Singapore Eye Research Institute, Singapore National Eye Centre, Singapore
Duke-National University of Singapore Medical School, Singapore
JAMA Ophthalmol. 2017 Dec 1;135(12):1387-1393. doi: 10.1001/jamaophthalmol.2017.4888.
A patient’s perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association.
To examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017.
The degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers.
Diabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels ≥53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye.
Among the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators.
These results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.
患者对糖尿病自我管理（DSM）的感知障碍可能会影响其糖尿病视网膜病变（DR）的风险；然而，很少有研究对此进行过检验。
检验亚洲 2 型糖尿病患者感知到的 DSM 障碍与 DR 严重程度谱之间的关联。
设计、地点和参与者：这是一项基于诊所的横断面研究，即新加坡糖尿病管理项目，于 2010 年 12 月 28 日至 2013 年 3 月 20 日在新加坡国家眼科中心进行，该中心是一家三级眼科医疗机构。在排除 1 型糖尿病患者和眼底图像无法分级的患者后，共有 361 名患者纳入分析。统计分析于 2017 年 7 月 20 日至 9 月 8 日进行。
使用包含 DSM 知识、获得护理的机会和对医疗保健专业人员信心的 23 项问卷评估感知到的 DSM 障碍程度。使用 Rasch 分析优化量表的心理计量学特性，分数越低表示自我感知障碍越高。
使用改良的 Airlie House DR 分类系统，从 2 个视野视网膜图像中将 DR 分级为无 DR（早期治疗糖尿病视网膜病变研究等级 10-15；n=154）、轻度至中度 DR（等级 20-43；n=112）和严重 DR（等级≥53 和/或存在临床显著的黄斑水肿；n=95）。使用多项逻辑回归模型来评估感知到的障碍与更严重眼睛的 DR 严重程度之间的关联。
在 361 名参与者（105 名女性和 256 名男性；平均[SD]年龄，57[8]岁）中，感知到的 DSM 障碍程度越大，与任何 DR（比值比，1.32；95%CI，1.06-1.66）、轻度至中度 DR（比值比，1.30；95%CI，1.01-1.68）和严重 DR（比值比，1.36；95%CI，1.03-1.79）的可能性越高。这种关联独立于糖尿病控制（血红蛋白 A1c、血压和血脂水平）、表现视力和社会经济指标。
这些结果表明，感知到的 DSM 障碍越大，与 DR 的严重程度越相关。尽管需要进行纵向研究，但这些发现表明，针对减少患者、医生和系统相关糖尿病护理障碍的循证干预措施可能有助于降低 DR 的风险。
