第二型糖尿病老人自我管理、憂鬱程度、社會參與與糖化血色素之相關研究

台灣地區65歲以上老年人診斷有糖尿病比率為24.7%，糖尿病同時高居老年人十大死因的第五位。本研究目的為(1)調查第二型糖尿病老人社會人口學特性、自我管理、憂鬱程度、社會參與與糖化血色素值(HbA1c)值情形；(2)探討第二型糖尿病老人社會人口學特性、自我管理、憂鬱程度、社會參與與糖化血色素(HbA1c)值之相關性；(3)探討影響第二型糖尿病老人糖化血色素值(HbA1c)之重要解釋因子。本研究採橫斷性、描述性與相關性研究設計，於民國105年11月30日至民國106年6月30日，以65歲(含)以上罹患第二型糖尿病六個月以上病人為研究對象，使用結構式問卷調查和方便取樣方式共收案200人。問卷內容包括個人社會人口學特性、自我管理、憂鬱程度和社會參與等量表，並由病歷查詢研究對象收案後之糖化血色素值。以百分比、平均值、標準差、獨立樣本t檢定、單因子變異數分析、皮爾森積差相關與線性迴歸分析進行資料分析。研究結果發現第二型糖尿病老人的年齡及糖尿病自我管理與HbA1c值有顯著負相關，憂鬱及社會參與與HbA1c值無顯著相關。線性迴歸分析發現，目前治療方式為使用胰島素、未受教育及自我管理是影響第二型糖尿病老人糖化血色素值(HbA1c)之重要解釋因子。目前治療方式為使用胰島素及未受教育的第二型糖尿病老人的HbA1c值較高，而第二型糖尿病老人的自我管理越好，血糖控制越好。建議使用適合的方法，提高第二型糖尿病老人學習自我管理。研究結果可提供健康照護人員參考，發展有效的血糖控制計畫，提升第二型糖尿病老人控制糖化血色素值。

關鍵字

糖尿病；糖尿病自我管理；憂鬱程度；社會參與；糖化血色素

並列摘要

Approximately 24.7% of the population of Taiwan aged 65 years and over are diagnosed with type 2 diabetes, which is the fifth among the top ten leading causes of death. The aim of this study was (1) examine the status of type 2 diabetes mellitus older patients demographic data, self-management, depression, social participation and their glycosylated hemoglobin (HbA1c) level; (2) examine the relationships between demographic data, self-management, depression, social participation and glycemic control in older patients with type 2 diabetes; and (3) to identify the important explanatory factors of glycemic control in such patients. This was a cross-sectional, correlated and descriptive research design. We collected data from November 30 2016 to June 30 2017. The 200 participants of this study were patients aged 65 years or over who had been suffering from type 2 diabetes at least for 6 months. We use a constructed questionnaire established with relevant scales, including questions on demographic data, disease characteristics, diabetes self-management, depression, social participation. Medical record was use collect HbA1c levels of each participant. Data analysis was performed by using descriptive statistics, independent t-test, one-way ANOVA, Pearson’s correlation, and linear regression analysis. The results indicated that age and self-management were significant negatively associated with HbA1c. Depression and social participation were not significantly associated with HbA1c. Linear regression indicated that current therapy with insulin, illiterate and diabetes self-management were important explanatory factors for the HbA1c. Current therapy with insulin and illiterate patients have higher HbA1c level. The better the self-management, the better the control of the HbA1c level. The results of this research suggest the use of methods to improve self-management of older patients with type 2 diabetes is efficacious and worthy of further investigation. The result of this study can provide the clinical practitioner with better understanding of glycemic control in order to conduct more efficacious projects to promote glycosylated hemoglobin control in older patients with type 2 diabetes