Kebede Mihiretu M, Schuett Cora, Pischke Claudia R
Health Sciences, University of Bremen, Grazerstrasse 2, D-28359 Bremen, Germany.
Leibniz Institute for Prevention Research and Epidemiology-BIPS, Achterstrasse 30, D-28359 Bremen, Germany.
J Clin Med. 2019 Jan 17;8(1):109. doi: 10.3390/jcm8010109.
This study investigated the determinants (with a special emphasis on the role of diabetes app use, use of continuous glucose monitoring (CGM) device, and self-care behavior) of glycemic control of type 1 and type 2 diabetes mellitus (DM). A web-based survey was conducted using diabetes Facebook groups, online patient-forums, and targeted Facebook advertisements (ads). Demographic, CGM, diabetes app use, and self-care behavior data were collected. Glycemic level data were categorized into hyperglycemia, hypoglycemia, and good control. Multinomial logistic regression stratified by diabetes type was performed. The survey URL was posted in 78 Facebook groups and eight online forums, and ten targeted Facebook ads were conducted yielding 1854 responses. Of those owning smartphones ( = 1753, 95%), 1052 (62.6%) had type 1 and 630 (37.4%) had type 2 DM. More than half of the type 1 respondents ( = 549, 52.2%) and one third the respondents with type 2 DM ( = 210, 33.3%) reported using diabetes apps. Increased odds of experiencing hyperglycemia were noted in persons with type 1 DM with lower educational status (Adjusted Odds Ratio (AOR) = 1.7; 95% Confidence Interval (CI): 1.21⁻2.39); smokers (1.63, 95% CI: 1.15⁻2.32), and high diabetes self-management concern (AOR = 2.09, 95% CI: 1.15⁻2.32). CGM use (AOR = 0.66, 95% CI: 0.44⁻1.00); "general diet" (AOR = 0.86, 95% CI: 0.79⁻0.94); and "blood glucose monitoring" (AOR = 0.88, 95%CI: 0.80⁻0.97) self-care behavior reduced the odds of experiencing hyperglycemia. Hypoglycemia in type 1 DM was reduced by using CGM (AOR = 0.24, 95% CI: 0.09⁻0.60), while it was increased by experiencing a high diabetes self-management concern (AOR = 1.94, 95% CI: 1.04⁻3.61). Hyperglycemia in type 2 DM was increased by age (OR = 1.02, 95% CI: 1.00⁻1.04); high self-management concern (AOR = 2.59, 95% CI: 1.74⁻3.84); and poor confidence in self-management capacity (AOR = 3.22, 2.07⁻5.00). Conversely, diabetes app use (AOR = 0.63, 95% CI: 0.41⁻0.96) and "general diet" self-care (AOR = 0.84, 95% CI: 0.75⁻0.94), were significantly associated with the reduced odds of hyperglycemia. Diabetes apps, CGM, and educational interventions aimed at reducing self-management concerns and enhancing dietary self-care behavior and self-management confidence may help patients with diabetes to improve glycemic control.
本研究调查了1型和2型糖尿病（DM）血糖控制的决定因素（特别强调糖尿病应用程序的使用、持续葡萄糖监测（CGM）设备的使用以及自我护理行为的作用）。通过糖尿病脸书群组、在线患者论坛和定向脸书广告开展了一项基于网络的调查。收集了人口统计学、CGM、糖尿病应用程序使用情况和自我护理行为数据。血糖水平数据分为高血糖、低血糖和良好控制。按糖尿病类型进行了多项逻辑回归分析。调查网址发布在78个脸书群组和8个在线论坛上，并投放了10条定向脸书广告，共收到1854份回复。在拥有智能手机的人群中（n = 1753，95%），1052人（62.6%）患有1型糖尿病，630人（37.4%）患有2型糖尿病。超过一半的1型糖尿病受访者（n = 549，52.2%）和三分之一的2型糖尿病受访者（n = 210，33.3%）报告使用过糖尿病应用程序。教育程度较低的1型糖尿病患者发生高血糖的几率增加（调整优势比（AOR）= 1.7；95%置信区间（CI）：1.21⁻2.39）；吸烟者（1.63，95%CI：1.15⁻2.32），以及对糖尿病自我管理高度关注者（AOR = 2.09，95%CI：1.15⁻2.32）。使用CGM（AOR = 0.66，95%CI：0.44⁻1.00）；“一般饮食”（AOR = 0.86，95%CI：0.79⁻0.94）；以及“血糖监测”（AOR = 0.88，95%CI：0.80⁻0.97）自我护理行为可降低发生高血糖的几率。1型糖尿病患者使用CGM可降低低血糖发生率（AOR = 0.24，95%CI：0.09⁻0.60），而对糖尿病自我管理高度关注则会增加低血糖发生率（AOR = 1.94，95%CI：1.04⁻3.61）。2型糖尿病患者的高血糖发生率随年龄增加而升高（OR = 1.02，95%CI：1.00⁻1.04）；对自我管理高度关注（AOR = 2.59，95%CI：1.74⁻3.84）；以及对自我管理能力信心不足（AOR = 3.22，2.07⁻5.00）。相反，使用糖尿病应用程序（AOR = 0.63，95%CI：0.41⁻0.96）和“一般饮食”自我护理（AOR = 0.84，95%CI：0.75⁻0.94）与高血糖几率降低显著相关。糖尿病应用程序、CGM以及旨在减少自我管理担忧、增强饮食自我护理行为和自我管理信心的教育干预措施可能有助于糖尿病患者改善血糖控制。
