Social Support and Spirituality as Determinants of Quality of Life in Diabetes Mellitus Patients on Hemodialysis: A Systematic Review

Background: Diabetes Mellitus (DM) patients undergoing hemodialysis often experience diminished quality of life (QoL) due to physical, psychological, and social challenges associated with chronic kidney disease. Social support and spirituality have been identified as key psychosocial factors that may influence patients’ well-being and treatment outcomes. Objective: This systematic review aims to evaluate the impact of social support and spirituality on the quality of life of DM patients undergoing hemodialysis, synthesizing evidence from recent studies conducted across diverse cultural and clinical settings. Methods: A comprehensive literature search was performed across PubMed, Scopus, ScienceDirect, and Google Scholar for studies published between 2015 and 2025. Inclusion criteria focused on studies reporting social support, family support, spiritual well-being, and QoL outcomes in hemodialysis patients, specifically those with DM or chronic kidney disease complications. Ten studies meeting eligibility criteria were analyzed, encompassing cross-sectional, descriptive-analytic, and quasi-experimental designs. Results: Across the studies, higher levels of social support, particularly from family and peers, were consistently associated with improved QoL. Spirituality, including religious engagement and personal spiritual well-being, further contributed to resilience, psychological stability, and enhanced coping with chronic treatment regimens. Combined interventions addressing both social support and spirituality demonstrated synergistic effects, leading to measurable improvements in physical, emotional, and social domains of QoL. Evidence from diverse regions, including Indonesia, Saudi Arabia, Iran, and Iraq, indicates the universal relevance of these factors. Conclusion: Social support and spirituality are pivotal determinants of QoL among DM patients undergoing hemodialysis. Integrating structured psychosocial and spiritual interventions into routine hemodialysis care may enhance patient outcomes and promote holistic management. Future research should investigate longitudinal effects and interventional strategies to optimize QoL in this population.