各級醫院糖尿病慢性合併症住院現況探討

Comparison in Diabetes-Related Complications for Inpatients Among University Medical Centers, Regional Hospitals and District Hospitals

10.6288/TJPH2002-21-02-04

魏榮男(Jung-Nan Wei)；宋鴻樟(Fung-Chang Sung)；林瑞雄(Chien-Wen Chou)；李中一(Chung-Yi Li)；莊明雄(Ming-Sion Tsuang)；王博仁(Po-Jen Wang)；周劍文(Chien-Wen Chou)；童瑞年(Jai-Nien Tung)；莊立民(Lee-Ming Chuang)

糖尿病 ； 住院 ； 慢性合併症 ； 治療效果 ； 自我照護行為 ； diabetes mellitus ； inpatient ； chronic complication ； treatment effectiveness ； self-care behavior

台灣公共衛生雜誌

21卷2期（2002 / 04 / 01）

115 - 122

繁體中文

目標：比較國內各級醫院糖尿病慢性合併症住院現況，並探討患者的居家自我照護行為。方法：以民國89年6月1日至90年5月31日期間因糖尿病慢性合併症住院的病患為對象，依據北中南分佈分層隨機抽樣，從醫學中心、區域醫院與地區醫院三個層級分別抽出4、3與6家醫院，抽出168、150與138名住院病人。以問卷訪視收集人口、醫療行為資料，並自病人病歷抄錄合併症、醫療檢測及住院資料。結果：各級醫院糖尿病人過去幾年平均住院約4次，腦血管病變比率（介於18.9~28.1%），心血管疾病（介於49.2~55.1%）和腎臟病變（介於43.8~57.4%）之比率，均無明顯統計差異。下肢血管病變（介於7.4~16.2%）和神經病變（介於14.2~33.5%）之比率均以醫學中心的最高，視網膜病變（介於29.7~46.0%）則以區域醫院的住院病人比率最高。定期追蹤率以地區醫院為最低，只有66.4%，各級醫院病人沒有自我監測血糖的有40.8~77.3%，也以地區醫院為最高。結論：糖尿病住院患者大多有多種合併症，重複住院的比率相當高，各級醫院對住院患者遵照醫囑與日常自我照護行為的衛生教育都有很大的改善空間。（台灣衛誌 2002；21（2）：115-122）

Objectives: The purpose of this study was to investigate and compare the rate of chronic complications for diabetic inpatients among three levels of medical facilities. Diabetic care and patients' self-homecare behaviors were also investigated. Methods: A total of 456 inpatients with diabetes mellitus were recruited from 4 university medical centers (UMC), 3 regional hospitals (RH) and 6 district hospitals (DH) in Taiwan, during June 2000 and May 2001. Patients were interviewed for information in demographic characteristics and health care behaviors. Medical records were reviewed for diabetic care provided to patients and diabetes-related complications diagnosed for them. Results: Patients have been hospitalized for approximately 4 events in average. No significant difference was found in the rates of cardiovascular disease (49.2%-55.1 %), nephropathy (43.8%-57.4%) and cerebrovascular disease (18.9-28.1%) for hospitalized patients, among the 3 levels of hospital. While the UMC inpatients had the highest prevalence rates of diabetic foot (16.2%) and neurophathy (33.5%), the RH inpatients had the highest rate of retinopathy (46. 0%). The rate of regular follow-up check was the lowest (66.4%) for inpatients of DR. They were also less likely than patients of UMC and RH to have self-monitoring of plasma sugar or urine sugar. Conclusions: A good proportion of diabetes inpatients have multiple diabetes-related complications with frequent hospitalizations. Patients cared at DH need greater attention in diabetic care than that at UMC and RH. Standard diabetes care protocol for complication prevention should be implemented.(Taiwan J Public Health. 2002;21(2):115-122)

1. (1998)。糖尿病防治手冊。臺北:行政院衛生署。
2. Amos, A. F. , McCarty, D. J. , Zimmet, P.(1997).The Rising Global Burden of Diabetes and Its Complications: Estimates and Projections to the Year 2010.Diabetic Medicine,14
3. Aro, S., Kangas, T., Reunanen, A., Salinto, M., Koivisto, V.(1994).Hospital Use Among Diabetic Patients and the General Population.Diabetes Care,17
4. Currie, C. J., Morgan, C. L., Peters, J. R.(1998).The Epidemiology and Cost of Inpatient Care for Peripheral Vascular Disease, Infection, Neuropathy, and Ulceration in Diabetes.Diabetes Care,21
5. Fu, C. C., 張智仁 Chang, Chih-Jen, 曾慶孝 Tseng, Chin-Hsiao(1993).Development of Macrovascular Disease in NIDDM Patients in Northern Taiwan：a 4-Year Follw-Up Study.Diabetes Care,16
6. Jiang, Y. D., 莊立民 Chuang, Li-Min, 吳惠培 Wu, Huey-Peir, 戴東原 Tai, Tong-Yuan, Lin, B. J.(1998).Role of An Outpatient Clinic in Screening Chronic Complications of Diabetes: A Model for Diabetes Managed Case.Journal of the Formosan Medical Association,97
7. Kittner, J., White, L., Losonezy, K.(1990).Black-White Differences in Stroke Incidence in A National Sample: the Contribution of Hypertension With Diabetes Mellitus.Journal of the American Medical Association,264
8. Lawler, F. H., Viviani, N.(1997).Patient and Physician Perspectives Regarding Treatment of Diabetes: Compliance With Practice Guidelines.Journal of Family Practice,44
9. Lee, E. T., Keen, H., Bennett, P. H., Fuller, J. H., Lu, M., WHO Multinational Study Group(2001).Follow-Up of the WHO Multinational Study of Vascular Disease in Diabetes: General Description and Morbidity.Diabetologia,44(suppl 2)
10. McGill, M. J., Donnelly, R., Molyneaux, L., Yue, D. K.(1996).Ethnic Differences in the Prevalence of Hypertension and Proteinuria in NIDDM.Diabetes Research ＆ Clinical Practice,33
11. Moss, S. E., Klein, R., Klein, B. E.(1999).Risk Factors for Hospitalization in People With Diabetes.Archives of Internal Medicine,159
12. Rewers, M., Shetterly, S. M., Baxter, J., Marshall, J. A., Hamman, R. F.(1992).Prevalence of Coronary Heart Disease in Subjects With Normal and Impaired Glucose Tolerance and Non-Insulin-Dependent Diabetes Mellitus in A Biethnic Colorado Population.American Journal of Epidemiology,135(12)
13. Rosenthal, M. J., Fajardo, M., Gilmore, S., Morley, J. E., Naliboff, B. D.(1998).Hospitalization and Mortality of Diabetes in Older Adults. A 3 Year Prospective Study.Diabetes Care,21
14. Selby, J. V., Ray, G. T., Zhang, D., Colby, C. J.(1997).Excess Cost of Medical Care for Patients With Diabetes in A Managed Care Population.Diabetes Care,20
15. The Diabetes Control and Complications Trial Research Group(1993).The Effect of Intensive Treatment of Diabetes on the Development and Progression of Long-Term Complications inInsulin-Dependent Diabetes Mellitus.New England Journal of Medicine,329
16. Tseng, F. Y.(1996).Quality of Medical Care for Noninsulin-Dependent Diabetic Patients in A Community Teaching Hospital in Taiwan.Journal of the Formosan Medical Association,95
17. UK Prospective Diabetes Study Group(1998).Tight Blood Pressure and Risk of Macrovascular and Microvascular Complications in Type 2 Diabetes: UKPDS 38.British Medical Journal,317
18. Wagner, E. H., Sandhu, N., Newton, K. M., McCulloch, D. K., Ramsey, S. D., Grothaus, L. C.(2001).Effect of Improved Glycemic Control on Health Care Costs and Utilization.Journal of the American Medical Association,285
19. 莊立民 Chuang, Li-Min, 蔡世澤 Tsai, Shih-Tzer, Huang, B. Y., 戴東原 Tai, Tong-Yuan(2001).The Current State of Diabetes Management in Taiwan.Diabetes Research ＆ Clinical Practice,50(Suppl 1)
20. 郭旭崧 Kuo, Hsu-Sung, 張鴻仁 Chang, Hong-Jen, 周碧瑟 Chou, Pe-Sus, Teng, L., 陳秀熙 Chen, Tony Hsiu-Hsi(1999).A Markov Chain Model to Assess the Efficacy of Screening for Non-Insulin Dependent Diabetes Mellitus (NIDDM).International Journal of Epidemiology,28
21. 曾慶孝 Tseng, Chin-Hsiao, 戴東原 Tai, Tong-Yuan, 陳建仁 Chen, Chien-Jen, Lin, B. J.(1994).Ten-Year Clinical Analysis of Diabetic Leg Amputees.Journal of the Formosan Medical Association,93
22. 蔡文惠(1999)。臺北，國立陽明大學衛生福利研究所。
23. 衛生統計
24. 衛生統計
25. 衛生統計
26. 戴東原 Tai, Tong-Yuan(2000).Current Status of Diabetes in Taiwan.Diabetes Research ＆ Clinical Practice,50

1. 譚家惠(2013)。醫療給付改善方案與照護過程對糖尿病病人健康結果之影響。國立臺灣大學健康政策與管理研究所學位論文。2013。1-123。