第二型糖尿病病人糖化血色素重要預測因子分析-回溯性病例對照研究

Important Predictors of Glycated Hemoglobin in Patients with Type 2 Diabetes Mellitus– A Retrospective Case-Control Study

劉怡彣(Yi-Wen Liu)

指導教授 ： 邱啟潤

高雄醫學大學/護理學院/護理學系碩士班/碩士(2016年)

摘要

背景：糖尿病在台灣於2013年已晉升為十大死因之第四名。糖尿病控制不佳會引發多種合併症，其致死率極高，嚴重造成國人健康的威脅及高醫療耗用。
目的：本研究希望探討自我效能、自我照顧行為、家庭支持三個重要變項與血糖控制的關係，找到何者是最重要的預測因子。
方法：採回溯性病例對照研究，以南部加入「國健局糖尿病共照網」診所之第二型糖尿病病人208位為對象，分為控制良好者(HbA1C<7mg/dl)及控制不佳者(HbA1C≧7mg/dl) ，透過病歷查閱收集病人最近兩次糖化血色素值，採具信、效度之糖尿病管理自我效能、糖尿病自我照顧量表、糖尿病家庭支持行為量表，分析影響糖化血色素控制的重要預測因子。
結果：本研究結果發現第二型糖尿病病人自我效能是糖化血色素控制重要預測因子，糖化血色素控制良好者第二型糖尿病病人的自我效能與自我照顧，皆比控制不佳者好，且自我效能每增加總分1分，糖化血色素數值大於7mg/dl的勝算比，會降低0.97倍，其中「遵守健康飲食計畫」更是重要。
結論與建議：自我效能、自我照顧行為和家庭支持三個重要變項，對第二型糖尿病病人而言，可預測血糖控制的唯一變項，是自我效能。故如何增加病人的自我效能是需要重視的問題。糖尿病病人同儕支持團體已被證實有提高自我效能的成效，進而提升自我照顧行為，故本研究建議鼓勵病人加入支持團體，將有助於血糖控制。

關鍵字

糖化血色素 ； 自我效能 ； 自我照顧 ； 家庭支持 ； 重要預測因子

並列摘要

Background: Diabetes rose to the fourth place in Taiwan’s top 10 causes of death in 2013. Poor diabetes control can cause multiple complications. With its extremely high morbidity rates, diabetes poses a threat to the health of Taiwanese people and has high healthcare utilization.
Purpose: The purpose of this study is to determine which of the three important predictors: self-efficacy, self-care behavior and family support, is the most important predictor by investigating their relationships with blood sugar control.
Methods: The study was a retrospective case-control study conducted on 208 patients with Type 2 diabetes mellitus from clinics in South Taiwan that participated in the ‘Shared Care Network for Diabetes of the Health Promotion Administration’. The patients were divided into the good control group (HbA1C<7mg/dl) and the poor control one (HbA1C≧7mg/dl) based on their latest two levels of glycated hemoglobin collected from their medical records. Reliable and valid scales for self-efficacy in diabetes management, self-care for diabetes and family support for diabetes were used to analyze important predictors for glycated hemoglobin control.
Results: The results of this study showed that self-efficacy in the patients with Type 2 diabetes mellitus was an important predictor for glycated hemoglobin control. The patients with good glycated hemoglobin control had better self-efficacy and self-care than those with poor control. Also, each additional point in the total score of self-efficacy was able to reduce the odds ratio of the glycated hemoglobin value greater than 7mg/dl by 0.97 time. In this relationship, ‘compliance with a healthy diet plan’ was of greater importance.
Conclusion and suggestions: Among the three important predictors: self-efficacy, self-care behavior and family support for patients with Type 2 diabetes mellitus, the only variable that can predict blood sugar control is self-efficacy. Therefore, how to improve self-efficacy in patients is an issue that requires attention. Peer support groups for diabetes patients have been proven to be able to enhance the effectiveness of self-efficacy and in turn self-care behavior. Therefore, the author suggests encouraging patients to join support groups, which will help their blood sugar control.

並列關鍵字

Glycated hemoglobin ； self-efficacy ； self-care ； family support ； important predictors

參考文獻

參考文獻

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