使用胰島素治療第2型糖尿病患之自我監測血糖行為與血糖控制的關係

The relationship between self-monitoring of blood glucose and glycemic control in patients with insulin-treated type 2 diabetes

陳真美(Chen-Mei Chen)

指導教授 ： 張媚

國立臺灣大學/醫學院/護理學研究所/博士(2017年)

https://doi.org/10.6342/NTU201703033

摘要

背景：自我監測血糖扮演著糖尿病照護的核心角色，被強烈推薦於使用胰島素治療的糖尿病患者，但其臨床利用率仍然偏低。此次研究目的主要調查使用胰島素治療的第2型糖尿病患者之自我監測血糖遵從度，並探討其預測因素以及探討病患的自我監測血糖遵從度與血糖控制的關係。

方法：本研究為橫斷性(cross sectional)之設計，研究對象為持續接受胰島素注射治療六個月以上的第2型糖尿病患，並且從中台灣的醫學中心及地區醫院之新陳代謝科門診進行收案。自2017年4月至5月，以結構式問卷進行研究資料的收集，有效樣本為101位。

結果：研究對象的自我監測血糖遵從度平均為45%；自我監測血糖遵從度80%者僅佔26.7%。研究對象最近一次的糖化血色素介於5.0-15.6%，平均值為8.45%(SD=1.84)。以多元迴歸分析發現自我效能、疾病認知表徵之疾病影響、治療控制等變項，可以預測自我監測血糖遵從度，整體模式經調整後可解釋的變異量為57.9%，其中又以自我效能其解釋的變異量最高。另外，自我監測血糖遵從度與糖化血色素呈顯著負相關(r=-0.34，p 0.01)，亦發現醫療人員社會支持對自我監測血糖遵從度與糖化血色素之間的關係具調節作用。

結論：研究對象自我監測血糖遵從度與糖化血色素呈顯著負相關。自我效能是自我監測血糖遵從度的重要預測因子，未來可透過加強病患自我效能鼓勵其執行血糖監測，協助病患發展自我照顧能力，並且醫療人員社會支持可以調節自我監測血糖遵從度與糖化血色素之關係，醫療專業人員應該主動與病患討論監測的結果與記錄，增進病患運用血糖監測結果調整自我照護的能力，以促進其血糖控制。

關鍵字

遵從度 ； 糖尿病 ； 血糖控制 ； 自我監測血糖

並列摘要

Background: Self-monitoring of blood glucose plays a core role in diabetes treatment and has been strongly recommended for use by patients with diabetes who are undergoing insulin treatment. However, clinical utilization remains low. The primary purpose of this study was to examine the degree of adherence to self-monitoring of blood glucose by patients with type 2 diabetes who were undergoing insulin treatment, assess predictive factors, and investigate the relationship between self-monitoring and glycemic control.

Methods: This study featured a cross-sectional design and primarily examined patients with type 2 diabetes who had received insulin treatment continuously for over 6 months. Subjects were recruited from the endocrinology departments of medical centers and regional hospitals located in central Taiwan. Structured questionnaires were used to collect research data from April 2017 to May 2017 and a total of 101 effective samples were obtained.

Results: The average degree of patient adherence to the self-monitoring of blood glucose was 45%, with only 26.7% of the patients demonstrating a degree of self-monitoring 80%. The most recent glycosylated hemoglobin levels measured by the research subjects were between 5.0% and 15.6%, with an average value of 8.45% (SD = 1.84). Multiple regression analysis showed that variables such as self-efficacy, consequences and treatment control of illness representation could predict the degree of adherence to self-monitoring of blood glucose. After adjustment, the overall model was able to explain 57.9% of variance, with self-efficacy demonstrating the greatest degree of explained variance. In addition, adherence to self-monitoring of blood glucose was negatively correlated with glycosylated hemoglobin (r = −0.34, p ＜ .01), indicating the moderating effect of the social support from professional healthcare providers on the relationship between adherence to the self-monitoring of blood glucose and glycosylated hemoglobin.

Conclusions: Adherence to the self-monitoring of blood glucose exhibited a negative correlation with glycosylated hemoglobin. As self-efficacy is a crucial predictor for self-monitoring of blood glucose, in the future, greater encouragement of patient self-efficacy to perform blood glucose monitoring will assist patients in developing self-care capabilities. Furthermore, social support from professional healthcare providers can regulate the relationship between adherence to the self-monitoring of blood glucose and glycosylated hemoglobin. Professional healthcare providers should proactively discuss monitoring results and records with patients to improve self-care capabilities based on the results of blood glucose monitoring and facilitate glycemic control.

並列關鍵字

adherence ； diabetes ； glycemic control ； self-monitoring of blood glucose

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