高齡糖尿病病人自我管理及其相關因素研究

A Study of Self-management and Associated Factors among Older Patients with Diabetes

10.6540/NTJN.202303_25(1).0004

薛琇憶(Hsiu-Yi Hsueh)；李淑君(Shu-Chun Lee)；顏心彥(Hsin-Yen Yen)；李佩宜(Pei-I Lee)；李碧霞(Pi-Hsia Lee)

糖尿病 ； 糖尿病自我管理 ； 糖尿病情緒困擾 ； 社會支持 ； diabetes ； diabetes self-management ； diabetes-related distress ； social support

新臺北護理期刊

25卷1期（2023 / 03 / 01）

34 - 45

繁體中文;英文

糖尿病是全球關注的議題之一，穩定的控制血糖，減少併發症的產生是需要糖尿病病人長期的自我管理。本研究旨在了解高齡糖尿病病人自我管理及其相關因素。採橫斷性、描述性研究設計，研究對象為北部某醫學中心新陳代謝科門診65歲以上之糖尿病病人，共計160位，以結構式問卷進行資料蒐集。研究工具包括社會人口學與疾病特性問卷、糖尿病自我管理量表、糖尿病情緒困擾量表、糖尿病社會支持量表。以描述性統計、t檢定、單因子變異數分析、皮爾森積差相關及多元迴歸等統計進行分析。結果顯示：糖尿病自我管理總分平均為28.81分（總分40分），情緒困擾總分平均為8.83分（總分80分），社會支持總分平均為43.88分（總分65分）。自覺健康狀況與糖尿病自我管理呈顯著中度正相關（r=.314, p<.001），情緒困擾與糖尿病自我管理呈低度負相關（r=-.172, p=.030）。高齡糖尿病自我管理的預測因子為自覺健康狀況，解釋變異量為9.3%。本研究結果可以提供臨床醫護人員參考，在照顧上除了著重血糖的控制及自我照護能力外，瞭解影響高齡糖尿病自我管理因素是非常重要的。

Diabetes is an important issue in the world. Diabetic patients need long term self-management for good blood sugar control and reduction of complication rate. The purpose of this study was to understand the self-management of older diabetic patients and associated factors. This was a cross-sectional, descriptive study design. Patients were enrolled from the metabolism department of a medical center in northern Taiwan, and we collected data by structural questionnaire. This study had a total of 160 diabetic patients over 65 years old. Research tools included social-demographics, disease characteristics, the Perceived Diabetes Self-Management Scale (PDSMS), Chinese Version of the Problem Areas in Diabetes Scale (PAID-C), and Diabetes Social Support Scale. Descriptive statistics, t-test, one-way analysis of variance, Pearson's product-moment correlation analysis, and multiple regression analysis were applied to conduct statistical analyses. The findings are as follows. The mean score of Diabetes self-management Scale was 28.81 points (total score 40 points); the Problem Areas in Diabetes Scale averaged 8.83 points (total score 80 points); and the mean Social Support Scale score was 43.88 points (total score 65 points). The correlation between self-perceived health status and diabetes self-management was significant moderately positive correlation (r = .314, p< .001). The correlation between diabetes-related distress and diabetes self-management also showed a significant low negative correlation (r = -.172, p = .030). The predictor of diabetes self-management is self-perceived health status, indicating that this result is predictive with an explained variation of 9.3%. The results of the study can provide reference for clinical medical staff that the care of diabetic patients should not only focus on blood sugar control and self-care ability. It is important to understand the factors that influence diabetes self-management in older patients with diabetes.

1. Hsu, H. C.,Chang, Y. H.,Lee, P. J.,Chen, S. Y.,Hsieh, C. H.,Lee, Y. J.,Wang, R. H.(2013).Developing and psychometric testing of a Short-Form Problem Areas in Diabetes Scale in Chinese patients.The Journal of Nursing Research,21(3),212-218.
   連結：
2. 王瑞霞,劉芸廷,楊春穎,段奇維,徐敏芬(2019)。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。榮總護理，36(1)，39-50。
   連結：
3. 余民寧,陳柏霖,許嘉家,鐘珮純,趙珮晴(2012)。自覺健康狀態、健康責任、情緒幸福感及憂鬱關係之調查。屏東教育大學學報-教育類，38，199-226。
   連結：
4. 張家蓉,徐慧君,李洮俊,王瑞霞(2020)。第二型糖尿病病人人格特質、情緒困擾、社會支持與自我照顧行為相關探討。護理雜誌，67(6)，40-50。
   連結：
5. 彭少貞,湯麗君(2019)。鄉村高齡糖尿病個案的自我管理教育。護理雜誌，66(6)，13-19。
   連結：
6. Adwan, M. A.,Najjar, Y. W.(2013).The relationship between demographic variables and diabetes self-management in diabetic patients in Amman City/Jordan.Global Journal of Health Science,5(2),213-220.
7. Alberti, G.(2002).The DAWN (Diabetes Attitudes, Wishes and Needs) study.Practical Diabetes International,19(1),22-24.
8. Allegrante, J. P.,Wells, M. T.,Peterson, J. C.(2019).Interventions to support behavioral self-management of chronic diseases.Annual Review of Public Health,40,127-146.
9. American Diabetes Association(2015).Standards of medical care in diabetes-2015: Summary of revisions.Diabetes Care,38(Suppl. 1),S4.
10. Barrera, M.,Sandier, I. N.,Ramsay, T. B.(1981).Preliminary development of a scale of social support: Studies on college students.American Journal of Community Psychology,9(4),435-447.
11. Brady, T. J.,Sacks, J. J.,Terrillion, A. J.,Colligan, E. M.(2018).Operationalizing surveillance of chronic disease self-management and self-management support.Preventing Chronic Disease,15,1-15.
12. British Psychological Society. (2017). Division of clinical psychology: Guidelines on language in relation to functional psychiatric diagnosis. http://www.bps.org.uk/system/files/Public%20files/guidelines_on_language_web.pdf.
13. Glasgow, R. E.,Toobert, D. J.,Hampson, S. E.,Strycker, L. A.(2002).Implementation, generalization and long-term results of the "choosing well" diabetes self-management intervention.Patient Education and Counseling,48(2),115-122.
14. Gonzalez-Zacarias, A. A.,Mavarez-Martinez, A.,Arias-Morales, C. E.,Stoicea, N.,Rogers, B.(2016).Impact of demographic, socioeconomic, and psychological factors on glycemic self-management in adults with type 2 diabetes mellitus.Frontiers in Health Public,4,195.
15. Gottlieb, B. H.,Bergen, A. E.(2010).Social support concepts and measures.Journal of Psychosomatic Research,69(5),511-520.
16. Houle, J.,Beaulieu, M. D.,Chiasson, J. L.,Lesperance, F.,Cote, J.,Strychar, I.,Lambert, J.(2015).Glycemic control and self-management behaviours in type 2 diabetes: Results from a 1-year longitudinal cohort study.Diabetic Medicine,32(9),1247-1254.
17. Huang, M. F.,Courtney, M.,Edwards, H.,McDowell, J.(2010).Validation of the Chinese version of the Problem Areas in Diabetes (PAID-C) scale.Diabetes Care,33(1),38-40.
18. Huang, M.,Zhao, R.,Li, S.,Jiang, X.(2014).Self-management behavior in patients with type 2 diabetes: A cross-sectional survey in western urban China.PLoS One,9(4),e95138.
19. Kleinbaum, D. G.,Kupper, L. L.,Nizam, A.,Rosenberg, E. S.(2014).Applied regression analysis and other multivariable methods.CenGage Learning.
20. Lin, M. Y.,Liu, M. F.,Hsu, L. F.,Tsai, P. S.(2017).Effects of self- management on chronic kidney disease: A meta- analysis.International Journal of Nursing Studies,74,128-137.
21. Luo, X.,Liu, T.,Yuan, X.,Ge, S.,Yang, J.,Li, C.,Sun, W.(2015).Factors influencing self-management in Chinese adults with type 2 diabetes: A systematic review and meta-analysis.International Journal of Environmental Research and Public Health,12,11304-11327.
22. Palank, C. L.(1991).Determinants of health-promotive behaviors: A review of current research.Nursing Clinics of North America,26(4),815-828.
23. Pender, N. J.(1987).Health promotion in nursing practice.Appleton- Lange.
24. Pender, N. J.,Walker, S. N.,Sechrist, K. R.,Frank-Stromborg, M.(1990).Predicting health-promoting lifestyles in the workplace.Nursing Research,39(6),326-332.
25. Polonsky, W. H.,Anderson, B. J.,Lohrer, P. A.,Welch, G.,Jacobson, A. M.,Aponte, J. E.,Schwartz, C. E.(1995).Assessment of diabetes-related distress.Diabetes Care,18(6),754-760.
26. Shrivastava, S. R.,Shrivastava, P. S.,Ramasamy, J.(2013).Role of self- care in management of diabetes mellitus.Journal of Diabetes & Metabolic Disorders,12,1-5.
27. Tang, T. S.,Brown, M. B.,Funnell, M. M.,Anderson, R. M.(2008).Social support, quality of life, and self-care behaviors among African with type 2 diabetes.The Diabetes Educator,34(2),266-276.
28. World Health Organization. (2020). The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death
29. Wu, F. L.,Tai, H. C.,Sun, J. C.(2019).Self-management experience of middle-aged and older adults with type 2 diabetes: A qualitative study.Asian Nursing Research,13(3),209-215.
30. Yu, D. S.,Lee, D. T.,Woo, J.(2004).Psychometric testing of the Chinese version of the medical outcomes study social support survey (MOS-SSS-C).Research in Nursing & Health,27(2),135-143.
31. Zhong, X.,Tanasugarn, C.,Fisher, E. B.,Krudsood, S.,Nityasuddhi, D.(2011).Awareness and practices of self-management and influence factors among individuals with type 2 diabetes in urban community settings in Anhui Province, China.The Southeast Asian Journal of Tropical Medicine and Public Health,42(1),184-196.
32. 中華民國糖尿病學會(2019).臺灣糖尿病年鑑--2019第2型糖尿病.
33. 王秀紅,邱啟潤,王瑞霞,李建廷(1992)。婦女健康行為及其相關因素—以高雄市三民區及屏東縣高樹鄉居民為例。公共衛生，19(3)，251-265。
34. 王曉云,蘭文霞,柳潔,高莉,魏慶莉,張晉峰,常淑娟,魏秀聰,余淑麗(2012)。山西省2型糖尿病患者自我管理現狀調查及相關因素分析。齊齊哈爾醫學院學報，33(8)，1065-1069。
35. 全金玉(2013)。中國延邊大學。
36. 吳姈娟(2019)。高雄醫學大學護理學系碩士班。
37. 吳淑芳(2014)。心理困擾之評估與處置；以糖尿病憂鬱為例。中華民國糖尿病衛教學會會訊，10(4)，11-17。
38. 林淑滿,林素蘭,吳月珠,張純明,吳秀麗(2011)。自覺糖尿病自我管理量表之兩階段翻譯及信效度測試。護理暨健康照護研究，7(3)，198-206。
39. 孫勝男,趙維綱,董穎越,李崢(2011)。糖尿病自我管理現狀及影響因素分析。中華護理雜誌，46(3)，229-232。
40. 許志成(2004)。行政院衛生署國民健康局年度委託研究計畫行政院衛生署國民健康局年度委託研究計畫,國家衛生研究院。
41. 許崇民,黃寶萱,王璟璇,黃詩媛(2007)。社區第二型糖尿病患自我管理行為之評估。南臺灣醫學雜誌，3(2)，76-83。
42. 趙櫻花,黃冠婷,吳長岳,張依旻,鍾巧婷,謝清心(2016)。第二型糖尿病年長患者居家自我照顧及相關因素探討。健康與建築雜誌，3(1)，59-68。
43. 衛生福利部國民健康署（2021，10月05日）‧國人三高盛行率。https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=641&pid=1231
44. 衛生福利部統計處（2022，6月30日）‧110年國人死因統計結果。https://www.mohw.gov.tw/cp-16-703141-1.html
45. 盧豐華,林品辰,楊宜青,吳晉祥,胡藝瀚,邱靜如(2014)。最小心理介入於降低中老年糖尿病人心理負擔與血糖之效果初探。臺灣老年醫學暨老年學雜誌，9(3)，96-110。
46. 賴妙芬,劉潔心(2003)。促進糖尿病患者社會支持與充能效果之介入研究。衛生教育學報，20，1-28。