解释 1 型糖尿病患者和糖化血红蛋白升高者中自尊差异的因素。

Factors explaining variation in self-esteem among persons with type 1 diabetes and elevated HbA1c.

机构信息

Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway.

Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.

出版信息

PLoS One. 2018 Aug 10;13(8):e0201006. doi: 10.1371/journal.pone.0201006. eCollection 2018.

DOI:10.1371/journal.pone.0201006

PMID:30096144

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6086418/

Abstract

OBJECTIVES

To investigate associations between perceived autonomy support from health-care professionals, autonomy-driven motivation, diabetes self-perceived competence and self-esteem in adults (age 18-55 yrs) with suboptimally regulated type 1 diabetes mellitus (T1DM) with at least one HbA1c≥8.0% (≥64 mmol/mol) during the past year, and whether these factors could predict decrease in self-esteem over time.

METHODS

A cross-sectional population-based survey was performed, and 9 months follow-up data were collected. Data collection comprised clinical and socio-demographic variables, blood sampling (HbA1c) and self-report questionnaires; the Health Care Climate Questionnaire (HCCQ), Treatment Self-Regulation Questionnaire (TSRQ), the Perceived Competence in Diabetes Scale (PCDS), and the Rosenberg Self-esteem Scale (RSES). We fitted block-wise linear regression models to assess associations between RSES and variables of interest (HCCQ, TSRQ, PCDS, HbA1c, clinical and socio-demographic variables) and linear regression models to assess predictors of change over time.

FINDINGS

In this study sample, aged 36.7 (±10.7) mean HbA1c 9.3% (±1.1), 31.5% had long-term complications and 42.7% had experienced severe hypoglycemia within the previous 12 months. In the final regression model the association between PCDS and RSES was strongly significant (B = 1.99, p<0.001) and the associations between HCCQ, TSRQ and RSES were reduced to non-significance. All predictor variables combined explained 42% of the variability of RSES (adjusted R2 = 0.423) with PCDS contributing 18% to explained variance (R-square change = 0.184, p<0.001). The strongest predictors of change in RSES over time were long-term complications (B = 2.76, p<0.001), specifically foot-related problems, and being female (B = -2.16, p = 0.002).

CONCLUSIONS

Perceived autonomy support, autonomy-driven motivation and diabetes self-perceived competence play a significant role in explaining self-esteem among adults with suboptimally regulated T1DM. Healthcare professionals should acknowledge self-esteem as a valuable factor in understanding the multifaceted health choices people with T1DM make.

TRIAL REGISTRATION

Clinical Trials.gov with identification number NCT 01317459.

摘要

目的

调查在过去一年中，HbA1c≥8.0%（≥64mmol/mol）的血糖控制不佳的 1 型糖尿病（T1DM）成年人（18-55 岁）中，医护人员感知的自主性支持、自主驱动动机、糖尿病自我效能感与自尊之间的关联，以及这些因素是否可以预测自尊随时间的下降。

方法

进行了一项横断面人群基础调查，并收集了 9 个月的随访数据。数据收集包括临床和社会人口统计学变量、血液采样（HbA1c）和自我报告问卷；医疗气候问卷（HCCQ）、治疗自我调节问卷（TSRQ）、糖尿病自我效能感量表（PCDS）和罗森伯格自尊量表（RSES）。我们使用分块线性回归模型评估 RSES 与感兴趣变量（HCCQ、TSRQ、PCDS、HbA1c、临床和社会人口统计学变量）之间的关系，并使用线性回归模型评估随时间变化的预测因素。

结果

在本研究样本中，年龄为 36.7（±10.7）岁，平均 HbA1c 为 9.3%（±1.1），31.5%有长期并发症，42.7%在过去 12 个月内有过严重低血糖。在最终的回归模型中，PCDS 与 RSES 之间的关联具有统计学意义（B=1.99，p<0.001），而 HCCQ、TSRQ 与 RSES 之间的关联则变得不具有统计学意义。所有预测变量的组合可以解释 RSES 的 42%的可变性（调整后的 R2=0.423），PCDS 对可变性的解释为 18%（R 平方变化=0.184，p<0.001）。随时间变化，RSES 的最强预测因素是长期并发症（B=2.76，p<0.001），特别是足部相关问题和女性（B=-2.16，p=0.002）。