Center for Health Economic Research (COHERE), University of Southern Denmark, Odense, Denmark; Department of Epidemiology, Novo Nordisk A/S, Søborg, Denmark.
Department of Epidemiology , Novo Nordisk A/S , Søborg , Denmark.
BMJ Open Diabetes Res Care. 2016 Apr 13;4(1):e000166. doi: 10.1136/bmjdrc-2015-000166. eCollection 2016.
While the prevalence of type 2 diabetes is growing, it is increasingly well recognized that treatment outcomes in primary care practice are often suboptimal. The aim of this study is to examine the extent to which treatment beliefs and health behaviors predict diabetes health outcome as measured by glycated hemoglobin (HbA1c) level, blood pressure, and lipid profile.
This was a large-scale cross-sectional, registry-based study involving a well-defined type 2 diabetes population, in the county of Funen, Denmark. Registry data were combined with a 27-item self-reported survey administered to all insulin-treated people in the registry (n=3160). The survey was constructed to operationalize key concepts of diabetes management, diabetes treatment beliefs, and health behaviors.
In total, 1033 respondents answered the survey. The majority of treatment beliefs and health behaviors examined were predictors of glycemic control and, to a large extent, lipid profile. Absence from, or a low frequency of, self-measured blood glucose, non-adherence to general medical advice and the prescribed treatment, a low primary care utilization, and perceived low treatment efficacy were factors positively associated with HbA1c levels, s-cholesterol, and low-density lipoprotein. Conversely, infrequent self-measured blood glucose was associated with a significantly higher likelihood of having a blood pressure below 130/80 mm Hg. Perceived low treatment efficacy was the only health belief associated with poorer levels of health outcome other than HbA1c.
Health behaviors were stronger predictors for health outcomes than treatment beliefs. Self-reported adherence to either the treatment regimen or general medical advice most consistently predicted both glycemic control and cardiovascular risk factors.
尽管 2 型糖尿病的患病率不断增加，但人们越来越认识到，初级保健实践中的治疗效果往往并不理想。本研究旨在探讨治疗信念和健康行为在多大程度上可以预测糖化血红蛋白（HbA1c）水平、血压和血脂谱等糖尿病健康结果。
这是一项大规模的横断面、基于注册的研究，涉及丹麦菲英郡一个明确的 2 型糖尿病人群。将注册数据与向注册中所有接受胰岛素治疗的人（n=3160）发放的 27 项自我报告调查相结合。该调查旨在对糖尿病管理、糖尿病治疗信念和健康行为的关键概念进行操作化。
共有 1033 名受访者回答了调查。所检查的大多数治疗信念和健康行为都是血糖控制的预测因素，在很大程度上也是血脂谱的预测因素。未进行或很少进行自我血糖测量、不遵守一般医疗建议和规定的治疗、初级保健利用率低以及感知治疗效果低，这些因素与 HbA1c 水平、总胆固醇和低密度脂蛋白呈正相关。相反，很少进行自我血糖测量与血压低于 130/80mmHg 的可能性显著增加有关。感知治疗效果低是除 HbA1c 外唯一与较差健康结果相关的健康信念。
健康行为是健康结果的更强预测因素，而治疗信念则不是。无论是对治疗方案还是一般医疗建议的自我报告依从性，最能一致预测血糖控制和心血管危险因素。
