糖尿病共同照護網收案患者之控制情形及其相關因子研究

Analysis of Diabetic Control and Its Correlating Factors for Patients in Diabetic Care Network

黃尊新(Chun-Shin Huang)

指導教授 ： 李孟智

中山醫學大學/醫學院/醫學研究所/碩士(2009年)

https://doi.org/10.6834/CSMU.2009.00145

摘要

研究背景：糖尿病是常見的慢性疾病之一，而高血糖即是其中一個主要的危險因子。隨著盛行率的增加，造成龐大的醫療花費，因此對於糖尿病治療效果的探討也逐漸重要。但是糖尿病這類的慢性疾病是屬於多個危險因子互相影響而造成，若是只研究單一的危險因子則稍嫌不足，因此本研究將利用多因子分析來探討糖尿病的治療成效，期望能夠藉由此研究更加了解糖尿病照護網的治療成效，並提出建議。
材料與方法：本研究利用中部某區域醫院糖尿病照護網為研究對象，以照護網所收集之病患基本資料及病況資料為本研究資料來源，共收案318份，剔除31份不完整資料（未作第二次年度複診臨床生化值的紀錄），計得287份有效資料。本研究經過資料蒐集完成後，以敘述性分析和推理性分析方式呈現，透過配對T檢定分析病患治療前後的差異，還有卡方檢定了解病患治療成效的情形，並且利用糖化血色素以及微白蛋白尿比值作邏輯斯迴歸分析危險因子，本研究將使用SAS9.13統計軟體進行分析研究。
研究結果：經過一年藥物治療後，使用配對T檢定發現在飯前血糖值、糖化血色素、三酸甘油酯、總膽固醇等臨床生化值皆有顯著的差異。此外，研究結果發現使用邏輯斯回歸分析經過一年的治療後的糖尿病病患之糖化血色素，與使用胰島素的治療方式有顯著相關。將微白蛋白尿數值分為兩組，利用卡方分析有29人（10.10％）微白蛋白數值從大於等於30下降到小於30。其中BMI對於微白蛋白尿數值有顯著相關。利用配對T檢定比較有微白蛋白尿的病人治療前後在糖化血色素、總膽固醇、低密度酯蛋白有顯著差異。利用邏輯斯迴歸分析則治療後與年齡、糖化血色素、總膽固醇、高密度酯蛋白有相關。
結論與建議：經過糖尿病照護網一年的治療後，糖尿病病人的臨床生化值已有所改善，因此糖尿病照護網治療成效值得推薦。但是本研究所納入的研究對象為有定期回診之糖尿病病人，而沒有定期回診之病人則無法得知其糖尿病控制情況，若能將這些對象納入研究則可以更加明確比較糖尿病照護網是否有較好的療效。此外本研究未加入生活型態及飲食記錄，若未來研究可加入這些指標相信研究可更加豐富。

關鍵字

糖化血色素 ； 微白蛋白尿 ； 糖尿病照護網 ； 控制

並列摘要

Background: Diabetes Mellitus is deemed as one of the common chronic diseases, of which hyperglycemia is one of the main risk factors. With the increase on the rate of prevalence, the medical cost is exceedingly enormous. Consequently, the discussion pertaining to the effects of therapies of diabetes gains importance gradually. However, chronic diseases like diabetes are attributed to the confluence of the interactive influences from many risk factors. The way that only one hazardous factor is taken into consideration is deficient. In view of this, the efficacy of treatments of diabetes is analyzed by virtue of many clinical risk factors, in attempts to better understand the efficacy of diabetic control and provide suggestions here.
Materials and Methods: The research objective consists in the diabetic care network of certain regional hospital in mid-Taiwan. In terms of the resources of the research, the basic data of patients and data with regards to medical conditions, both of which are collected via the diabetic care network. The number of the total collection is 318, 31of which are omitted due to the incompleteness (by reason of the loss of patients’ follow-ups). Hence, the number of the valid data is amounted to 287. After the completion of the data collection, descriptive analysis and inferential analysis are conducted. Paired-T test is taken to judge the discrepancies of the conditions of patients before and after the treatments. In addition, chi-square test is used to determine the efficacy of the treatments. HbAlC and Ma/Cr ratio are used as the risk factors of logistic regression analysis. SAS 9.13 is conducted for the analysis.
Results: After one-year medical treatment, it is found by paired-T test that the clinical biochemical factors such as fasting glucose, HbAlC, total cholesterol and triglyceride show significant discrepancies. Besides, the finding is gained by logistic regression analysis that HbAlC of the patients who receive one-year treatments correlates greatly to the method of insulin therapy, in which they are divided into two groups according to microalbuminuria. Analyzed by chi-square test, microalbuminuria data of 29 patients (10.10%), which is originally above 30, decreases to less than 30. Also, BMI plays a major role in the discrepancy of microalbuminuria. It is compared by paired-T test that the salient discrepancy exists in HbAlC, total cholesterol and low-density lipoprotein of patients with microalbumin before and after therapies. It is also found by logistic regression analysis that the conditions after therapies are affected by age, HbAlC, total cholesterol and high-density lipoprotein.
Conclusions and Suggestions: The clinical biochemical factors of diabetic patients have been improved after one-year treatment of the diabetic care network. As a result, the efficacy of the diabetic care network is commendable. Nonetheless, the patients who have follow-ups are the objects here. The conditions of patients who have no follow-ups are beyond comprehension, which shall be taken into consideration for the thorough understanding of the efficacy of the diabetic care network. In addition, the lifestyle and records of diets are not discussed here, which are expected to be delved into for the resourcefulness in this domain.

並列關鍵字

HbA1C ； Ma/Cr ratio ； Diabetic care network ； Control

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