Associations between diabetes-related symptoms, glycemic control, and health-related quality of life in adult Samoans

Aim 
The prevalence of Type 2 diabetes in Samoa has increased substantially over the last 30 years. Identifying common symptoms in those living with diabetes may be instrumental in directing those at risk to seek early evaluation, diagnosis, and treatment. Additionally, identifying associations between diabetes experiences and health-related quality of life is useful for understanding the lived experience of having diabetes in this setting. Here we present the first description of diabetes-related symptoms in an adult cohort of Samoans with diabetes and prediabetes and describe associations between symptom presence and sex, glycemic control (HbA1c ≥ 8.0%), and health-related quality of life (HRQL). We also assessed whether reported symptoms were independently associated, when adjusting for other factors, with increased odds of having diabetes. 
METHODS 
Analyses were conducted on n = 123 adult Samoan participants selectively sampled from the observational cohort Soifua Manuia study, and who were living with either prediabetes or diabetes. Participants completed a series of anthropometric, biochemical, and questionnaire measures including the Revised Diabetes Symptoms Checklist (DSC-R) questionnaire between 2017-2019. Differences in symptom presence by sex, diabetes status (prediabetes vs. diabetes), glycemic control (HbA1c < or ≥ 8.0%), and HRQL were assessed using Independent Sample T-tests, Mann Whitney U tests and Chi-square tests of association. Multivariate logistic regression was used to assess which symptoms, when controlling for other factors, were associated with increased odds of having diabetes. 
RESULTS 
In a small sample of adult Samoans, we observed high symptom burdens among those with prediabetes and diabetes, and sex differences in the reported impact of diabetes symptoms on health-related quality of life. We identified three specific symptoms – frequent urination, difficulty thinking clearly, and chest/heart pains – that may be useful indicators of diabetes in this setting. 
DISCUSSION 
A high prevalence of symptoms was observed among those with prediabetes and among those with diabetes. It is recommended that individuals experiencing any of the measured symptoms seek early evaluation and engage in diabetes self-care behaviors to prevent diabetes-related complications and/or progression to diabetes among those in the early stages of the disease.