Topsever P, Filiz T M, Salman S, Sengul A, Sarac E, Topalli R, Gorpelioglu S, Yilmaz T
Kocaeli University Faculty of Medicine, Department of Family Medicine, Kocaeli.
Scott Med J. 2006 Aug;51(3):15-20. doi: 10.1258/RSMSMJ.51.3.15.
Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation.
To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes.
In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean +/- SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant.
The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2 +/- 14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243 +/- 110 mg/dl HbA1 c 7.3 +/- 3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3 +/- 3.7 vs. 10.6 +/- 3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.
糖尿病是一种慢性进行性疾病，其治疗方案复杂，患者需要付出巨大努力来实现并维持血糖控制，以降低糖尿病并发症的风险。据报道，述情障碍特征会损害包括糖尿病知识掌握良好和自我护理能力强在内的疾病应对策略。述情障碍是一种心理特质，其特征是无法用言语表达情感、想象力贫乏和操作性思维差，导致心理自我调节失败。
比较糖尿病患者与非糖尿病对照者述情障碍的患病率及多伦多述情障碍量表-26（TAS-26）平均得分；研究述情障碍与糖尿病患者血糖控制的相关性。
在这项横断面研究中，比较了193例糖尿病患者和49例非糖尿病对照者的TAS-26得分。从患者记录中获取疾病相关因素。述情障碍被用作连续变量（TAS-26平均得分）和半定量变量（分为非述情障碍者，TAS-26得分>11分，以及述情障碍者）。描述性数据以均数±标准差、中位数（范围）或百分比表示。通过独立样本t检验和单因素方差分析比较均数差异。采用卡方检验分析比例，并通过交叉表计算比值比（OR），置信区间（CI）为95%。P<0.05被认为具有统计学意义。
对照组在年龄、性别和教育程度方面与糖尿病组相似。在糖尿病研究人群中（n = 193，男性/女性：42/58%，年龄54.2±14.0岁，糖尿病病程中位数7年（1 - 32年），餐后血糖（PBG）243±110mg/dl，糖化血红蛋白（HbA1c）7.3±3.6%），述情障碍的患病率显著高于对照组（糖尿病患者为65%，对照组为45%，p = 0.011；TAS-26平均得分分别为12.3±3.7和10.6±3.6，p = 0.004）。餐后血糖控制不佳（p = 0.002）、女性（p = 0.026）、联合治疗（p = 0.037）和教育水平低（p = 0.005）与糖尿病患者的TAS-26得分呈正相关。与非述情障碍的糖尿病患者相比，述情障碍的糖尿病患者受教育程度较低（OR = 1.2，p = 0.046），血糖控制更差（OR = 2.4，p = 0.005）。
