第2型糖尿病病患執行胰島素注射遵從行為及其相關因素之探討

背景：胰島素治療已證實為控制糖尿病最有療效的藥物，對於控制不良的糖尿病患有其重要性與必要性，研究者在臨床上發現個案由口服降血糖藥物轉換為胰島素注射時接受度低，其注射後的遵囑性不佳，所以找出影響病患持續接受胰島素注射的因素，方能協助病患的糖尿病獲得有效之控制。目的：以PRECEDE模式為架構，瞭解胰島素注射者遵從行為及其相關因素的影響因素。方法：本研究採橫斷式研究法，於2011年12月至2012年3月，以南部某醫學中心內分泌科門診，第 2型糖尿病胰島素自我注射者為對象，共收案128人，使用結構性問卷，包括：人口學資料及疾病特性、胰島素注射之認知、能力、態度、自我效能、及醫療資源可獲性、和社會支持、胰島素注射遵從行為。結果：在素質因素以自我效能有顯著相關，使能因素以醫療資源可獲性有顯著相關，增強因素之親友家人及醫療專業人員的社會支持皆無顯著相關，將胰島素注射者遵從行為有顯著相關之變項，以多元逐步迴歸進行分析。可解釋胰島素注射遵從行為之變異量達13.4％，其中以自我效能的解釋力最大9.2%。結論：提供護理專業人員於照護第2型糖尿病病患注射胰島素病人，善用個案自我效能，給予相關胰島素注射訊息的醫療資源，將可增強其遵從行為，並改善其糖化血色素。

關鍵字

第2型糖尿病；胰島素注射；遵從行為

並列摘要

Background：Insulin therapy has been demonstrated as the most effective treatment for diabetes control. It is rather important and inevitable for diabetic patients who has poor contrrol. Clinical study has shown that patient is less acceptive when making the transition from oral administration of glycemia reducing medicien to insulin injection. Meanwhile, their post-injection compliance is also very poor. Therefore, it is necessaryto identify the parameters where patients can sustain insulin injection, in orderr to help patients with effective diabetes control. Objective：Utilize PRECEDE model as a framework to explore the behvior of compliance among insulin injectors and relavent prameters plus the impact on HbA1c. Methodds：This research applies cross-sectional study from December 2011 to March 2012 targeted on type 2 diabetic patients wih insulin self-injection who are outpatients from department of endocrinology in a medical center at southern Taiwan. Total case have 128 patients. The study use structural questionaire as a tool to conduct measuring. It icludes demographic data, the characters of the disease, the awareness of insulin injection, capability, attittude, self-efficacy, accessibility of medical resources, social support, and compliance of insulin injection. Result：With regard to parameter of diathesis, it is significantly relevnt to self-efficacy, while capability parameter is significantly relevant to the accessibility of medical resources. There is no significant relationship for enhancing parameters such as social support from friends family members and healthcare givers. Using multiple stepwise regression analysis on the variations which have significant relationship with the compliance behavior of insulin injectiors, it can reveal that compliance behavior of insulin injection has 13.4% variation. Among this figure, self-efficacy has the largest interpretation power at 9.2%. Conclusion：While professional healthcare givers helping type 2 diabetic patients with insulin injection,this can be a reference to best utilize patient’s self-efficacy, provide medical resources such as relevant information of insulin injectiton, which will enhance their compliance behavior, and ameliorate their glycosylated hemoglobin.