Devries J H, Snoek F J, Heine R J
Department of Endocrinology, Diabetes Centre, VU University Medical Centre, Amsterdam, The Netherlands.
Diabet Med. 2004 Dec;21(12):1263-8. doi: 10.1111/j.1464-5491.2004.01386.x.
Around 25% of the adult Type 1 diabetes population is in persistent poor glycaemic control and thus at increased risk of developing microvascular complications. We here discuss correlates of long-standing poor glycaemic control and review the efficacy of clinical strategies designed to overcome persistent poor control. Only a few studies have identified determinants and correlates of long-standing poor glycaemic control in Type 1 diabetes. There is some evidence implicating genetic factors, as well as lower economic status, and psychological factors, including lack of motivation, emotional distress, depression and eating disorders. Ways of improving glycaemic control include strategies to enable self-management, e.g. motivational strategies, coping-orientated education, psychosocial therapies, and/or intensifying insulin injection therapy plus continuous subcutaneous insulin infusion. Long-standing poor glycaemic control appears to be a heterogeneous and complex phenomenon, for which there is no simple, single solution. Comprehensive psycho-medical assessment in diabetes care may prove useful in tailoring interventions. Further research is warranted, to increase our understanding how psychosocial and biomedical factors, separately and in interaction, determine poor outcomes in Type 1 diabetes.
约25%的成年1型糖尿病患者血糖一直控制不佳，因此发生微血管并发症的风险增加。我们在此讨论长期血糖控制不佳的相关因素，并综述旨在克服持续性血糖控制不佳的临床策略的疗效。仅有少数研究确定了1型糖尿病患者长期血糖控制不佳的决定因素和相关因素。有证据表明遗传因素、较低的经济地位以及心理因素（包括缺乏动力、情绪困扰、抑郁和饮食失调）与之相关。改善血糖控制的方法包括促进自我管理的策略，如动机策略、应对导向教育、心理社会治疗，和/或强化胰岛素注射治疗加持续皮下胰岛素输注。长期血糖控制不佳似乎是一种异质性和复杂的现象，对此没有简单的单一解决方案。糖尿病护理中的综合心理医学评估可能有助于制定个性化干预措施。有必要进行进一步研究，以增进我们对心理社会和生物医学因素如何单独以及相互作用决定1型糖尿病不良结局的理解。
