探討成年糖尿病人的生活品質及其相關因素

Abstract

研究目的：生活品質是照護糖尿病重要的課題之一。本研究目的在瞭解台灣成年人糖尿病患者生活品質狀況及其相關因素。 研究對象與方法：本研為橫斷性研究，研究對象為台大醫學中心一般內科、家庭醫學科及新陳代謝專科門診成年糖尿病患。病人自填中文版糖尿病生活品質量表(Diabetes Quality of Life； DQOL)收集健康相關生活品質。以訪談方式收集病患之人口學基本資料，以查閱病例方式收集病患有關糖尿病及其他醫療相關因素，如糖化血色素質、罹病時間、治療方式、糖尿病合併症、其他慢性合併症、代謝症候群等資料。糖尿病生活品質量表包含三面向：滿意度、衝擊、憂慮；得分由1-5分轉為0-100分，得分越高表示生活品質狀況越佳。分析方法先以單變項線性迴歸評估糖尿病生活品質量表總分及三面向與人口學變項、糖尿病及其他醫療相關變項之關係，再以複迴歸方式尋找與糖尿病生活品質有顯著相關之變項。 結果：共有205為病患參與此研究，平均年齡62.4±13歲，男性95人(46.3)%，多數(81.3%)存有婚姻關係，超過半數(51.2%)受教高於高中教育。平均診斷患有糖尿病9.02±7.6年，平均HbA1c值為7.55±1.55%，29人(14.2%)使用胰島素治療，109人(53.2%)來自新陳代謝專科門診，35人只有合併大血管病變(17.1%)，58人只有合併小血管病變(28.3%)，31人併存兩類病變(15.1%)。病患之生活品質總分與其他研究類似，但是滿意度得分較其他研究低，衝擊與憂慮得分較其他研究高。複迴歸結果顯示年齡及存有婚姻關係對生活品質總分有正向影響，合併小血管病變及HbA1c值對生活品質總分有負向影響；規則運動的滿意度得分有正向影響，HbA1c值對滿意度得分有負向影響；年齡及在新陳代謝專科看診對衝擊得分有正向影響，使用胰島素治療及HbA1c值對衝擊得分有負向影響；教育程度及及HbA1c值對憂慮得分有負向影響。 結論：HbA1c值對糖尿病生活品質量表總得分及滿意度、衝擊、憂慮三面向之得分都有影響；而年齡、婚姻狀態、教育程度、合併症、治療方式則對不同面向有不同影響。

Objective: To assess the factors associated with health-related quality of life (HRQL) among patients with diabetes mellitus in Taiwan. Methods: This is a cross-sectional observational study comprising 205 adult patients with diabetes (mean age of 62±13 years) cared at clinics of family medicine, general internal medicine and endocrinology of National Taiwan University Hospital. Participants were interviewed using the Chinese-version Diabetes Quality of Life (DQOL) questionnaire to assess the three dimensions of HRQL (i.e. satisfaction, impact and worry) and the total score. All the scores were transformed into 0-100 scales with a higher score representing a better HRQL. Multiple regression analysis was used to examine the factors associated with the three dimensions and the total DQOL score. Results: Patients in this study reported similar total DQOL scores but lower scores in Satisfaction dimension, and higher scores in the two other dimensions than previous studies. In the multiple linear regression analysis, age and being married were positively associated, while having micro-vascular complications and the level of HbA1c were negatively associated with total score of DQOL. As for the three dimensions of the HRQL; having regular physical activity was positively associated, while level of HbA1c was negatively associated with the score of Satisfaction; age and being cared at endocrine special clinic was positively associated, while insulin injection and the level of HbA1c were negatively associated with the score of Impact and education level and the level of HbA1c were negatively associated with the score of Worry. Conclusions: The level of HbA1c was associated both with the total and the scores of entire three dimensions, while age, marital status, complications, education level, insulin injection and physical activity affected only some of the scores.