{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T07:18:16Z","timestamp":1788851896480,"version":"build-2803163510"},"reference-count":32,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T00:00:00Z","timestamp":1777939200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:00:00Z","timestamp":1783296000000},"content-version":"vor","delay-in-days":62,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Sci Rep"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Type 2 diabetes mellitus (T2DM) is a growing public health concern in Brazil, especially in underserved regions where social and geographic barriers may affect disease management and quality of life. Functional capacity and health-related quality of life (HRQoL) are critical dimensions often overlooked in primary care approaches. To assess the functional capacity and HRQoL of individuals with T2DM receiving care in primary health units in Tocantin\u00f3polis, Northern Brazil, and to explore associations with sociodemographic and clinical variables. This is a cross-sectional, descriptive, and analytical study involving 99 adults diagnosed with T2DM. Functional capacity was assessed through validated protocols measuring upper and lower limb muscle strength, hamstring flexibility, mobility and cardiorrespiratry fitness. Physical activity was analyzed using the International Physical Activity Questionnaire (IPAQ) and HRQoL was assessed through Diabetes Quality of Life (DQOL). Sociodemographic and clinical data were also collected. Statistical analysis included descriptive statistics and linear regression models. Most participants were women (71%), with a mean age of 58.7 years. The physical and psychological domains of DQOL presented the lowest scores, while the social domain had the highest. Functional capacity was low for most participants. There were significant associations between low physical activity levels and poorer HRQoL scores in the physical and psychological domains. Individuals with T2DM in this sample presented reduced functional capacity and compromised HRQoL, particularly in domains related to physical and psychological well-being. These findings highlight the urgent need for integrated health strategies in primary care that address physical activity and emotional support for people living with diabetes in remote and low-resource settings.<\/jats:p>","DOI":"10.1038\/s41598-026-37453-7","type":"journal-article","created":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T14:35:35Z","timestamp":1777991735000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Living with diabetes: quality of life and functional impairment among adults with type 2 diabetes in Northern Brazil"],"prefix":"10.1038","volume":"16","author":[{"given":"Joana Marcela Sales","family":"de Lucena","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Denise Maria Martins","family":"Vancea","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jorge Luiz","family":"de Brito-Gomes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sacha","family":"Clael","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandre Lima de Ara\u00fajo","family":"Ribeiro","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luiz Guilherme Grossi","family":"Porto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wagner Rodrigues","family":"Martins","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,5]]},"reference":[{"key":"37453_CR1","unstructured":"International Diabetes Federation. Diabetes Atlas 11th edition [Internet]. 11o ed. 2025 [citado 26 de outubro de 2025]. Dispon\u00edvel em: diabetesatlas.org."},{"key":"37453_CR2","doi-asserted-by":"crossref","unstructured":"Celli, A. et al. Lifestyle intervention strategy to treat diabetes in older adults: A randomized controlled trial. Diabetes Care 1o de setembro de. 45 (9), 1943\u20131952 (2022).","DOI":"10.2337\/dc22-0338"},{"key":"37453_CR3","doi-asserted-by":"crossref","unstructured":"Bersch-Ferreira, A. C. et al. A Nutritional Strategy Based on Multiple Components for Glycemic Control in Type 2 Diabetes: A Multicenter Randomized Controlled Clinical Trial. Nutrients. 1o de novembro de. 16(22) (2024).","DOI":"10.3390\/nu16223849"},{"key":"37453_CR4","unstructured":"WHO. WHOQOL: measuring quality of life. Psychol. Med. ; (1998)."},{"key":"37453_CR5","doi-asserted-by":"crossref","unstructured":"Umegaki, H. Management of Older Adults with Diabetes Mellitus: Perspective from Geriatric Medicine Vol. 15, p. 1347\u20131354 (John Wiley and Sons Inc, 2024). Journal of Diabetes Investigation.","DOI":"10.1111\/jdi.14283"},{"key":"37453_CR6","doi-asserted-by":"crossref","unstructured":"Cheng, L. et al. The effects of an empowerment-based self-management intervention on empowerment level, psychological distress, and quality of life in patients with poorly controlled type 2 diabetes: A randomized controlled trial. Int J Nurs Stud [Internet]. 1o de abril de 2021 [citado 21 de outubro de 2025];116:103407. Dispon\u00edvel em: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0020748919302147","DOI":"10.1016\/j.ijnurstu.2019.103407"},{"key":"37453_CR7","doi-asserted-by":"crossref","unstructured":"G\u00e1lvez Gal\u00e1n, I., C\u00e1ceres Le\u00f3n, M. C., Guerrero-Mart\u00edn, J., L\u00f3pez Jurado, C. F. & Dur\u00e1n-G\u00f3mez, N. Health-related quality of life in diabetes mellitus patients in primary health care. Enferm Clin. 1o de setembro de. 31 (5), 313\u2013322 (2021).","DOI":"10.1016\/j.enfcle.2021.03.003"},{"key":"37453_CR8","doi-asserted-by":"crossref","unstructured":"Zhuang, Y. et al. The effect of multidisciplinary team and experience-based co-design on the care of older adult patients with type 2 diabetes: A randomized controlled trial. Diabetes Res Clin Pract [Internet]. 1o de mar\u00e7o de 2025 [citado 26 de outubro de 2025];221:112028. Dispon\u00edvel em: https:\/\/www.sciencedirect.com\/science\/article\/pii\/S0168822725000427","DOI":"10.1016\/j.diabres.2025.112028"},{"key":"37453_CR9","doi-asserted-by":"crossref","unstructured":"Kim, H. J., Hwang, Y. J., Park, J. E. & Lee, D. Y. Effectiveness of walking prescription using mobile health technology on the changes in daily steps in older adults with cognitive impairment: randomized controlled study. JMIR Aging [Internet]. 11 de junho de 2025;8:e63081\u2013e63081. Dispon\u00edvel em: https:\/\/aging.jmir.org\/2025\/1\/e63081","DOI":"10.2196\/63081"},{"issue":"3","key":"37453_CR10","doi-asserted-by":"publisher","first-page":"515","DOI":"10.1590\/S0004-27302008000300012","volume":"52","author":"CJ Correr","year":"2008","unstructured":"Correr, C. J. et al. Translation to Portuguese and validation of the diabetes quality of life measure (DQOL-Brazil). Arq. Bras. Endocrinol. Metabol Abril De. 52 (3), 515\u2013522 (2008).","journal-title":"Arq. Bras. Endocrinol. Metabol Abril De"},{"key":"37453_CR11","doi-asserted-by":"crossref","unstructured":"Jacobson, A. M., De Groot, M. & Samson, J. A. The evaluation of two measures of quality of life in patients with type I and type II diabetes. Diabetes Care ; (1994).","DOI":"10.2337\/diacare.17.4.267"},{"key":"37453_CR12","unstructured":"American College of Sports Medicine. ACSM\u2019s Fitness Assessment Manual. 6a. Wolters Kluwer, organizador. Philadelphia; (2021)."},{"issue":"3","key":"37453_CR13","first-page":"244","volume":"5","author":"RE Rikli","year":"1997","unstructured":"Rikli, R. E. & Jones, C. J. Assessing physical performance in independent older adults: issues and guidelines. J. Aging Phys. Act. 5 (3), 244\u2013261 (1997).","journal-title":"J. Aging Phys. Act."},{"issue":"2","key":"37453_CR14","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1111\/j.1532-5415.1991.tb01616.x","volume":"39","author":"D Podsiadlo","year":"1991","unstructured":"Podsiadlo, D. & Richardson, S. The timed up & go: a test of basic functional mobility for frail elderly persons. J. Am. Geriatr. Soc. 39 (2), 142\u2013148 (1991).","journal-title":"J. Am. Geriatr. Soc."},{"key":"37453_CR15","doi-asserted-by":"crossref","unstructured":"de Lima, A. B., Faber, M. A., Peralta, M., Vila-Su\u00e1rez, H. & Henriques-Neto, D. Functional Fitness of Low-Income Community-Dwelling Older Adults in Amazonian Brazilian. Healthcare [Internet]. 14 de outubro de; 13(20), 2575 (2025). Dispon\u00edvel em: https:\/\/www.mdpi.com\/2227-9032\/13\/20\/2575","DOI":"10.3390\/healthcare13202575"},{"issue":"7487","key":"37453_CR16","doi-asserted-by":"publisher","first-page":"150","DOI":"10.1038\/506150a","volume":"506","author":"R Nuzzo","year":"2014","unstructured":"Nuzzo, R. Statistical errors: P values, the\u2019gold standard\u2019of statistical validity, are not as reliable as many scientists assume. Nature 506 (7487), 150\u2013153 (2014).","journal-title":"Nature"},{"key":"37453_CR17","unstructured":"Associa\u00e7\u00e3o Brasileira Para O Estudo Da Obesidade E Da S\u00edndrome Metab\u00f3lica (Diretrizes Brasileiras de Obesidade, 2016)."},{"key":"37453_CR18","doi-asserted-by":"crossref","unstructured":"Esp\u00edrito-Santo, H. & Daniel, F. Calcular e apresentar tamanhos do efeito em trabalhos cient\u00edficos (3): Guia para reportar os tamanhos do efeito para an\u00e1lises de regress\u00e3o e ANOVAs. (2018).","DOI":"10.31211\/rpics.2018.4.1.72"},{"key":"37453_CR19","doi-asserted-by":"crossref","unstructured":"Lucia, S., Fornaro, S., Federici, M. & Rumiati, R. I. The impact of type 2 diabetes on aging: multidimensional approaches to preserve cognitive health. Acta Diabetologica. Springer-Verlag Italia s.r.l. (2025).","DOI":"10.1007\/s00592-025-02583-3"},{"key":"37453_CR20","doi-asserted-by":"crossref","unstructured":"Dinges, S. M. T. et al. Cardiovascular risk factors, exercise capacity and health literacy in patients with chronic ischaemic heart disease and type 2 diabetes mellitus in germany: baseline characteristics of the lifestyle intervention in chronic ischaemic heart disease and type 2 diabetes study. Diab Vasc Dis. Res. 1o de julho de, 19(4), (2022).","DOI":"10.1177\/14791641221113781"},{"key":"37453_CR21","doi-asserted-by":"crossref","unstructured":"Nomura, T., Kawae, T., Kataoka, H. & Ikeda, Y. Loss of lower extremity muscle strength based on diabetic polyneuropathy in older patients with type 2 diabetes: multicenter survey of the isometric lower extremity strength in type 2 diabetes: phase 2 study. J. Diabetes Investig 1o de mar\u00e7o de. 12 (3), 390\u2013397 (2021).","DOI":"10.1111\/jdi.13354"},{"key":"37453_CR22","doi-asserted-by":"crossref","unstructured":"Lin, C. L. et al. Risk factors for falls in older adults with type 2 diabetes: A cross-sectional study. Med. (United States),\u00a0 103(50), e40895 (2024) (13 de dezembro de).","DOI":"10.1097\/MD.0000000000040895"},{"issue":"3","key":"37453_CR23","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1590\/S1414-81452010000300025","volume":"14","author":"AF Vitor","year":"2010","unstructured":"Vitor, A. F., Lopes, M. V. & de O, Ara\u00fajo, T. L. Teoria do d\u00e9ficit de autocuidado: an\u00e1lise Da suaimport\u00e2ncia e aplicabilidade Na pr\u00e1tica de enfermagem. Esc Anna Nery. 14 (3), 611\u2013616 (2010).","journal-title":"Esc Anna Nery"},{"key":"37453_CR24","doi-asserted-by":"crossref","unstructured":"Mueller, J. et al. Glucose Lowering through weight management (GLoW): a randomised controlled trial of the clinical and cost effectiveness of a diabetes education and behavioural weight management programme vs a diabetes education programme in adults with a recent diagnosis of type 2 diabetes. Diabetologia 1o de maio de. 68 (5), 969\u2013980 (2025).","DOI":"10.1007\/s00125-024-06355-6"},{"key":"37453_CR25","doi-asserted-by":"crossref","unstructured":"Yoo, J. H., Jun, J. E., Kwak, S. H. & Kim, J. H. Improved glycemic control in Insulin-Treated individuals with poorly controlled type 2 diabetes through combined structured education with Real-Time continuous glucose monitoring. J. Diabetes Sci. Technol. ; (2025).","DOI":"10.1177\/19322968241306136"},{"key":"37453_CR26","doi-asserted-by":"crossref","unstructured":"Jamshidpour, B., Bahrpeyma, F. & Khatami, M. R. The effect of aerobic and resistance exercise training on the health related quality of life, physical function, and muscle strength among hemodialysis patients with Type 2 diabetes. J Bodyw Mov Ther [Internet]. 1o de abril de 2020 [citado 21 de outubro de 2025];\u00a024(2), 98\u2013103. Dispon\u00edvel em: https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S1360859219303134","DOI":"10.1016\/j.jbmt.2019.10.003"},{"key":"37453_CR27","doi-asserted-by":"crossref","unstructured":"Naila de Souza, G., Pellegrino Baena, C., Rabbers Vasconcelos, J. C. & Duarte de Lima Moser, A. Associa\u00e7\u00e3o entre Capacidade funcional e for\u00e7a de preens\u00e3o manual Em Pessoas com diabetes mellitus. Cogitare Enfermagem 28 De Setembro De ;(27):1\u201314. (2022).","DOI":"10.5380\/ce.v27i0.82690"},{"key":"37453_CR28","unstructured":"de Barros Basso, G. et al. Relationship between handgrip strength and body composition and laboratory indicators in diabetic and hypertensive patients. Med. (Brazil) ;56(4). (2023)."},{"issue":"3","key":"37453_CR29","doi-asserted-by":"publisher","first-page":"390","DOI":"10.1111\/jdi.13354","volume":"12","author":"T Nomura","year":"2021","unstructured":"Nomura, T., Kawae, T., Kataoka, H. & Ikeda, Y. Loss of lower extremity muscle strength based on diabetic polyneuropathy in older patients with type 2 diabetes: multicenter survey of the isometric lower extremity strength in type 2 diabetes: phase 2 study. J. Diabetes Investig. 12 (3), 390\u2013397 (2021).","journal-title":"J. Diabetes Investig"},{"key":"37453_CR30","doi-asserted-by":"crossref","unstructured":"M\u0142ynarska, E. et al. Type 2 Diabetes Mellitus: New Pathogenetic Mechanisms, Treatment and the Most Important Complications Vol. 26 (Multidisciplinary Digital Publishing Institute (MDPI), 2025). International Journal of Molecular Sciences.","DOI":"10.3390\/ijms26031094"},{"key":"37453_CR31","doi-asserted-by":"crossref","unstructured":"Rydberg, M., Zimmerman, M., Gotts\u00e4ater, A., Eeg-Olofsson, K. & Dahlin, L. B. High HbA1c levels are associated with development of trigger finger in type 1 and type 2 diabetes: an observational Register-Based study from Sweden. Diabetes Care 1o de novembro de. 45 (11), 2669\u20132674 (2022).","DOI":"10.2337\/dc22-0829"},{"key":"37453_CR32","doi-asserted-by":"crossref","unstructured":"Tonga, E. et al. Physical Activity Guidelines for Adults with Type 2 Diabetes: Systematic Review Vol. 220 (Elsevier Ireland Ltd, 2025). Diabetes Research and Clinical Practice.","DOI":"10.1016\/j.diabres.2024.111982"}],"container-title":["Scientific Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-37453-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-37453-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-37453-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T00:27:10Z","timestamp":1783297630000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.nature.com\/articles\/s41598-026-37453-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,5]]},"references-count":32,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["37453"],"URL":"https:\/\/doi.org\/10.1038\/s41598-026-37453-7","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-7076089\/v1","asserted-by":"object"}]},"ISSN":["2045-2322"],"issn-type":[{"value":"2045-2322","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,5]]},"assertion":[{"value":"8 July 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"5 May 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}},{"value":"This study was approved by the\n                      Comit\u00ea de \u00c9tica em Pesquisa com Seres Humanos da Universidade Federal do Tocantins (CEP\/UFT)\n                      \u2013 Ethics Committee for Research Involving Human Subjects at the Federal University of Tocantins, under protocol CAAE: 59157316.2.0000.5519.\u00a0The research complied with the ethical principles outlined in Resolution No. 466\/2012 of the Brazilian National Health Council and the Declaration of Helsinki. All participants were fully informed about the aims, procedures, potential risks, and benefits of the study. Participation was voluntary, and all individuals provided written consent by signing a Free and Informed Consent Form (FICF) prior to inclusion.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"All participants provided written informed consent (\n                      Termo de Consentimento Livre e Esclarecido \u2013 TCLE\n                      ) authorizing the use and publication of anonymized data collected for the purposes of this study.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}],"article-number":"20682"}}