New York University Rory Meyers College of Nursing, New York, NY
Yale School of Nursing, Orange, CT.
Diabetes Care. 2018 Aug;41(8):1608-1614. doi: 10.2337/dc17-2597. Epub 2018 May 25.
The purpose of this study of adults with type 1 diabetes was to analyze patterns of diabetes self-management behaviors and predictors of glycemic control across the adult life span.
This study was a secondary cross-sectional analysis of data of 7,153 adults enrolled in the T1D Exchange Clinic Registry who were divided into four developmental stages (emerging, young, middle-aged, and older adults). Data were collected by questionnaire and medical record review at enrollment. Statistical analyses compared sociodemographic, clinical, and diabetes-related factors across groups. Logistic regressions were conducted for each group to identify factors associated with hemoglobin A ≥7%.
The sample was divided according to adult developmental stage: emerging adults, age 18 to <25 years ( = 2,478 [35%]); young adults, age 25 to <45 years ( = 2,274 [32%]); middle-aged adults, age 45 to <65 years ( = 1,868 [26%]); and older adults, age ≥65 years ( = 533 [7%]). Emerging adults had the highest mean hemoglobin A level (8.4 ± 1.7% [68 mmol/mol]), whereas older adults had the lowest level (7.3 ± 0.97% [56 mmol/mol]; < 0.0001). Emerging adults were less likely to use an insulin pump (56%) or a continuous glucose monitor (7%) but were more likely to miss at least one insulin dose per day (3%) and to have had an episode of diabetic ketoacidosis in the past year (7%) (all < 0.0001). Different factors were associated with hemoglobin A ≥7% in each age-group, but two factors were noted across several groups: the frequency of blood glucose checks and missed insulin doses.
When discussing diabetes self-management, providers may consider a patient's developmental stage, with its competing demands (such as work and family), psychosocial adjustments, and the potential burden of comorbidities.
本项针对 1 型糖尿病成人患者的研究旨在分析整个成年期的糖尿病自我管理行为模式和血糖控制的预测因素。
本研究为 T1D Exchange 诊所注册登记处 7153 名成年患者数据的二次横断面分析，这些患者被分为四个发育阶段（青春期、青年期、中年期和老年期）。在入组时通过问卷调查和病历回顾收集数据。统计分析比较了各小组的社会人口统计学、临床和与糖尿病相关的因素。对每组进行逻辑回归分析，以确定与血红蛋白 A ≥7%相关的因素。
根据成年期发育阶段对样本进行分组：青春期，年龄 18 岁至<25 岁（=2478[35%]）；青年期，年龄 25 岁至<45 岁（=2274[32%]）；中年期，年龄 45 岁至<65 岁（=1868[26%]）；老年期，年龄≥65 岁（=533[7%]）。青春期患者的平均血红蛋白 A 水平最高（8.4 ± 1.7%[68 mmol/mol]），而老年期患者的水平最低（7.3 ± 0.97%[56 mmol/mol]；<0.0001）。青春期患者使用胰岛素泵（56%）或连续血糖监测仪（7%）的可能性较低，但每天漏用至少一剂胰岛素（3%）和过去一年中发生糖尿病酮症酸中毒（7%）的可能性较高（均<0.0001）。不同年龄段与血红蛋白 A ≥7%相关的因素不同，但有两个因素在多个年龄段中都有体现：血糖监测频率和漏用胰岛素剂量。
在讨论糖尿病自我管理时，医务人员可能需要考虑患者的发育阶段，及其竞争需求（如工作和家庭）、心理社会调整和合并症的潜在负担。
