Joslin Diabetes Center, Boston, MA, USA.
Diabetes Care. 2012 Jul;35(7):1466-72. doi: 10.2337/dc11-2422. Epub 2012 May 22.
Nearly one-half of diabetic patients have glycated hemoglobin A(1c) (HbA(1c)) levels above recommended targets. Effective physician-patient communication improves glycemia and diabetes self-care; however, communication gaps may exist that prevent patients from discussing self-care problems with treatment providers.
We assessed diabetic patients' (n = 316, 85% white, 51% female, 71% type 2 diabetes, 59 ± 11 years old, 16 ± 3 years education, 19 ± 13 years diabetes duration, and HbA(1c) = 7.9 ± 1.4%) HbA(1c), frequency of self-care, diabetes-related distress, depressive and anxiety symptoms, coping styles, diabetes quality of life, and self-care communication in the treatment relationship. Multivariate logistic regression models examined the main and interaction effects of health and psychosocial factors associated with patients' reluctance to discuss self-care.
Patients reported positive relationships with their doctors and valued honest communication; however, 30% of patients were reluctant to discuss self-care. Reluctant patients reported less frequent self-care (P = 0.05), lower diabetes quality of life (P = 0.002), and more diabetes-related distress (P = 0.001), depressive symptoms (P < 0.001), and anxiety symptoms (P = 0.001). Patients who reported elevated depressive symptoms, although not necessarily major depression, were more likely to be reluctant to discuss self-care (odds ratio [OR] 1.66 for 10-point change in t score; P < 0.001), whereas patients who were older (OR 0.78 for 10-year change; P = 0.05) and those who used more self-controlled coping styles (OR 0.78 for 10-point change; P = 0.007) were less likely to be reluctant.
Awareness of elevated depressive symptoms is important in clinical practice given that these patients may be more reluctant to discuss self-care. Interventions and evidence-based approaches are needed to improve both depressive symptoms and physician-patient communication about self-care.
近一半的糖尿病患者糖化血红蛋白 A（1c）（HbA（1c））水平高于推荐目标。有效的医患沟通可以改善血糖控制和糖尿病自我护理；然而，沟通障碍可能存在，导致患者不愿与治疗提供者讨论自我护理问题。
我们评估了 316 例糖尿病患者（85%为白人，51%为女性，71%为 2 型糖尿病，59 ± 11 岁，16 ± 3 年教育程度，19 ± 13 年糖尿病病程，HbA（1c）= 7.9 ± 1.4%）的 HbA（1c）、自我护理频率、糖尿病相关困扰、抑郁和焦虑症状、应对方式、糖尿病生活质量和治疗关系中的自我护理沟通情况。多变量逻辑回归模型检查了与患者不愿讨论自我护理相关的健康和社会心理因素的主要和交互效应。
患者报告与医生的关系良好，并重视诚实沟通；然而，30%的患者不愿讨论自我护理。不愿讨论自我护理的患者报告自我护理频率较低（P = 0.05），糖尿病生活质量较低（P = 0.002），糖尿病相关困扰（P = 0.001）、抑郁症状（P < 0.001）和焦虑症状（P = 0.001）较多。报告有抑郁症状的患者（即使不一定患有重度抑郁症）更有可能不愿讨论自我护理（t 评分每增加 10 分的比值比 [OR] 为 1.66；P < 0.001），而年龄较大的患者（OR 为 10 年变化的 0.78；P = 0.05）和使用自我控制应对方式较多的患者（OR 为 10 点变化的 0.78；P = 0.007）则不太可能不愿讨论自我护理。
鉴于这些患者可能更不愿意讨论自我护理，因此在临床实践中，应注意到抑郁症状的升高。需要采取干预措施和基于证据的方法，以改善抑郁症状和医生与患者之间关于自我护理的沟通。
