第2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

How Self-management, Depression, and Social Participation Relate to Glycosylated Hemoglobin Levels in Older Patients with Type 2 Diabetes

王瑞霞(Ruey-Hsia Wang) ； 劉芸廷(Yun-Ting Liu) ； 楊春穎(Chin-Ying Yang) ； 段奇維(Chi-Wei Tuan) ； 徐敏芬(Min-Fen Hsu)

《榮總護理》 36卷1期 (2019/03) Pp. 39-50

https://doi.org/10.6142/VGHN.201903_36(1).0004

摘要

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。本研究目的為調查第2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）值情形及相關性；並探討影響第2型糖尿病老人糖化血色素（HbA1c）值之重要解釋因子。本研究採橫斷性、描述相關性研究設計，於2016年11月30日至2017年6月30日，以65歲（含）以上罹患第2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。問卷內容包括社會人口學特性、HbA1c值、自我管理、憂鬱程度和社會參與等量表。研究結果顯示第2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。線性迴歸分析發現，目前治療方式為使用胰島素及未受教育的第2型糖尿病老人的HbA1c值較高，而第2型糖尿病老人的自我管理越好，血糖控制越好。建議未來應發展及應用適合的教育方案，提升第2型糖尿病老人學習自我管理，並提供健康照護人員改善第2型糖尿病老人的血糖控制之有效策略。

關鍵字

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% of the population aged 65 years and over in Taiwan are diagnosed with type 2 diabetes, which ranks fifth among the top 10 leading causes of death. This study (1) examined the demographic data, self-management behaviors, depression, social participation behaviors, and glycosylated hemoglobin (HbA1c) levels of older patients with type 2 diabetes mellitus; (2) examined how glycemic control in these older patients is related to demographic data, self-management, depression, and social participation; and (3) identified explanatory factors for 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 in this study were patients aged 65 years or more who had been affected by type 2 diabetes for at least 6 months. We used a questionnaire, with relevant scales, including questions on demographic data, disease characteristics, diabetes self-management, depression, and social participation. Medical records were used to collect data about participants' HbA1c levels. The results indicated that age and self-management were significantly negatively associated with HbA1c. Depression and social participation were not significantly associated with HbA1c. Linear regression indicated that current therapy with insulin, illiteracy, and diabetes self-management were explanatory factors for HbA1c levels. Patients receiving current therapy with insulin and illiterate patients had higher HbA1c levels. Better self-management was associated with better control of HbA1c levels. The results of this research suggest that self-management methods for older patients with type 2 diabetes are efficacious and merit further investigation. This study provides clinical practitioners with greater understanding of glycemic control to conduct more efficacious projects for promoting glycosylated hemoglobin control in older patients with type 2 diabetes.

並列關鍵字

type 2 diabetes ； diabetes self-management ； depression ； social participation ； glycosylated hemoglobin

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