Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20099, Monza, Italy.
Centre of Biostatistics for Clinical Epidemiology, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Acta Diabetol. 2018 Jul;55(7):691-702. doi: 10.1007/s00592-018-1135-x. Epub 2018 Apr 5.
To describe self-care as defined by the Middle Range Theory of Self-Care of Chronic Illness and to identify clinical and socio-demographic determinants in a T2DM population.
A multicentre observational cross-sectional study was conducted involving 540 adults with a confirmed diagnosis of T2DM from six outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management, and confidence dimensions. For each separate scale, scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥ 70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension.
Self-care maintenance (median = 81.3) and self-care confidence (median = 79.5) were adequate in most of the subjects. Self-care monitoring was adequate in only half of the sample (median = 70.6). Self-care management was poor (median = 59.4). Lower self-care maintenance was associated with lower self-care confidence (p < 0.001). Lower self-care monitoring was associated with being male (p < 0.001), having lower self-care confidence (p < 001), and having diabetes for < 10 years (p < 0.001). Lower self-care management was associated with being male (p = 0.002), being older (p = 0.005), having a low income (p = 0.030), being employed (p = 0.008), having missed diabetes education in the last year (p = 0.002), and lower self-care confidence (p < 0.0001). Lower self-care confidence was associated with having diabetes for < 10 years (p = 0.008), and having at least one comorbid condition (p = 0.006).
Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence and diabetes self-care management education could be used to tailor interventions to improve diabetes self-care.
描述慢性病自我护理中程理论所定义的自我护理，并确定 2 型糖尿病（T2DM）人群中的临床和社会人口统计学决定因素。
本研究是一项多中心、观察性、横断面研究，纳入了来自意大利六个门诊糖尿病服务中心的 540 名 T2DM 确诊成年人。从病历中收集社会人口统计学和临床数据。采用糖尿病自我护理量表（SCODI）测量自我护理维持、监测、管理和信心维度。对于每个单独的量表，得分标准化为 0-100，SCODI 得分越高表示自我护理越好；得分≥70 为足够。采用多分位数回归模型确定每个自我护理维度的决定因素。
在大多数患者中，自我护理维持（中位数=81.3）和自我护理信心（中位数=79.5）处于中等水平。仅有一半的样本自我护理监测处于中等水平（中位数=70.6）。自我护理管理较差（中位数=59.4）。较低的自我护理维持与较低的自我护理信心相关（p<0.001）。较低的自我护理监测与男性（p<0.001）、较低的自我护理信心（p<0.001）和糖尿病病程<10 年（p<0.001）相关。较低的自我护理管理与男性（p=0.002）、年龄较大（p=0.005）、收入较低（p=0.030）、就业（p=0.008）、去年错过糖尿病教育（p=0.002）和较低的自我护理信心（p<0.0001）相关。较低的自我护理信心与糖尿病病程<10 年（p=0.008）和至少有一种合并症（p=0.006）相关。
自我护理维持、监测、管理和信心的决定因素包括临床和社会人口统计学变量。可改变的决定因素，如自我护理信心和糖尿病自我护理管理教育，可以用来调整干预措施以改善糖尿病自我护理。
