第二型糖尿病病人一般日常身體活動與糖尿病控制之相關性探討

糖尿病是全球性的重大健康議題，為最常見的一種慢性非傳染性疾病，推測至2025年將會影響三億八千萬人口，盛行率及發病率的增加，將造成我們醫療系統沉重的負擔，而藥物治療、飲食管理及規律運動之生活方式介入計劃已被證明有效治療第二型糖尿病的策略，然而，一般日常身體活動與運動是否對於糖尿病控制有相同的成效目前仍未知，本研究旨在探討第二型糖尿病病人一般日常身體活動與糖尿病控制之相關性研究，以立意取樣台灣中部某醫學中心之第二型糖尿病病人206位進行研究，平均年齡62.5 ± 10.4歲(平均33-82歲)。以國際身體活動問卷(IPAQ)問卷評估日常身體活動程度，糖尿病遵醫囑行為問卷評估藥物、飲食及運動遵從性，收案後一年期間以病歷查閱方式收集血糖、血壓、血脂相關數據，資料整理後以SPSS 18.0套裝軟體進行統計分析。研究結果顯示糖化血色素(HbA1c)平均值：7.8%(+1.4)，糖尿病整體控制不佳78.2% (HbA1c >7.0%)，依照代謝當量(MET)將身體活動分為三種不同動態活動，年齡小於65歲以下從事中、低動態活動89.3%，高動態10.7%，大於65歲，多數仍從事中、低動態活動87%，高動態12.9%，以卡方檢定分析不同動態活動對於糖尿病控制無相關性，以邏輯斯回歸(Logistic regression)分析，控制變項之藥物遵從性能預測血壓控制狀況，小於65歲研究對象，藥物遵從性與血壓控制之勝算比為3.77(p值=0.005，95% CI：1.492-9.529)，藥物遵從性不佳比藥物遵從性佳的人，有3.77倍導致血壓控制不良;大於 65歲研究對象，藥物遵從性與血壓控制之勝算比為3.27(p值=0.026，95% CI：1.152-9.287)，藥物遵從性不佳比藥物遵從性佳的人，有3.27倍導致血壓控制不良，在控制藥物遵從性及飲食遵從性相關變項後，以多變量分析結果顯示，一般日常身體活動程度對於糖尿病控制無顯著相關。本研究結果得知一般日常身體活動無法取代運動，可提供臨床照護者對於第二型糖尿病病人在活動程度及類型上之依據，需教導病人除藥物及飲食控制外，仍需進行規律、有組織且重複性運動才能促進糖尿病控制，以降低糖尿病之合併症及醫療相關費用。

關鍵字

第二型糖尿病；一般日常身體活動；糖尿病控制

並列摘要

Type 2 Diabetes Mellitus (T2DM) induced global health issues. It is one of the most common chronic non-communicable diseases and is expected to affect 380 millions of people by 2025.The increasing prevalence and incidence of T2D provokes a growing burden worldwide. Exercise along with dietary and pharmacological interventions is suggested for managing diabetes. However, whether exercise compatible physical activities can have similar effect on diabetes control is unknown. The purpose of this study was to investigate if daily physical activities have effects on diabetes mellitus control in type 2 diabetes mellitus patient. A purpose sampling and cross-sectional design was used in this study. Patients were recruited from the endocrinology and metabolism outpatient clinics of a medical center. A total of 206 patients with a mean age of 62.5 ± 10.4 years (range 33-82 years) completed this study. The International Physical Activity Questionnaire (IPAQ) was used to assess daily physical activity level. The Diabetes Compliance Questionnaire was used to assess patients’ compliance in medication, diet, and exercise. Their glycemic, lipid, and blood pressure data were followed up for one year after recruiting. SPSS 18.0 software package was used to for statistical analysis Results showed that the mean HbA1c of the following one year was 7.8% (±1.4) with 78.2% of diabetic patient in poor glycemic control (HbA1c >7.0%). There are three levels of physical activity according to MET. Young diabetics (< 65 years) engaged in more moderate and low levels of physical activities (89.3%) but less high levels of physical activities (10.7%). Old diabetics (>65 years) engaged in more moderate and low levels of physical activities (87%) but less high levels (12.9%). Results of correlation analysis showed that daily physical activity level was not significantly associated with diabetes mellitus control in both young and old diabetics. Results of logistic regression shows that medication compliance was associated with better blood pressure control in both young (OR=3.77, p=0.005，95% CI：1.49-9.53) and old (OR=3.72, p=0.026，95% CI：1.15-9.29) diabetics. After controlling medication and diet compliance, levels of daily physical activities were not significantly associated with diabetes mellitus control. The findings of this study suggest that daily physical activities can’t replace exercise. Except medication and diet compliance, health providers need to encourage patients to engage in exercise that is planned, structured, and repetitive for better diabetes mellitus control. It may reduce the complications of diabetes mellitus and medical-related costs as well.

並列關鍵字

Type 2 diabetes mellitus ； Daily physical activity ； Diabetes control

參考文獻

徐錦興、曹德弘、張蕙雯(2011)•第二類型糖尿病人之身體活動建議量初

陳敏弘(2000)•運動強度設定之新觀念－VO2 Reserve•中華體育季刊，

郝立智、楊純宜、林興中(2011)•第二型糖尿病之診斷和藥物治療趨勢•當

許承儒、許惠恒(2012)•第二型糖尿病病患血壓控制之理想目標•當代醫

許惠恒(2013)•糖尿病之理想控制：ABC達標•當代醫學，40(9)，691-

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第二型糖尿病病人一般日常身體活動與糖尿病控制之相關性探討

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