Krousel-Wood Marie, Radosevich David M, Erikson Clese, Blonde Lawrence, Sanderson-Austin Julie
Ochsner J. 2007 Winter;7(4):158-66.
Physical functioning is an important and often neglected outcome in patients with diabetes. Identification of quality of care indicators and health behaviors associated with higher physical functioning may lead to improved care and outcomes for adult diabetic patients.
We studied 3,521 adult persons with diabetes mellitus from 13 geographically dispersed, multi-specialty group practices in a cross-sectional survey. The outcome variable was the 10-item physical functioning scale. Independent variables included demographics, health behaviors, diabetes management, use of services, health status, risk for depression, comorbidities, and testing for albuminuria, glycosylated hemoglobin, and low-density lipoprotein. From these data, 10 quality-of-care indicators were constructed. We evaluated relationships between physical functioning and the quality of care indicators.
Participants had a mean age of 64.2 +/- 12.6 years, and 52% were female, 67% married, 78% had a high school education or higher, and 73% were white. Multivariate analyses revealed several factors independently associated with higher physical functioning score on the 10-item scale (each p < 0.05, R(2) = 0.54): recent test for albuminuria or low-density lipoprotein lipids; no hospitalization or emergency admission in the prior year; being married; younger age; male gender; African American or Asian race; higher formal education; regular physical exercise; fewer comorbidities; better perceived health; not at risk for depression; not more limited in activities and health not worse compared to a year ago; nonsmoker; not being obese; and not taking insulin.
We identified quality of care and health behaviors associated with higher physical functioning in adult patients with diabetes mellitus. Interventions to enhance the modifiable risk factors may lead to improved physical functioning and delay the onset of disability in these patients.
身体功能是糖尿病患者一项重要但常被忽视的结果。确定与更高身体功能相关的护理质量指标和健康行为，可能会改善成年糖尿病患者的护理及预后。
我们在一项横断面调查中，研究了来自13个地理位置分散的多专科医疗集团的3521名成年糖尿病患者。结果变量是10项身体功能量表。自变量包括人口统计学特征、健康行为、糖尿病管理、服务利用情况、健康状况、抑郁风险、合并症，以及白蛋白尿、糖化血红蛋白和低密度脂蛋白检测。根据这些数据构建了10项护理质量指标。我们评估了身体功能与护理质量指标之间的关系。
参与者的平均年龄为64.2±12.6岁，52%为女性，67%已婚，78%拥有高中或以上学历，73%为白人。多变量分析显示，有几个因素与10项量表上更高的身体功能得分独立相关（各p<0.05，R² = 0.54）：近期白蛋白尿或低密度脂蛋白检测；前一年无住院或急诊入院；已婚；年龄较小；男性；非裔美国人或亚裔种族；正规教育程度较高；定期体育锻炼；合并症较少；自我感觉健康状况较好；无抑郁风险；与一年前相比活动受限不多且健康状况未变差；不吸烟；不肥胖；未使用胰岛素。
我们确定了成年糖尿病患者中与更高身体功能相关的护理质量和健康行为。加强可改变的危险因素的干预措施，可能会改善这些患者的身体功能，并延缓残疾的发生。
