1型糖尿病青少年和青年中的耻辱感及其与血糖控制和低血糖的关联：横断面研究
Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study.
作者信息
Brazeau Anne-Sophie, Nakhla Meranda, Wright Michael, Henderson Mélanie, Panagiotopoulos Constadina, Pacaud Daniele, Kearns Patricia, Rahme Elham, Da Costa Deborah, Dasgupta Kaberi
机构信息
School of Human Nutrition, McGill University, Montreal, QC, Canada.
Department of Pediatrics, McGill University, Montreal, QC, Canada.
出版信息
J Med Internet Res. 2018 Apr 20;20(4):e151. doi: 10.2196/jmir.9432.
BACKGROUND
Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices.
OBJECTIVE
The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control.
METHODS
Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA>9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models).
RESULTS
Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA>9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31).
CONCLUSIONS
There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA levels and severe hypoglycemia. Targeted strategies to address stigma are needed.
TRIAL REGISTRATION
ClinicalTrials.gov NCT02796248; http://clinicaltrials.gov/ct2/show/NCT02796248 (Archived by WebCite at http://www.webcitation.org/6yisxeV0B).
背景
1型糖尿病的定性研究表明，糖尿病用品的可见性、自我护理和低血糖症状与耻辱感及管理欠佳相关。这在面临诸如确立自主性和做出职业选择等同时存在的挑战的青少年中可能尤为突出。
目的
本研究旨在评估1型糖尿病青少年（14 - 24岁）的耻辱感患病率及其与血糖控制的关联。
方法
主要通过社交媒体招募参与者，要求他们完成一项基于网络的调查，并通过邮件发送毛细血管血样以测量糖化血红蛋白（HbA）。耻辱感的主要定义要求认可糖尿病依从性障碍问卷中3个特定耻辱感项目中的一项或多项。这些项目涉及在有朋友在场时避免糖尿病管理、难以告知他人糖尿病诊断情况以及在他人在场时进行糖尿病护理感到尴尬。血糖控制不佳定义为HbA>9%（即>75 mmol/mol；如有可用测量值则采用测量值，否则采用自我报告）和/或前一年发生≥1次严重低血糖事件（报告称事件期间需要他人协助）。计算耻辱感患病率（95%置信区间），并评估其与血糖控制的关联（多变量逻辑回归模型）。
结果
在380名受访者中，耻辱感患病率为65.5%（95%置信区间60.7 - 70.3）。总体而言，耻辱感与血糖控制不佳的几率高出2倍相关（优势比[OR]2.25，95%置信区间1.33 - 3.80；根据年龄、性别和治疗类型进行调整）。与HbA>9%（75 mmol/mol；OR 3.05，95%置信区间1.36 - 6.86）以及前一年的严重低血糖均存在特定关联（OR 1.86，95%置信区间1.05 - 3.31）。
结论
1型糖尿病青少年中耻辱感患病率很高，且与HbA水平升高和严重低血糖均相关。需要针对性地制定应对耻辱感的策略。
试验注册
ClinicalTrials.gov NCT02796248；http://clinicaltrials.gov/ct2/show/NCT02796248（由WebCite存档于http://www.webcitation.org/6yisxeV0B）
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