台灣版糖尿病生活品質測量工具Diabetes-39的發展與驗證

目標：進行糖尿病生活品質測量工具D-39中文版的翻譯及驗證。方法：橫斷式研究法。對象為署立台南醫院糖尿病門診病患280人。資料收集為病人問卷與病歷摘要。病歷摘要收集臨床變項用以驗證D-39，包括實驗室診斷（醣化血色素、飯前與飯後2小時血糖）與糖尿病併發症（視網膜病變、腎臟病變、神經病變、足部病變、心血管疾病、及腦血管疾病）。心理計量分析包括信度與效度。結果：翻譯結果顯示，中文版D-39在語意上與英文版相似，且能被病人接受。心理計量分析發現，D-39中文版的測量結構與英文版相吻合。D-39與SF-36（效標）同質性面向之相關性較異質性面向強。D-39對於飯後2小時血糖及肌酸酐等指標，及心血管疾病、腦血管疾病、與足部病變等併發症，分別呈現有意義的預知組別效度（效果量＞0.2）。D-39對於神經病變、腦血管疾病、視網膜病變、足部病變、心血管疾病、與腎臟病變的綜合鑑別效度達到可接受的標準（C-統計值＞0.7）。結論：本研究翻譯並驗證了中文版D-39，其結果將有助於糖尿病人健康結果之評估。

關鍵字

糖尿病；生活品質； Diabetes-39台灣版；心理計量

並列摘要

Objectives: The Diabetes-39 (D-39) is a well-validated and widely used diabetes quality of life (QOL) instrument. The purpose of this study was to translate the D-39 into Chinese and test its psychometric properties. Methods: Data were collected from 280 patients treated in diabetes clinics of the Tainan Hospital, Taiwan Department of Health, through QOL survey and medical record review. Information collected from medical records, used to validate the D-39, included laboratory indicators (hemoglobin A1c (HbA1c), fasting plasma glucose, 2-hour postprandial plasma glucose (2-h PPG), creatinine (Cr), and glomerular filtration rate) and diabetes complications (retinopathy, nephropathy, neuropathy, diabetic foot complications, cardiovascular complications, and cerebrovascular complications). We conducted forward/back translations and a focus group session to develop the Chinese version of the instrument. For psychometric evaluation, we analyzed construct validity, convergent/discriminant validity (using the SF-36 as the standard), known-group validity, and overall discriminant validity of the D-39. Results: The D-39 Chinese version demonstrated equivalent semantics to the original D-39. Pearson's correlations were weak with subscales measuring heterogeneous constructs between the D-39 and SF-36, but high among subscales measuring homogenous constructs, suggesting good convergent/discriminant validity. The D-39 discriminated better for 2-h PPG, Cr, cardiovascular, cerebrovascular, and diabetic foot complications (effect size ＞0.2), suggesting good knowngroup validity. C-indexes suggested greater discrimination (＞0.7) by the D-39 compared to the SF-36 across all complications, indicating good overall discriminate validity. Conclusions: Our successfully translated D-39 demonstrated good psychometric properties. The D-39 Chinese version is an acceptable instrument for assessing treatment effectiveness and monitoring patient outcomes in Taiwan.

並列關鍵字

Diabetes Mellitus ； Quality of life ； D-39 Chinese version ； psychometric property

參考文獻

Huang MC,Hung CH.(2007).Quality of life and its predictors for middle-aged and elderly patients with type 2 diabetes mellitus.J Nurs Res.15,193-201.

Lu JF,Tseng HM,Tsai YJ.(2003).Assessment of healthrelated quality of life in Taiwan (I): development and psychometric testing of SF-36 Taiwan version.Taiwan J Public Health.22,501-511.

American Diabetes Association(2007).Standards of medical care in diabetes-2007.Diabetes Care.30,4-41.

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