The effect of stress on the quality of life of type 2 diabetes mellitus patients in the MENA region: a systematic review

To explore the effect of stress on the quality of life (QoL) of patients with Type 2 Diabetes Mellitus (T2DM) in the Middle East and North Africa (MENA) region and compare with other regions. T2DM prevalence has increased in the MENA region. Besides its physiological implications, T2DM affects patients’ QoL by influencing psychosocial and health-related stressors. This systematic review explores how stress can affect the QoL of T2DM patients, providing MENA region-specific insights to improve patient outcomes. This review also compares QoL across high- and low-income countries within and beyond the MENA region. Our review was registered on the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024612361. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were used to guide our review. A robust search strategy was employed in 4 databases: PubMed, Scopus, Cochrane, and Embase. We included observational studies published between January 1, 2004, and July 20, 2025, that explored the association between stress and the QoL of T2DM patients. The quality of the included studies was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS) and the Newcastle-Ottawa Scale. Data extraction and analysis were conducted in accordance with the PRISMA guidelines. The search identified 402 publications, of which 28 observational studies met the inclusion criteria. Five main factors were identified as stressors contributing to T2DM patients’ QoL: gender differences, psychological factors, socioeconomic factors, lifestyle factors, and health-related factors. Emotional distress, female gender, diabetes-related complications, elevated Hemoglobin A1c (HbA1c) levels, and poor lifestyle were all negatively associated with QoL. A positive correlation was drawn between education, health literacy, and QoL. Higher-income countries have a better T2DM QoL. Stress factors significantly affect QoL in T2DM patients, with psychological, socioeconomic, gender differences, lifestyle, and health-related factors playing an important role. Future studies should explore direct causal relationships between stress factors and QoL in T2DM, particularly emphasizing the female population.