第二型糖尿病病人足部神經病變及其影響因素之研究

Diabetic Foot Neuropathy and Related Factors in Patients With Type 2 Diabetes Mellitus

陳姿踰(Tzu-Yu CHEN) ； 林佳慧(Chia-Huei LIN) ； 張玉坤(Yue-Cune CHANG) ； 王志信(Chih-Hsin WANG) ； 洪乙仁(Yi-Jen HUNG) ； 曾雯琦(Wen-Chii TZENG)

《護理雜誌》 65卷3期 (2018/06) Pp. 28-37

https://doi.org/10.6224/JN.201806_65(3).06

摘要

背景：足部神經病變不僅是第二型糖尿病病人容易出現的合併症，並且容易增加死亡的風險。早期偵測造成糖尿病神經病變的因素應有助於避免後續足部潰瘍、下肢截肢及死亡率的發生。目的：探討人口學、疾病特性、健康素養以及足部自我照護行為等變項，是否為第二型糖尿病病人罹患足部神經病變的相關危險因素。方法：採病例對照研究，在北部一所醫學中心招募第二型糖尿病門診病人為研究對象，以兩側足部的密西根神經病變篩檢工具（Michigan Neuropathy Screening Instrument, MNSI）測得總分≥ 2分時為病例組，然後依病例組的年齡和性別進行配對，共有114位病人參與。以結構式問卷進行資料收集，並透過Fisher's exact test、Mann-Whitney U test和logistic regression等統計方法進行資料分析。結果：研究結果顯示糖化血色素（B = 1.696, p = .041）及溝通和批判性健康素養（B = -0.082, p = .034）與第二型糖尿病病人發生足部神經病變有關。結論／實務應用：建議護理師於衛教前，能先評估T2DM病人的健康素養，並且針對血糖控制較差者，發展適切的足部照護介入措施，以預防後續足部神經病變的發生。

關鍵字

糖尿病足部神經病變 ； 健康素養 ； 血糖控制 ； 第二型糖尿病

並列摘要

Background: Patients with type 2 diabetes mellitus (T2DM) face a higher risk of diabetic foot neuropathy, which increases the risk of death. The early detection of factors that influence diabetic neuropathy reduces the risk of foot lesions, including foot ulcerations, lower extremity amputation, and mortality. Purpose: To explore the demographic, disease-characteristic, health-literacy, and foot-self-care-behavior factors that affect diabetic foot neuropathy in patients with T2DM. Methods: A case-control study design was employed in which cases (Michigan Neuropathy Screening Instrument, MNSI) ≥ 2 were matched to controls based on age and gender in a medical center. A total of 114 patients diagnosed with T2DM in a medical center were recruited as participants. Data were collected using a structured questionnaire. The collected data were analyzed using Fisher's exact test, Mann-Whitney U test, and logistic regression. Results: The results of multiple logistic regression showed that glycated hemoglobin (B = 1.696, p = .041) and communication and critical health literacy (B = -0.082, p = .034) were significant factors of diabetic foot neuropathy. Conclusions/Implications for Practice: The findings of this study suggest that nurses should assess the health literacy of patients with T2DM before providing health education and should develop a specific foot-care intervention for individuals with poor glycemic control.

並列關鍵字

diabetic foot neuropathy ； health literacy ； glycemic control ； type 2 diabetes mellitus

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