Emoto Naoya, Okajima Fumitaka, Sugihara Hitoshi, Goto Rei
Department of Endocrinology, Nippon Medical School Chiba-Hokusoh Hospital, Chiba; Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo.
Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo.
Patient Prefer Adherence. 2016 Oct 25;10:2151-2162. doi: 10.2147/PPA.S116198. eCollection 2016.
We have recently reported that the attitude of patients toward risk could be a factor in the progression of diabetic complications. In general, risk preference is closely related to socioeconomic status (SES), which includes factors such as age, sex, income, and educational attainment.
We aimed to determine the effect of SES and behavioral propensity on the progress of diabetic complications in patients with type 2 diabetes mellitus (T2DM).
We conducted a survey of 238 patients with difficult-to-control T2DM treated at a hospital in Japan using a modified behavioral economics questionnaire that included questions related to SES. The patients had been referred by general practitioners or other departments in the hospital because of poor metabolic control or unstable complications.
Educational attainment was significantly associated with progression of retinopathy in patients <65 years of age. Educational attainment of a high school diploma (12 years of education) or lower was a significant risk factor, but there were no differences among levels of attainment beyond high school (13-16 years or more of education). Behavioral propensities were also weakly associated with complications, but not as much as educational attainment. Personal income level and economic status did not show an association with the retinopathy levels.
Lower educational attainment is a strong risk factor for diabetic retinopathy, and it is independent of the economic status. The result suggests that cognitive function may play an important role in the progression of diabetic retinopathy in patients with T2DM.
我们最近报告称，患者对风险的态度可能是糖尿病并发症进展的一个因素。一般来说，风险偏好与社会经济地位（SES）密切相关，社会经济地位包括年龄、性别、收入和教育程度等因素。
我们旨在确定社会经济地位和行为倾向对2型糖尿病（T2DM）患者糖尿病并发症进展的影响。
我们使用一份经过修改的行为经济学问卷，对日本一家医院收治的238例难以控制的T2DM患者进行了调查，问卷中包括与社会经济地位相关的问题。这些患者因代谢控制不佳或并发症不稳定而由全科医生或医院其他科室转诊而来。
在65岁以下的患者中，教育程度与视网膜病变的进展显著相关。高中文凭（12年教育）或更低的教育程度是一个显著的风险因素，但高中以上教育程度（13 - 16年或更长时间的教育）之间没有差异。行为倾向也与并发症有较弱的关联，但不如教育程度密切。个人收入水平和经济状况与视网膜病变程度没有关联。
较低的教育程度是糖尿病视网膜病变的一个强有力的风险因素，且独立于经济状况。该结果表明认知功能可能在T2DM患者糖尿病视网膜病变的进展中起重要作用。
