Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
SUNY Upstate Medical University, Syracuse, NY, USA.
J Natl Med Assoc. 2019 Feb;111(1):37-45. doi: 10.1016/j.jnma.2018.05.002. Epub 2018 Jun 25.
With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population.
A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis.
Mean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients' knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2-3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3-4 checks/day vs >4 checks/day BS checks. Most patients reported 'forgetfulness' (19%) followed by 'too time consuming' (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c.
Frequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.
随着 1 型糖尿病（T1DM）发病率的上升，认识到护理不足和需要改进的领域，为 T1DM 患者提供更好的资源和教育至关重要。本研究的目的是确定影响少数族裔 T1D 患者糖化血红蛋白（A1c）水平的社会因素和依从性障碍。
共有 84 名年龄在 3 至 21 岁的 T1DM 患者参与了这项研究，其中 49%为男性，87%为非裔美国人。研究问卷评估了患者的知识和其他变量，并回顾性地查阅了患者的病历以获取相关的临床数据。使用 t 检验、单因素方差分析和斯皮尔曼相关性分析进行分析。
本研究中 A1c 的平均值为 10.5%，知识得分的平均值为 14 分中的 10.1 分。A1c 与患者知识得分之间没有显著相关性（r=0.12，p=0.26）。血糖（BS）监测次数较多（3-4 次/天）的患者 A1c 低 2 个百分点（9.6% vs 11.6%，95%CI 0.2-3.7，p=0.03），而每天监测 2 次或更少的患者则没有显著差异。BS 监测 3-4 次/天与>4 次/天之间的 A1c 无显著差异。大多数患者报告“健忘”（19%）是日常 BS 监测的障碍，其次是“太耗时”（17.9%）。使用笔式注射器或胰岛素泵的患者 A1c 无显著差异（10.5% vs 10.2%，p=0.55）。令人惊讶的是，有家庭监督的患者的 A1c 高于无家庭监督的患者（10.7% vs 9.6%，p=0.04），而在校有或没有护士监督的患者之间的 A1c 没有显著差异（10.6% vs 9.8%，p=0.33）。有趣的是，报告情绪愉快的患者的 A1c 高于情绪悲伤/沮丧的患者（10.7% vs 9.4%，p=0.04）。多元线性回归分析显示，BS 监测频率、家庭监督和情绪是 A1c 的最显著预测因素，共解释了 A1c 变异的 20%。
频繁的 BS 监测与较低的 A1c 相关。家庭和学校的监督并没有改善 A1c，但这是自我报告的信息。与其他研究报告相反，情绪并没有影响 A1c。
