Emoto Naoya, Okajima Fumitaka, Sugihara Hitoshi, Goto Rei
Division of Endocrinology, Department of Medicine, Nippon Medical School Chiba Hokusoh Hospital, Chiba, Japan.
Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Patient Prefer Adherence. 2015 May 11;9:649-58. doi: 10.2147/PPA.S82022. eCollection 2015.
Adherence to treatment and the metabolic control of diabetes are challenging in many patients with diabetes. The theory of neuroeconomics can provide important clues for understanding unreasonable human behavior concerning decisions between outcomes occurring at different time points.
We investigated patients with type 1 and type 2 diabetes to determine whether patients who are at a risk of developing complications are less risk averse. We also examined whether patients with type 1 and type 2 diabetes have different behavioral traits in decision making under risk.
We conducted a behavioral economics survey of 219 outpatients, 66 with type 1 diabetes and 153 with type 2 diabetes. All patients had been referred by general practitioners or other departments in the hospital. At the time of the survey, levels of hemoglobin A1c were not significantly different between patients with type 1 and type 2 diabetes.
Patients with type 2 diabetes showed a lower response rate to the survey compared with patients with type 1 diabetes (71.9% vs 87.9%, P<0.01). Logistic regression analysis indicated that diabetic retinopathy was negatively associated with risk averse in pricing of hypothetical lotteries, myopic time preference, willingness to pay for preventive medicine, and levels of satisfaction with life. Diabetic nephropathy was also negatively associated with risk averse in pricing of hypothetical lotteries. Detailed analysis revealed that a lower proportion of patients with type 2 diabetes (22.7%) were categorized as risk averse compared with patients with type 1 diabetes (43.1%, P<0.05) in hypothetical lottery risk estimation.
This is the first report that investigated patients with diabetes in a clinical setting using a method based on behavioral economics. The results suggest that the attitude of patients toward risk plays an important role in the progress of the complications of diabetes. Different educational and psychological approaches may be necessary to assess patients with diabetes based on whether they have traits such as risk seeking or risk averse.
对于许多糖尿病患者而言，坚持治疗和控制糖尿病代谢颇具挑战。神经经济学理论可为理解人类在不同时间点出现的结果之间进行决策时的不合理行为提供重要线索。
我们对1型和2型糖尿病患者展开调查，以确定有并发症发生风险的患者是否风险规避性较低。我们还研究了1型和2型糖尿病患者在风险决策中是否具有不同的行为特征。
我们对219名门诊患者进行了行为经济学调查，其中66名1型糖尿病患者，153名2型糖尿病患者。所有患者均由全科医生或医院其他科室转诊而来。在调查时，1型和2型糖尿病患者的糖化血红蛋白水平无显著差异。
与1型糖尿病患者相比，2型糖尿病患者的调查应答率较低（71.9%对87.9%，P<0.01）。逻辑回归分析表明，糖尿病视网膜病变与假设彩票定价中的风险规避、近视时间偏好、预防医学支付意愿以及生活满意度水平呈负相关。糖尿病肾病在假设彩票定价中也与风险规避呈负相关。详细分析显示，在假设彩票风险估计中，2型糖尿病患者被归类为风险规避型的比例（22.7%）低于1型糖尿病患者（43.1%，P<0.05）。
这是首份在临床环境中使用基于行为经济学方法对糖尿病患者进行调查的报告。结果表明，患者对风险的态度在糖尿病并发症进展中起重要作用。基于患者是否具有风险寻求或风险规避等特征，可能需要采用不同的教育和心理方法来评估糖尿病患者。
