Holmes-Truscott E, Browne J L, Ventura A D, Pouwer F, Speight J
School of Psychology, Deakin University, Geelong, Australia.
The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, Australia.
Diabet Med. 2018 May;35(5):658-662. doi: 10.1111/dme.13598. Epub 2018 Mar 13.
To explore factors associated with negative insulin appraisals among adults with Type 2 diabetes, including perceived and experienced diabetes stigma.
The second Diabetes MILES - Australia study (MILES-2) is a national survey of adults with diabetes, focused on behavioural and psychosocial issues. Subgroup analyses were conducted on the responses of 456 adults with insulin-treated Type 2 diabetes (38% women; mean ± sd age: 61.2 ± 8.8 years; diabetes duration: 14.5 ± 7.5 years; years using insulin: 6.4 ± 5.5). Participants completed validated measures of perceived and experienced diabetes stigma (Type 2 Diabetes Stigma Assessment Scale), insulin appraisals [Insulin Treatment Appraisal Scale (ITAS)] and known correlates of insulin appraisals: diabetes-specific distress (Problem Areas In Diabetes scale) and diabetes-specific self-efficacy (Confidence in Diabetes Self-care scale). A multiple linear regression was conducted (N = 279) to determine the contribution of those variables found to be associated with ITAS Negative scores.
Univariable analyses revealed negative insulin appraisals were associated with demographic and self-care characteristics (age, employment status, BMI, years using insulin, injections per day), self-efficacy, diabetes-specific distress and diabetes stigma (all P < 0.01). Number of injections per day [regression coefficient [95% confidence interval]: 0.74 [0.08, 1.40]; P = 0.028], self-efficacy [-0.12 [-0.19, -0.06]; P < 0.001] and diabetes stigma [0.39 (0.31, 0.46); P < 0.001) significantly and independently contributed to the final multivariable model, explaining 58% of the variance in ITAS Negative scores. The independent contribution of diabetes-specific distress was suppressed following the inclusion of diabetes stigma.
This study represents the first step in understanding the relationship between perceived and experienced diabetes stigma and negative insulin appraisals, and provides quantitative evidence for the strong, independent relationship between these two important constructs.
探讨2型糖尿病成年患者中与胰岛素负面评价相关的因素，包括感知到的和经历过的糖尿病耻辱感。
第二项澳大利亚糖尿病MILES研究（MILES-2）是一项针对糖尿病成年患者的全国性调查，重点关注行为和心理社会问题。对456例接受胰岛素治疗的2型糖尿病成年患者的回答进行了亚组分析（女性占38%；平均年龄±标准差：61.2±8.8岁；糖尿病病程：14.5±7.5年；使用胰岛素年限：6.4±5.5年）。参与者完成了关于感知到的和经历过的糖尿病耻辱感（2型糖尿病耻辱感评估量表）、胰岛素评价[胰岛素治疗评价量表（ITAS）]以及胰岛素评价的已知相关因素的有效测量：糖尿病特异性困扰（糖尿病问题领域量表）和糖尿病特异性自我效能感（糖尿病自我护理信心量表）。进行了多元线性回归分析（N = 279），以确定那些与ITAS负面得分相关的变量的贡献。
单变量分析显示，胰岛素负面评价与人口统计学和自我护理特征（年龄、就业状况、体重指数、使用胰岛素年限、每日注射次数）、自我效能感、糖尿病特异性困扰和糖尿病耻辱感相关（所有P<0.01）。每日注射次数[回归系数[95%置信区间]：0.74[0.08，1.40]；P = 0.028]、自我效能感[-0.12[-0.19，-0.06]；P<0.001]和糖尿病耻辱感[0.39（0.31，0.46）；P<0.001]对最终的多变量模型有显著且独立的贡献，解释了ITAS负面得分中58%的变异。纳入糖尿病耻辱感后，糖尿病特异性困扰的独立贡献被抑制。
本研究是理解感知到的和经历过的糖尿病耻辱感与胰岛素负面评价之间关系的第一步，并为这两个重要概念之间的强独立关系提供了定量证据。
