Emoto Naoya, Soga Akimi, Fukuda Izumi, Tanimura-Inagaki Kyoko, Harada Taro, Koyano Hajime M, Goto Rei, Sugihara Hitoshi
Department of Endocrinology, Diabetes and Metabolism, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
Diabetes & Thyroid Clinic, Sakura Chuo Hospital, Chiba, Japan.
Diabetes Metab Syndr Obes. 2020 Dec 14;13:4961-4971. doi: 10.2147/DMSO.S283591. eCollection 2020.
The risk preferences of patients with diabetes have profound effects on the progression of complications. The present study aimed to clarify whether the preferences of patients with diabetes and retinopathy are deliberately risk-seeking or irrational and whether this propensity is specific to those with retinopathy or is also found in patients without retinopathy compared with those without diabetes.
A total of 394 patients with diabetes (264 without retinopathy and 130 with retinopathy) and 198 patients without diabetes agreed to participate in this survey. The questions were modified versions of those from the Japan Household Survey on Consumer Preferences and Satisfaction, which sought to determine the participants' personal socioeconomic status and risk preferences. In the questionnaires, responses were analyzed by determining the participants' willingness to pay for a lottery ticket and for an insurance policy. Irrational responses were defined as violations of two axioms of the Expected Utility Theory: completeness and transitivity.
The incidence of irrational responses increased with age and was associated with educational level. The incidence of irrational responses was significantly higher in patients with retinopathy than in those without retinopathy after adjusting for age and educational level. There was no significant difference in the incidence of irrational responses between patients with diabetes but without retinopathy and those without diabetes.
The risk-seeking behavior of patients with diabetes and retinopathy was not deliberate but was irrational under uncertainty. Medical professionals should be aware of their patients' propensity to make irrational decisions, which is an important risk factor for the progression of retinopathy in patients with diabetes regardless of age and educational level.
糖尿病患者的风险偏好对并发症的进展有深远影响。本研究旨在阐明糖尿病视网膜病变患者的偏好是刻意寻求风险还是不理性的，以及这种倾向是视网膜病变患者所特有的，还是与无糖尿病的患者相比，在无视网膜病变的糖尿病患者中也存在。
共有394例糖尿病患者（264例无视网膜病变，130例有视网膜病变）和198例无糖尿病患者同意参与本调查。问题是对日本家庭消费者偏好与满意度调查中的问题进行修改后的版本，旨在确定参与者的个人社会经济状况和风险偏好。在问卷中，通过确定参与者购买彩票和保险单的意愿来分析回答。不理性回答被定义为违反预期效用理论的两个公理：完备性和传递性。
不理性回答的发生率随年龄增加而上升，且与教育水平相关。在调整年龄和教育水平后，视网膜病变患者中不理性回答的发生率显著高于无视网膜病变的患者。无视网膜病变的糖尿病患者和无糖尿病患者之间不理性回答的发生率没有显著差异。
糖尿病视网膜病变患者的风险寻求行为并非刻意为之，而是在不确定性下不理性的。医学专业人员应意识到患者做出不理性决策的倾向，这是糖尿病患者视网膜病变进展的一个重要风险因素，无论年龄和教育水平如何。
