van Puffelen Anne, Kasteleyn Marise, de Vries Lianne, Rijken Mieke, Heijmans Monique, Nijpels Giel, Schellevis François
NIVEL (the Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, the Netherlands.
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Universiteitsweg 100, 3584 CG Utrecht, the Netherlands.
J Diabetes Metab Disord. 2020 Jan 27;19(1):81-89. doi: 10.1007/s40200-019-00479-y. eCollection 2020 Jun.
Type 2 diabetes requires patients to make lifestyle changes and perform daily self-care. To determine at what stages patients may need particular self-management support, we examined (1) whether patients' performance of self-care related to their diabetes duration, and (2) whether illness characteristics (treatment and complications) and diabetes-related distress influenced this relationship.
Cross-sectional data from 590 type 2 diabetes patients were analysed through linear and logistic regression analysis. Self-care behaviours were assessed by the revised Summary of Diabetes Self-Care Activities (SDSCA) measure. Diabetes duration (model 1), treatment and complications (model 2), and distress, as assessed by the Problem Areas In Diabetes (PAID) scale (model 3), were stepwise included. Sociodemographic characteristics were added to all models to account for confounding.
Patients with a longer history of diabetes were less physically active, but monitored their blood glucose levels more frequently than more recently diagnosed patients. These relationships were mediated by the presence of complications and the use of insulin, with lower levels of physical activity being found among patients with macrovascular complications and higher frequencies of glucose monitoring among patients on insulin. All predictors together explained maximally 5% of the variance in self-care, except for glucose monitoring (37%) and smoking (11%).
Type 2 diabetes patients' self-care activity changes over the course of illness. To provide tailored self-management support, diabetes care providers should take into account patients' phase of illness, including their treatment and complications, as well as their personal characteristics and distress level.
2型糖尿病患者需要改变生活方式并进行日常自我护理。为了确定患者在哪些阶段可能需要特定的自我管理支持，我们研究了：（1）患者的自我护理行为是否与其糖尿病病程相关；（2）疾病特征（治疗和并发症）以及糖尿病相关困扰是否会影响这种关系。
通过线性和逻辑回归分析对590例2型糖尿病患者的横断面数据进行分析。自我护理行为通过修订后的糖尿病自我护理活动总结（SDSCA）量表进行评估。逐步纳入糖尿病病程（模型1）、治疗和并发症（模型2）以及由糖尿病问题领域（PAID）量表评估的困扰（模型3）。将社会人口统计学特征添加到所有模型中以控制混杂因素。
糖尿病病程较长的患者身体活动较少，但比近期诊断的患者更频繁地监测血糖水平。这些关系由并发症的存在和胰岛素的使用介导，大血管并发症患者的身体活动水平较低，使用胰岛素的患者血糖监测频率较高。除血糖监测（37%）和吸烟（11%）外，所有预测因素共同解释了自我护理中最大5%的方差。
2型糖尿病患者的自我护理活动在疾病过程中会发生变化。为了提供个性化的自我管理支持，糖尿病护理提供者应考虑患者的疾病阶段，包括其治疗和并发症，以及他们的个人特征和困扰程度。
