants are men, while 51.2% (197/385) are women (two cases were eliminated from the system, so we have a total of 385 cases analyzed and two cases lost).

Occupation

The most frequent occupation was as an employee at 26.0%, followed by trade at 21.3%, professional at 17.4%, and cleaning work at 15.6%, respectively.

Multiple Regression Model

According to Pearson’s correlation coefficient (R² = 0.357), 35.7% of the data is explained by the mathematical model, because these are results with great variability. The above confirms that the dimensions studied in this research are supported by the objective of the study. The results of Table V are obtained.

Table V. Multiple Regression Model and Regression Statistics

Model overview
Model	R	R-squared	Adjusted R-squared	Standard estimation error
3	0.597c	0.357	0.351	0.09762

According to the ANOVA results of the Linear Regression, the model is statistically significant and would look like the following (P < 0.001):

$$\begin{array}{rl}Y\left(Workperformance\right)& =\beta 0+\beta 1\times X1\\ & \left(Physicalhealth\right)+\beta 2\times X2\\ & \left(Psychologicalhealth\right)+\beta 4\\ & \times X4\left(Socialrelationships\right)\end{array}$$

For this analysis, 387 surveys were evaluated (Table VI).

Table VI. Analysis of Variance (ANOVA)

	Degrees of freedom	Sum of squares	Average of squares	F	Gis
Regression	3	1.687	0.562	59.009	<0.001d
Waste	319	3.040	0.010
Total	322	4.727

As can be seen in the graph of the multiple regression model (Fig. 1) with the data obtained through a valid and reliable instrument that tells us that there is a statistically significant relationship between quality of life and work performance, that is, the relationship between both variables is directly proportional, which shows that the better the quality of life, the better the work performance of an employee who suffers from T2DM.

Fig. 1. Quality of life vs work performance.

Discussion

This chapter discusses the results obtained from this research related to the theoretical framework. The general objective of this research is to evaluate the influence of quality of life on work performance in the population suffering from Type II Diabetes Mellitus (T2DM). Both variables represent important social and economic changes in the individual with this condition, so it is essential to implement lifestyle changes with a comprehensive approach in the workplace (Basto-Abreuet al., 2023).

Cases of diabetes have increased; according to World Health Organization (2023), there are more than 420 million personnel worldwide, and it is the second cause of disability, which represents lost years of healthy life, causing significant effects on the worker’s work environment.

A study in Australia evaluated the possibility of increasing productivity by preventing T2DM, expressed that it is necessary to implement effective prevention strategies in employees with this condition, raising awareness that it represents a future investment and not an immediate expense since potential benefits for the health of the individual are obtained (Menonet al., 2021).

However, Nieuwenhuizenet al. (2014) used the Canadian Occupational Performance Measure Performance Scale (COPM) in 87 subjects. They carried out the correlation of the Pain Disability Index (PDI) and the 36-item RAND Health Survey (RAND-36), and as a result, they observed that chronic pain of moderate to severe intensity is reflected in 19% of the population studied and has repercussions on their work performance and social relationships, which affects their ability to be independent. affecting their quality of life and physical and occupational functions, psychological health, are involved. Finally, they concluded that quality of life and functioning correlate with an individual’s work performance as the ability to choose, organize, and effectively perform their daily tasks.

In this sense, Kantrowitzet al. (2012) evaluate the relationship between job performance and polychronicity (performing several tasks at the same time), carry out two studies, and include employees from different organizations. As a result, they observe that time is an important factor in the individual’s work life, as workers are expected to perform several activities at the same time, so time plays an important role in the worker’s individual performance and is intimately related to the organization’s goals and bottom line.

They conclude that temporary problems such as health and personal issues of the individual are often ignored since more importance is given to the multiple tasks assigned, which translates into frequent changes of tasks, uncertainty, and time pressure to fulfill the assigned activities.

As we can see, there is a relationship between the variables motivation-satisfaction-productivity that considers the physical and psychological needs of the individual and is part of Maslow’s hierarchy theory in such a way that these dimensions were evaluated in the measurement instrument of this study.

Thus, we can say that the following hypotheses are fulfilled: General hypothesis: The level of quality of life influences the work performance of people with Type II Diabetes Mellitus. Specific hypothesis 1: The quality of life of people with Type II Diabetes Mellitus is directly related to their work performance. Specific hypothesis 2: The main factors and dimensions that make up the quality of life of people with Type II Diabetes Mellitus will influence their work performance.

This indicates that it is essential that an individual with T2DM with a high level of quality of life be able to have better work performance. This is supported by Buyset al. (2007), who point out that there is a relationship between chronic pain and work performance, affecting their ability to be independent and, as a consequence, their health-related quality of life. They conclude that quality of life and functioning correlate with an individual’s work performance and develop the ability to choose, organize, and effectively perform their daily tasks.

Conclusion

The aim of this research was to evaluate the influence of quality of life on work performance in people suffering from Type II Diabetes Mellitus. It is confirmed by multiple regression that the better the quality of life, the greater the work performance, so the proposed hypotheses are accepted, which are: the quality of life of people with T2DM is directly related to their work performance, the main factors and dimensions that make up the quality of life of people with this condition will influence their work performance and the strategies that improve the quality of life of people with T2DM. People with Type II Diabetes Mellitus will contribute to the improvement of work performance.

With the results obtained in this study, it is proposed to apply the survey “Quality of life and work performance in the population with T2DM” in organizations as a tool for senior management to assume responsibility for workers with this condition and define their priorities, increase efforts, implement requirements for a better quality of life and act in favor of their well-being.

Additionally, for future studies, an interest in employees with diabetes mellitus in organizations should be shown, making the subject’s own well-being as part of the company’s sustainable development goals, conducting an annual survey on quality of life and work performance, and carrying out programs to detect diagnosed and undiagnosed patients early.

In addition, it is advisable to adhere to health sector programs such as the one carried out at the Center for Comprehensive Care of Patients with Diabetes (CaIPaDi, 2015) for people with a recent diagnosis, which has a comprehensive model of diabetes care and education.

It is also recommended to promote sports actions in favor of the prevention and control of diabetes by generating habits such as diet and daily exercise. An example is the Mexico City Marathon, where runners participate with the slogan “Let’s control diabetes.” Likewise, maintain healthy eating habits so that overweight and obesity can be prevented; for this reason, food is an energy intake in individuals with this condition.

The issue of diabetes mellitus in Mexico and in the world is a priority because it is the second cause of death, and it is necessary to face the challenges of globalization that require qualified personnel in good health, so it will be interesting to replicate this research in other states of the republic.