Predictors of Glycemic Control in Adolescents of Various Age Groups With Type 1 Diabetes

第一型糖尿病青少年在不同年齡層血糖控制預測因子之探討

李淑莉(Shu-Li Lee) ； 羅福松(Fu-Sung Lo) ； 李燕晉(Yann-Jinn Lee) ； 陳百薰(Bai-Hsiun Chen) ； 王瑞霞(Ruey-Hsia Wang)

《The Journal of Nursing Research》 23卷4期 (2015/12) Pp. 271-279

https://doi.org/10.1097/jnr.0000000000000096

摘要

背景：了解第一型糖尿病青少年在不同年齡層之血糖控制的預測因子，將有助於護理人員發展適合該年齡層之血糖控制的護理措施。然而此議題鮮少被探究，尤其是針對亞洲人口群。目的：探討台灣第一型糖尿病青少年在其不同年齡層的人口學特徵、自我照顧行為、家庭衝突和父母參與對其六個月後糖化血色素（HbA1_c）值的預測。方法：採前瞻性調查設計。在基線時，第一型糖尿病青少年完成自我照顧行為量表，父母／監護者完成父母參與和家庭衝突量表，六個月後從病歷上取得HbA1_c值。共有210對青少年—父母／監護者參與。以多元逐步複迴歸檢測10-12、13-15 和16-18歲第一型糖尿病青少年，於基線測量後六個月HbA1c值的重要預測因子。結果：家庭衝突是10-12歲年齡層在基線測量後六個月HbA1_c值的重要預測因子，自我照顧行為是13-15歲年齡層在基線測量後六個月HbA1_c值的重要預測因子，性別和自我照顧行為是16-18 歲年齡層在基線測量後六個月HbA1c值的重要預測因子。結論／實務應用：護理人員需依據第一型糖尿病青少年各年齡層的發展需求設計特定的護理措施，以提昇其血糖的控制。在10-12歲的青少年，須積極評估家庭衝突和提供相關措施；對13-18歲的青少年，應加強其自我照顧行為；青少女應被視為16-18歲青少年的高危險群。

關鍵字

第一型糖尿病 ； 血糖控制 ； 青少年 ； 預測因子 ； 年齡層

並列摘要

Background: Understanding the predictors of glycemic control in adolescents of various age groups with type 1 diabetes (T1D) is crucial for nurses to cultivate developmental-specific interventions to improve glycemic control in this age group. However, research has rarely addressed this issue, particularly in the context of Asian populations. Purpose: We explored the predictive influence of demographic characteristics, self-care behaviors, family conflict, and parental involvement on glycosylated hemoglobin (HbA1C) levels 6months after the baseline measurement in adolescents of various age groups with T1D in Taiwan. Methods: A prospective survey design was applied. At baseline, adolescents with T1D completed a self-care behavior scale. Parents or guardians finished scales of parental involvement and family conflict. The HbA1C levels 6 months after baseline measurement were collected from medical records. Two hundred ten adolescent-parent/guardian pairs were enrolled as participants. Multiple stepwise regressions examined the significant predictors of HbA1C levels 6 months after the baseline measurement in the three adolescent age groups: 10-12, 13-15, and 16-18 years. Results: Family conflict was a significant predictor ofHbA1C level within the 10-12 years of age group 6 months after the baseline measurement. Self-care behaviors were a significant predictor of HbA1C level within the 13-15 years of age group 6 months after the baseline measurement. Being female and self-care behaviors were each significant predictors of HbA1C level in the 16-18 years of age group 6months after the baseline measurement. Conclusions/Implications for Practice: Nurses should design specific interventions to improve glycemic control in adolescents of various age groups with T1D that are tailored to their developmental needs. For adolescents with T1D aged 10-12 years, nurses should actively assess family conflict and provide necessary interventions. For adolescents with T1D aged 13-18 years, nurses should exert special efforts to improve their self-care behaviors. In addition, female adolescents aged 16-18 years should be considered an at-risk group.

並列關鍵字

type 1 diabetes ； glycemic control ； adolescent ； predictors ； age groups

參考文獻

Tang, S. M.,Chen, S. W.,Wang, R. H.(2013).Establishing a model to assess the effects of school support and self-care behaviors on life satisfaction in adolescents with type 1 diabetes in Taiwan.The Journal of Nursing Research.21(4),244-251.

American Diabetes Association(2013).Standards of medical care in diabetes-2013.Diabetes Care.36(1),s11-s66.

Cameron, F. J.,Skinner, T. C.,de Beaufort, C. E.,Hoey, H.,Swift, P. G. F.,Aanstoot, H.,Skovlund, S. E.(2008).Are family factors universally related to metabolic outcomes in adolescents with type 1 diabetes?.Diabetic Medicine.25(4),463-468.

Carey, W. B.(Ed.),Crocker, A. C.(Ed.),Coleman, W. L.(Ed.),Elias, E. R.(Ed.),Feldman, H. M.(Ed.)(2009).Developmental-behavioral pediatrics.Philadelphia, PA:Saunders.

Chang, C. W.,Yeh, C. H.,Lo, F. S.,Shih, Y. L.(2007).Adherence behaviours in Taiwanese children and adolescents with type 1 diabetesmellitus.Journal of Clinical Nursing.16(7b),207-214.