Background <p>This study aimed to determine and compare quality of life, level of daily living activities, and sexual satisfaction in two groups: insulin users and oral medications.</p> Materials and methods <p>This prospective cohort study was conducted on patients attending the diabetes clinics at Baghdad Hospital in Iraq between 2021 and 2024. The number of patients in the study was 130 participants including two groups (using insulin vs. oral medication). At First, after one year, and after three years, all participants completed four questionnaires: Quality of Life, Sexual Satisfaction, and Activities of Daily Living.</p> Results <p>According to the results, activity daily living, quality of life and sexual satisfaction in both groups decreased over time from first to the third time, and this difference was significant in the all three variables except in the oral medications group quality of life was not significant (<i>p</i> = 0.68), also in the insulin group sexual satisfaction was not significant (<i>p</i> = 0.72). In the between-group comparison showed quality of life just three years later difference was significant (<i>p</i> = 0.017). In the Activities of daily living variable, no significant difference was observed between the two groups at any time. However, in the sexual satisfaction the insulin group’s score was higher at one year and three years later, and the difference was significant at both mentioned times (<i>p</i> = 0.049, and <i>p</i> = 0.054 respectively).</p> Discussion <p>This study found that in both groups’ daily activities, quality of life, and sexual satisfaction reduced over time.</p>