調適方式、社會支持與壓力感受對糖尿病患者血糖控制之影響

Abstract

目的 : 本研究旨在瞭解調適方式、社會支持及壓力感受對糖尿病患者血糖控制所產生的影響，藉此找出目前糖尿病照護政策不足之處，做為日後改善的參考依據。 方法 : 針對北部某醫學中心新陳代謝科的門診的糖尿病患者進行收案。患者必須被診斷糖尿病至少六個月以上且規則門診追蹤，目前使用口服降血糖藥物治療者，研究透過問卷調查方式瞭解病患的調適方式、社會支持及壓力感受並以最近三個月內的糖化血色素為血糖控制的成效。 結果 : 本研究有效問卷共301份，男性患者佔大多數，年齡分佈以50-59 歲居多，五成三的教育程度方面在國中以下，婚姻狀況以已婚者佔多數，居住狀況以跟家人或親友一起居住者佔多數，就業狀況已有工作者佔多數，其中大部份為受薪受僱者，職業等級以低技術性、勞動性業務工作者居多，工作班別方面以固定班別佔多數。罹病時間平均為5.59年，以診斷五年內者佔大多數，約兩成的病患已經有糖尿病相關的合併症產生。有運動者、罹病時間在五年內者其血糖控制比無運動及罹病五年以上者佳。以單因子變異數分析發現在壓力感受部份，女性患者顯著大於男性，年齡層的不同對於壓力感受有差異性存在，其中以30-39歲族群的壓力感受最大及有工作者的壓力感受比無工作者大。在複迴歸模式中發現運動、罹病年數、工作、調適方式及壓力感受為糖化血色素之重要預測因子，以上變項總共可解釋22% (adjusted R square = 15.9%, p<0.001) 病人的糖化血色素控制的總變異量。 結論 : 調適方式及壓力感受會影響糖尿病患者的血糖控制，目前國內糖尿病的照顧欠缺病患心理方面的評估，未來應該加強衛教人員有關病患心理調適方面的教育訓練、例行為糖尿病患者進行社會心理方面的評估。

Objective : This study was designed to investigated patterns of coping methods, levels of social support and perceived stress, as well as the effects of these factors on glycemic control among diabetic patients. The purpose of this study was to improved current diabetic care related health care policies. Methods : A validated questionnaire was administered to patients with type 2 diabetes who were regularly followed at a metabolism outpatient clinic during the past six months. Informations obtained by the questionnaire included socio-demographic background, coping methods, social support and perceived stress. Multivariate regression analysis was used to assess the association of above factors with the level of glycosylated haemoglobin (Hba1c) which was assesses as an outcome variable for quality of diabetic control. Results : A total of 301 diabetic patients completed the questionnaire. Among them, 60.1% were male, 43.2% were between 50-59 years old and about 53% of the patients had an educational level of junior high school or below. Most of the patients married and lived with family members. With regard to work status, 60.8% of the patients were working and most of them were employees. With regard to disease status, most patients were diagnosed within five years period with mean duration of 5.59 years, 20% of the patients with had diabetes-related complications. Descriptive analyses showed that better glycemic controlled was found in patients with more regular exercises and diabetes duration less than five years. Level of perceived stress was higher in woman, those aged between 30-39 and working group. In multivariate analyses, exercise, diabetes duration, working status, coping methods and perceived stress were important predictors of the level of glycosylated haemoglobin – all those factors explained 22% (adjusted R square = 15.9%, p<0.001) of the variation of glycoslylated hemoglobin in diabetes patients. Conclusions : Coping methods and perceived stress play important roles on glycemic control in diabetic patients. However, current diabetes health care providers pay less attention on their psychosocial evaluation. Therefore, more resources should be provided for health education in order to improve the psychosocial care for diabetic patients.