2 型糖尿病患者的治疗依从性及其相关因素：来自里约热内卢 2 型糖尿病队列研究的结果。
Treatment Adherence and Its Associated Factors in Patients with Type 2 Diabetes: Results from the Rio de Janeiro Type 2 Diabetes Cohort Study.
机构信息
Department of Occupational Therapy, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Brazil.
Department of Internal Medicine, University Hospital Clementino Fraga Filho, School of Medicine, Universidade Federal do Rio de Janeiro, Brazil.
出版信息
J Diabetes Res. 2018 Nov 27;2018:8970196. doi: 10.1155/2018/8970196. eCollection 2018.
OBJECTIVES
To investigate treatment adherence in patients with type 2 diabetes and to evaluate its associated factors.
METHODS
The Summary of Diabetes Self-Care Activities (SDSCA) questionnaire was used to assess treatment adherence. Good adherence was defined as ≥5 days a week in each SDSCA item. Pain, emotional, and physical domains of the SF-36 quality of life questionnaire and the Canadian Occupational Performance Measure (COPM) were also evaluated. Multivariable logistic regressions explored the independent correlates of good general adherence and of specific items of the SDSCA (diet, exercise, and medications).
RESULTS
Good adherence was 93.5% for medication use, 59.3% for foot care, 56.1% for blood glucose monitoring, 29.2% for diet, and 22.5% for exercise. Patients with general good adherence had lower BMI, better serum lipid profile, higher values of functional capacity, emotional and pain domains of SF-36, better occupational performance, and lower prevalence of pain or limitation in the upper and lower limbs than patients with worse adherence. The variables associated with good adherence were younger age, lower BMI, presence of macrovascular complications, better occupational performance and emotional domain of SF-36, and higher HDL cholesterol levels. The presence of pain/limitation in the upper limbs was associated with worse adherence. Good medication adherence was associated with longer diabetes duration, lower BMI, and lower HbA levels. Higher values of pain and emotional domains of the SF-36 and lower BMI were related to better exercise and diet adherence, while the presence of peripheral neuropathy and joint pain/limitation were associated with worse exercise adherence.
CONCLUSIONS
Emotional and physical performances are important determinants of good diabetic treatment adherence. Good adherence has beneficial impact on BMI, lipid, and glycemic control.
目的
调查 2 型糖尿病患者的治疗依从性，并评估其相关因素。
方法
采用糖尿病自我护理活动量表（SDSCA）评估治疗依从性。良好的依从性定义为 SDSCA 每个项目每周≥5 天。还评估了 SF-36 生活质量问卷的疼痛、情绪和身体领域以及加拿大职业表现测量（COPM）。多变量逻辑回归探讨了良好总体依从性和 SDSCA 特定项目（饮食、运动和药物）的独立相关因素。
结果
药物使用的依从性良好率为 93.5%，足部护理为 59.3%，血糖监测为 56.1%，饮食为 29.2%，运动为 22.5%。总体依从性良好的患者 BMI 较低，血脂状况较好，功能能力、SF-36 的情绪和疼痛领域得分较高，职业表现较好，上下肢疼痛或受限的发生率较低。与较差的依从性相比，与良好的依从性相关的变量是年龄较小、BMI 较低、存在大血管并发症、职业表现和 SF-36 的情绪领域较好以及 HDL 胆固醇水平较高。上肢疼痛/受限与较差的依从性相关。良好的药物依从性与糖尿病病程较长、BMI 较低和 HbA1c 水平较低有关。SF-36 的疼痛和情绪领域得分较高以及 BMI 较低与更好的运动和饮食依从性相关，而周围神经病变和关节疼痛/受限与较差的运动依从性相关。
结论
情绪和身体表现是良好糖尿病治疗依从性的重要决定因素。良好的依从性对 BMI、血脂和血糖控制有有益的影响。
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