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

10.6224/JN.201806_65(3).06

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)

糖尿病足部神經病變 ； 健康素養 ； 血糖控制 ； 第二型糖尿病 ； diabetic foot neuropathy ； health literacy ； glycemic control ； type 2 diabetes mellitus

護理雜誌

65卷3期（2018 / 06 / 01）

28 - 37

繁體中文

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。

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.

1. Chin, Y. F.,Huang, T. T.(2013).Development and validation of a diabetes foot self-care behavior scale.The Journal of Nursing Research,21(1),19-25.
   連結：
2. American Diabetes Association(2018).Microvascular complications and foot care: Standards of medical care in diabetes-2018.Diabetes Care,41(Supplement 1)
3. Anderson, R. M.,Funnell, M. M.(2010).Patient empowerment: Myths and misconceptions.Patient Education and Counseling,79(3),277-282.
4. Bains, S. S.,Egede, L. E.(2011).Associations between health literacy, diabetes knowledge, self-care behaviors, and glycemic control in a low income population with type 2 diabetes.Diabetes Technology & Therapeutics,13(3),335-341.
5. Caruso, R.,Magon, A.,Baroni, I.,Dellafiore, F.,Arrigoni, C.,Pittella, F.,Ausili, D.(2018).Health literacy in type 2 diabetes patients: A systematic review of systematic reviews.Acta Diabetologica,55(1),1-12.
6. Chin, Y. F.,Liang, J.,Wang, W. S.,Hsu, B. R.-S.,Huang, T. T.(2014).The role of foot self-care behavior on developing foot ulcers in diabetic patients with peripheral neuropathy: A prospective study.International Journal of Nursing Studies,51(12),1568-1574.
7. Forbes, J. M.,Cooper, M. E.(2013).Mechanisms of diabetic complications.Physiological Reviews,93(1),137-188.
8. Heijmans, M.,Waverijn, G.,Rademakers, J.,van der Vaart, R.,Rijken, M.(2015).Functional, communicative and critical health literacy of chronic disease patients and their importance for self-management.Patient Education and Counseling,98(1),41-48.
9. Hosmer, D. W., Jr.,Lemeshow, S.,Sturdivant, R. X.(2013).Applied logistic regression.Hoboken, NJ:Wiley.
10. Inoue, M.,Takahashi, M.,Kai, I.(2013).Impact of communicative and critical health literacy on understanding of diabetes care and self-efficacy in diabetes management: A cross-sectional study of primary care in Japan.BMC Family Practice,14(1),article 40.
11. Ishikawa, H.,Takeuchi, T.,Yano, E.(2008).Measuring functional, communicative, and critical health literacy among diabetic patients.Diabetes Care,31(5),874-879.
12. Kim, S. H.,Lee, A.(2016).Health-literacy-sensitive diabetes self-management interventions: A systematic review and meta-analysis.Worldviews on Evidence-Based Nursing,13(4),324-333.
13. Kochanek, K. D.,Murphy, S. L.,Xu, J.,Tejada-Vera, B.(2016).Deaths: Final data for 2014.National vital statistics reports,65(4)
14. Lai, A. Y.,Ishikawa, H.,Kiuchi, T.,Mooppil, N.,Griva, K.(2013).Communicative and critical health literacy, and self-management behaviors in end-stage renal disease patients with diabetes on hemodialysis.Patient Education and Counseling,91(2),221-227.
15. Lee, C. M.,Chang, C. C.,Pan, M. Y.,Chang, C. F.,Chen, M. Y.(2014).Insufficient early detection of peripheral neurovasculopathy and associated factors in rural diabetes residents of Taiwan: A cross-sectional study.BMC Endocrine Disorders,14,article 89.
16. Lee, Y. J.,Shin, S. J.,Wang, R. H.,Lin, K. D.,Lee, Y. L.,Wang, Y. H.(2016).Pathways of empowerment perceptions, health literacy, self-efficacy, and self-care behaviors to glycemic control in patients with type 2 diabetes mellitus.Patient Education and Counseling,99(2),287-294.
17. Lunetta, M.,Le Moli, R.,Grasso, G.,Sangiorgio, L.(1998).A simplified diagnostic test for ambulatory screening of peripheral diabetic neuropathy.Diabetes Research and Clinical Practice,39(3),165-172.
18. Margolis, D. J.,Hampton, M.,Hoffstad, O.,Malay, D. S.,Thom, S.(2015).Health literacy and diabetic foot ulcer healing.Wound Repair and Regeneration,23(3),299-301.
19. Moghtaderi, A.,Bakhshipour, A.,Rashidi, H.(2006).Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy.Clinical Neurology and Neurosurgery,108(5),477-481.
20. Nelson, L. A.,Coston, T. D.,Cherrington, A. L.,Osborn, C. Y.(2016).Patterns of user engagement with mobile- and web-delivered self-care interventions for adults with T2DM: A review of the literature.Current Diabetes Reports,16(7),article 66.
21. Office of Disease Prevention and Health Promotion, U.S. Department of Health and Human Services. (2000). Quick guide to health literacy. Retrieved from http://www.health.gov/communication/literacy/quickguide/quickguide.pdf
22. Pai, Y. W.,Lin, C. H.,Lee, I. T.,Chang, M. H.(2017).Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus.Diabetes & Metabolic Syndrome & Clinical Research Review,12(2),111-116.
23. Perrin, B. M.,Swerissen, H.,Payne, C. B.,Skinner, T. C.(2014).Cognitive representations of peripheral neuropathy and self-reported foot-care behaviour of people at high risk of diabetes-related foot complications.Diabetic Medicine,31(1),102-106.
24. Pop-Busui, R.,Boulton, A. J. M.,Feldman, E. L.,Bril, V.,Freeman, R.,Malik, R. A.,Ziegler, D.(2017).Diabetic neuropathy: A position statement by the American Diabetes Association.Diabetes Care,40(1),136-154.
25. Sarkar, U.,Karter, A. J.,Liu, J. Y.,Moffet, H. H.,Adler, N. E.,Schillinger, D.(2010).Hypoglycemia is more common among type 2 diabetes patients with limited health literacy: The Diabetes Study of Northern California (DISTANCE).Journal of General Internal Medicine,25(9),962-968.
26. Smith, A. G.,Singleton, J. R.(2013).Obesity and hyperlipidemia are risk factors for early diabetic neuropathy.Journal of Diabetes and Its Complications,27(5),436-442.
27. Thurston, M. M.,Bourg, C. A.,Phillips, B. B.,Huston, S. A.(2015).Impact of health literacy level on aspects of medication nonadherence reported by underserved patients with type 2 diabetes.Diabetes Technology & Therapeutics,17(3),187-193.
28. Wang, R. H.,Hsu, H. C.,Lee, Y. J.,Shin, S. J.,Lin, K. D.,An, L. W.(2016).Patient empowerment interacts with health literacy to associate with subsequent self-management behaviors in patients with type 2 diabetes: A prospective study in Taiwan.Patient Education and Counseling,99(10),1626-1631.
29. Yang, C. P.,Li, C. I.,Liu, C. S.,Lin, W. Y.,Hwang, K. L.,Yang, S. Y.,Lin, C. C.(2017).Variability of fasting plasma glucose increased risks of diabetic polyneuropathy in T2DM.Neurology,88(10),944-951.
30. Yang, C. P.,Lin, C. C.,Li, C. I.,Liu, C. S.,Lin, W. Y.,Hwang, K. L.,Li, T. C.(2015).Cardiovascular risk factors increase the risks of diabetic peripheral neuropathy in patients with type 2 diabetes mellitus: The Taiwan diabetes study.Medicine,94(42),e1783.
31. 王瑞霞(2016)。病人賦權與健康素養。中華民國糖尿病衛教學會會訊，12(4)，20-22。
32. 沈惠民、林東亮、鍾進燈、許惠恒(2011)。糖尿病足之臨床評估與治療。內科學誌，22(4)，254-265。
33. 靳燕芬、王婉璇、王碧華、黃子庭(2011)。糖尿病老人的足部照護。源遠護理，5(1)，60-65。
34. 蔡清標(2013)。糖尿病周邊神經病變。臺北市醫師公會會刊，57(6)，39-42。
35. 衛生福利部（2017，6月26日）．105 年死因統計結果分析． 取自http://www.mohw.gov.tw/dl-33660-b7dfc331-94bb-4da3-ae09-6aa58a3ee861.html [Ministry of Health and Welfare, Taiwan, ROC. (2017, June 26). Analysis of cause of death statistics, 2016. Retrieved from http://www.mohw.gov.tw/dl-33660-b7dfc331-94bb-4da3-ae09-6aa58a3ee861.html]
36. 衛生福利部(2018)。糖尿病共同照護工作指引手冊。

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