口服降血糖藥失效之第2型糖尿病患對胰島素治療信念之追蹤研究

Abstract

本研究為了解第2型糖尿病患者於接受胰島素治療前後對胰島素治療信念之差異，針對2013年汪惠芬博士所著「口服降血糖藥失效之第2型糖尿病病人的疾病感受、胰島素治療信念與胰島素治療意向」中的研究對象，共101位某醫學中心門診第2型糖尿病患者進行追蹤。距離前次研究約兩年後，本研究在同一門診追蹤到70位個案，以胰島素治療評估量表(ITAS)進行問卷調查，並將調查結果與該研究對象前次在汪的研究中所填寫之ITAS量表分數作比較，以探討同一群第2型糖尿病患者在接受胰島素治療前後對胰島素治療信念之變化。本研究發現，汪的研究結束後有一些研究對象已陸續接受胰島素治療(接受組)，其他研究對象仍然尚未開始接受胰島素治療(抗拒組)。觀察研究對象對胰島素治療之正向信念變化可發現，無論接受組或抗拒組在前後兩次調查中正向信念皆沒有顯著變化。觀察負向信念變化可發現，在前次汪的調查中兩組的負向信念沒有顯著差異，但在本次調查中接受組的負向信念明顯降低且顯著低於抗拒組，而抗拒組負向信念則沒有明顯變化，且以共變數分析排除可能影響個案對胰島素治療信念的共變項後，在本次調查中接受組的負向信念仍顯著低於抗拒組。此外，比較各組組內正負向信念平均分數可發現，接受組在前次調查中正負向信念沒有差異，但在本次調查中正向信念平均分數明顯大於負向信念。藉由跨組比較正負向信念平均分數差也可發現在本次調查中接受組正負向信念互相抵銷後剩餘的正向信念顯著大於抗拒組。綜上結果，本研究發現對於口服降血糖藥失效需要胰島素治療的糖尿病病患，若能使其親自體驗胰島素治療應有機會能降低其對胰島素治療的負向信念，且可能使正向信念明顯大於負向信念，也因此在對胰島素治療的正負向信念相互抵銷後仍有較多的正向信念支持個案持續接受胰島素治療。 本研究以自擬式問卷收集歸納出個案拒絕胰島素治療的原因，包括：個案對胰島素治療、血糖控制與疾病關係的錯誤認知，以及對於胰島素治療操作過程的擔心。建議在糖尿病衛教中，除了提供糖尿病與胰島素的正確認知外，可以讓個案親自體驗胰島素注射以降低個案對胰島素治療的負向信念。此外建議未來研究可進行介入性研究，了解改變個案對胰島素之信念對其接受胰島素治療之效果。

In order to learn about the difference in the treatment beliefs of patients to insulin before and after insulin treatment, the study conducted a follow-up survey on 101 outpatients in a medical center, who were the research subjects in the Illness Perceptions, Treatment Beliefs to Insulin, and Intention to Insulin Therapy of Patients with Failure to Oral Drugs written by doctor Huey-Fen Wang in 2013. About two years after the former study, the present study performed the follow-up survey of 70 cases in the outpatient department of the same hospital. A questionnaire survey was made using Insulin Treatment Appraisal Scale (ITAS), and the ITAS score of each subject was compared with that in the study of Wang to explore the changes in the treatment beliefs to insulin of the same patients before and after insulin treatment. The present study found that after the study of Wang, some subjects successively received insulin treatment (acceptance group), while other subjects had not begun to receive insulin treatment (resistance group). Observation on the positive beliefs of subjects to insulin treatment found that neither the acceptance group nor the resistance group showed significant changes of positive beliefs in the former and later survey. Observation on the changes of negative beliefs found that the negative beliefs of two groups showed no significant difference in the study of Wang, while in the present study, the acceptance group showed significantly reduced and lower negative beliefs compared with the resistance group, but the resistance group showed no significant changes of negative beliefs. With the covariates that may influence the treatment beliefs to insulin of cases excluded by covariance analysis, the negative beliefs in the present study were still significantly lower in the acceptance group than in the resistance group. In addition, comparison of the mean of the positive and negative beliefs in each group found that the positive and negative beliefs of the acceptance group showed no difference in the former study, while the positive beliefs were significantly larger than the negative beliefs in the present study. Cross-group comparison of the difference in positive and negative beliefs found that with the positive and negative beliefs offset mutually, the rest of positive beliefs in the acceptance group were significantly larger than those in the resistance group. In conclusion, the present study found that for the patients with failure to oral hypoglycemic agents who require insulin treatment, if they can experience the insulin treatment by themselves, there is the possibility that their negative beliefs to insulin treatment will be reduced, and their positive beliefs also could be larger than the negative beliefs. With the positive and negative beliefs to insulin treatment offset mutually, there are still more positive beliefs supporting the patients to continue the insulin treatment. The present study summarized the reasons of cases for refusing insulin treatment using a self-made questionnaire, including misconceptions of cases to the relationship of insulin treatment and blood glucose control with the disease, as well as their worries about the operations in the insulin treatment. It is suggested that besides providing correct knowledge of diabetes and insulin, the diabetes education should also allow the patients to experience insulin injection by themselves, so as to reduce the negative beliefs of patients to insulin treatment. In addition, it is suggested that interventional studies can be made in the future to learn about the effects of changing the beliefs of patients to insulin on their acceptance for insulin treatment.