新診斷糖尿病人自我照護因子及生活型態與血糖控制的關聯：縱貫性觀察研究_

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題名：	新診斷糖尿病人自我照護因子及生活型態與血糖控制的關聯：縱貫性觀察研究
作者：	謝芳傑
作者(外文)：	SIA, HONKE
校院名稱：	亞洲大學
系所名稱：	健康產業管理學系健康管理組
指導教授：	王俊毅
學位類別：	博士
出版日期：	2021
主題關鍵詞：	糖尿病；血糖控制；預測因子；自我監測血糖；吸菸；diabetes mellitus；glycemic control；predictors；self-monitoring of blood glucose；smoking
原始連結：	連回原系統網址
相關次數：	被引用次數:期刊(0) 博士論文(0) 專書(0) 專書論文(0) 排除自我引用:0 共同引用:0 點閱:1

研究背景：在罹病早期，良好的血糖控制可降低併發症的風險，甚至可能逆轉β細胞的功能障礙。因此新診斷糖尿病人需要盡快實現更好的血糖控制。本文目的是探討新診斷第2型糖尿病人之自我照護因子及生活型態與血糖控制的關聯，進行了三項研究。研究一，是辨識新診斷第2型糖尿病人在第一年血糖控制失敗的預測因子。研究二、三則針對自我監測血糖（自我照護因子）及吸菸（生活型態）進行縱貫型研究，評估這些因素對血糖控制的關聯及程度。
研究方法：本研究為縱貫型觀察性研究。以回顧方式，進行次級資料分析。研究對象為在2002年1月至2017年12月之間在台灣中部某醫學中心接受衛教及完成糖尿病照護系統登錄之新診斷第2型糖尿病人。使用電子病歷系統中的數據進行篩查。主要結果是血糖控制，以糖化血色素值進行評估。變項包括人口學資料，家族病史，生活型態（吸菸，飲酒和身體活動），臨床因素（包括身體檢查、實驗室檢驗、藥物使用及共病），自我照護因子（包括藥物依從性、自我監測血糖、疾病相關的知識及自我管理的意願）等。
結果：研究一顯示，研究參與者中有33.6%第一年治療失敗。基線糖化血色素值每增加1%，治療失敗的風險就上升為1.17倍（95%信賴區間，1.15至1.20）。男性、規律運動、進行自我監測血糖、藥物依從性佳以及近年
（2010至2017年）發病收案者，在所有模式中均有較低的治療失敗風險。研究二，根據模型估計的縱向糖化血色素軌跡，調整其他干擾變項後顯示，自我監測血糖「早期使用者」比「未早期使用者」的糖化血色素降幅大，組間的糖化血色素降幅差異為0.55%。次群體分析中，無論是使用胰島素增泌劑或非胰島素增泌劑，自我監測血糖皆與改善血糖控制顯著關聯。此外，較高自我監測血糖頻率（≥7次/週）與更大的糖化血色素降幅顯著關聯。雖然自我監測血糖的監測頻率會隨時間逐漸耗損，但血糖控制改善效果仍可持續到一年。研究三顯示，新診斷第2型糖尿病男性病人，在一年的觀察期間，吸菸者的血糖控制比不吸菸者差。兩組間的糖化血色素降幅差異約為0.25到0.33%。在身體質量指數<25 kg/m2者更為明顯，組間的糖化血色素降幅差異0.68到0.74%，顯示可能身體質量指數較低的男性病人吸菸與血糖控制間的負向關聯更強。
結論：本研究顯示自我監測血糖，藥物依從性和規律運動等自我照護行為及生活型態對新診斷第2型的糖尿病人避免治療失敗關聯甚大。男性病人吸菸與血糖控制不良有顯著關聯。

以文找文

Background: Early glycemic control may have long-term effects in reducing the risk of diabetes related complications and reverse β cell dysfunction. Therefore, it is urgent to achieve optimal glycemic control in patients with newly diagnosed type 2 diabetes mellitus (T2DM).
This thesis was proposed to explore the association between self-care factors and lifestyles on glycemic control among adult patients with newly diagnosed T2DM. Three studies were separately conducted. The aim of study 1 was to identify factors that predict treatment failure during the first year in adult with newly diagnosed T2DM. The other two studies aimed to examine the longitudinal association between glycemic control and two major factors: self-monitoring of blood glucose (SMBG) and smoking, in non-insulin-treated patients and men, respectively.
Methods: The studies used secondary data analyses with retrospective longitudinal design. Adult patients who received diabetes education and completed registration at a medical center in Taiwan between January 2002 and December 2017 were screened for eligibility based on data from the hospital’s electronic medical record system. Glycemic control, the primary outcome, was assessed by repeated measures of hemoglobin A1c (HbA1c) levels. Covariate data on demographics, family history, lifestyles (habits and physical activity), physical examinations, laboratory tests, medications, adherence, knowledge regarding glycemic control, and willingness toward diabetes self-management were collected.
Results: Study 1 showed that 33.6% of participants were classified as treatment failure (TF) during the first year. For every 1% increase in baseline HbA1c, the
risk of TF was 1.17 (95%CI, 1.15−1.20) times higher. Gender (men), medication adherence, SMBG, regular exercise, and enrollment during 2010−2017 predicted a lower risk of TF in both of primary and subgroup models. In study 2, longitudinal HbA1c trajectory after adjustment of other control variables showed that early SMBG users had a lower estimated HbA1c reduction than non-users, with the maximal difference being 0.55%. Performing SMBG at disease onset was positively associated with better glycemic control in newly diagnosed non-insulin treated T2DM patients, regardless of whether non-insulin secretagogues or insulin secretagogues were used. In addition, higher SMBG frequency (≥ 7 times/week) was associated with greater HbA1c reduction. Study 3 demonstrated that smoking was independently associated with unfavorable glycemic control among men with newly diagnosed T2DM. The estimated difference in HbA1c reduction between smokers and non-smokers was 0.25 – 0.33. For those with body mass index < 25 kg/m2, the difference in HbA1c reduction was much remarkable.
Conclusions: Overall, the findings show that self-care behaviors and lifestyles, such as medication adherence, SMBG, and regular exercise were major predictors of treatment failure during the first year. In addition, the studies add evidence on the longitudinal associations of glycemic control with SMBG and smoking among patients with newly diagnosed T2DM.

以文找文

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