糖尿病患者的胰岛素依从性、情绪困扰及对医生的信任：一项横断面研究。
Adherence to Insulin, Emotional Distress, and Trust in Physician Among Patients with Diabetes: A Cross-Sectional Study.
作者信息
Halepian Lucine, Saleh Mary Bou, Hallit Souheil, Khabbaz Lydia Rabbaa
机构信息
Pharmacology, Clinical Pharmacy and Drug Quality Control Laboratory, Saint-Joseph University of Beirut, Beirut, Lebanon.
Faculty of Pharmacy, Saint-Joseph University of Beirut, Beirut, Lebanon.
出版信息
Diabetes Ther. 2018 Apr;9(2):713-726. doi: 10.1007/s13300-018-0389-1. Epub 2018 Mar 8.
INTRODUCTION
Type 2 diabetes represents a significant public health issue, with increasing prevalence in developing countries while adherence to insulin treatment remains a challenge. No studies have evaluated the relationship between adherence to insulin, diabetes-related distress, and trust in physician among persons with diabetes. Our objectives were to evaluate treatment adherence to insulin, emotional distress (using the Problem Areas in Diabetes Questionnaire, PAID), trust in physician, and to examine associations between them among Lebanese patients with diabetes.
METHODS
This cross-sectional study, conducted in all districts of Lebanon between August 2016 and April 2017, enrolled 135 adult patients.
RESULTS
The mean percentage score of adherence to insulin was 79.7 ± 19.94. A significantly higher mean adherence score was found in non-sedentary (81.96) compared to sedentary patients (67.41) (p = 0.017), with no difference between gender, employment, rural vs non-rural residence, or familial history of diabetes. In addition, no significant relationship was seen between adherence score and education level, smoking, or alcohol intake. A significant positive association was found between trust in physician and adherence scores, whereas a significant but negative one was found between PAID and adherence scores. The results of linear regressions showed that a secondary level of education (beta = - 13.48) significantly decreased the trust in physician score, whereas the total number of oral antidiabetics (beta = 0.93) increased it. Having a sedentary lifestyle (beta = - 12.73) and smoking < 3 waterpipes/week compared to no smoking (beta = - 16.82) significantly decreased the adherence score. Female gender (beta = 10.46), smoking < 3 waterpipes (beta = 27.42) and 3 + waterpipes/week (beta = 17.95) significantly increased the PAID score.
CONCLUSION
Trust in physician is associated with an increased adherence and with decreased diabetes-related distress. This distress was also associated with poor adherence in our study.
引言
2型糖尿病是一个重大的公共卫生问题，在发展中国家的患病率不断上升，而坚持胰岛素治疗仍然是一项挑战。尚无研究评估糖尿病患者中胰岛素治疗依从性、糖尿病相关困扰与对医生的信任之间的关系。我们的目标是评估黎巴嫩糖尿病患者对胰岛素治疗的依从性、情绪困扰（使用糖尿病问题领域问卷，PAID）、对医生的信任，并研究它们之间的关联。
方法
这项横断面研究于2016年8月至2017年4月在黎巴嫩所有地区进行，纳入了135名成年患者。
结果
胰岛素治疗依从性的平均百分比得分为79.7±19.94。与久坐患者（67.41）相比，非久坐患者（81.96）的平均依从性得分显著更高（p = 0.017），在性别、就业、农村与非农村居住或糖尿病家族史方面无差异。此外，依从性得分与教育水平、吸烟或饮酒之间未见显著关系。对医生的信任与依从性得分之间存在显著正相关，而PAID与依从性得分之间存在显著负相关。线性回归结果显示，中学教育水平（β = - 13.48）显著降低了对医生的信任得分，而口服降糖药的总数（β = 0.93）则增加了该得分。与不吸烟相比，久坐的生活方式（β = - 12.73）和每周吸烟<3根水烟（β = - 16.82）显著降低了依从性得分。女性（β = 10.46）、吸烟<3根水烟（β = 27.42）和每周3根及以上水烟（β = 17.95）显著增加了PAID得分。
结论
对医生的信任与依从性增加以及糖尿病相关困扰减少有关。在我们的研究中，这种困扰也与依从性差有关。
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