Franklin Victoria
Raigmore Hospital, Inverness, Scotland, UK University of Aberdeen, Scotland, UK
J Diabetes Sci Technol. 2016 May 3;10(3):647-55. doi: 10.1177/1932296816639315. Print 2016 May.
The majority of people with type 1 diabetes have suboptimal glycemic control, increasing their complication risk. Technology to support diabetes self-care has advanced significantly and includes self-monitoring of blood glucose (SMBG), insulin pump therapy (IPT), continuous glucose monitoring (CGM), and sensor-augmented pump therapy (SAPT), which are stepping stones toward the "artificial pancreas" using closed-loop technology. Use of these technologies improves clinical outcomes for patients with the appropriate skills and motivation. This review addresses the psychosocial factors that influence both technology provision and clinical outcome and also how technology impacts on psychological outcomes. Optimal use of the various diabetes self-management technologies is influenced by previous self-care behaviors, demographic and psychological factors. Provision of IPT is also influenced by the same factors. Despite technology increasing the complexity of treatment, the lack of evidence for adverse psychological outcomes is reassuring. Treatment satisfaction is high, and discontinuation rates are low. However, technology will widen the health inequality gap if its use is limited to motivated patients who demonstrate good self-care behaviors. Pivotal to the success of the various technologies is provision of appropriate education at initiation of the technology, regular ongoing contact for treatment adjustments and trouble-shooting device issues plus access to psychological support when required. Additional support strategies may be required to help patients struggling with their diabetes to benefit from the available technology, recognizing that they may have most to gain.
大多数1型糖尿病患者的血糖控制并不理想，这增加了他们发生并发症的风险。支持糖尿病自我管理的技术已经取得了显著进展，包括血糖自我监测（SMBG）、胰岛素泵治疗（IPT）、持续葡萄糖监测（CGM）和传感器增强泵治疗（SAPT），这些都是迈向使用闭环技术的“人工胰腺”的垫脚石。对于具备适当技能和积极性的患者，使用这些技术可改善临床结局。本综述探讨了影响技术提供和临床结局的社会心理因素，以及技术如何影响心理结局。各种糖尿病自我管理技术的最佳使用受到先前自我管理行为、人口统计学和心理因素的影响。IPT的提供也受到相同因素的影响。尽管技术增加了治疗的复杂性，但缺乏不良心理结局的证据还是令人安心的。治疗满意度较高，停用率较低。然而，如果技术的使用仅限于那些表现出良好自我管理行为的积极患者，那么技术将扩大健康不平等差距。各种技术成功的关键在于在开始使用技术时提供适当的教育、定期进行治疗调整和解决设备问题的持续联系，以及在需要时获得心理支持。可能需要额外的支持策略来帮助那些与糖尿病作斗争的患者从现有技术中受益，因为他们可能获益最多。
