新型冠状病毒肺炎疫情及部分封控措施对糖尿病患者医疗服务可及性、自我管理及心理健康的影响：一项横断面研究。
Impact of COVID-19 and partial lockdown on access to care, self-management and psychological well-being among people with diabetes: A cross-sectional study.
机构信息
Diabetes Centre, Admiralty Medical Centre, Khoo Teck Puat Hospital, Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
出版信息
Int J Clin Pract. 2021 Aug;75(8):e14319. doi: 10.1111/ijcp.14319. Epub 2021 May 21.
BACKGROUND
The impact of lockdown measures can be widespread, affecting both clinical and psychosocial aspects of health. This study aims to assess changes in health services access, self-care, behavioural, and psychological impact of COVID-19 and partial lockdown amongst diabetes patients in Singapore.
METHODS
We conducted a cross-sectional online survey amongst people with diabetes with the Diabetes Health Profile-18 (DHP-18). Hierarchical regression analyses were performed for each DHP-18 subscale (Psychological Distress, Disinhibited Eating and Barriers to Activity) as dependent variables in separate models.
RESULTS
Among 301 respondents, 45.2% were women, 67.1% of Chinese ethnicity, 24.2% were aged 40 to 49 years, 68.4% have Type 2 diabetes and 42.2% on oral medications alone. During the pandemic and the lockdown, nearly all respondents were able to receive care safely from the clinics they attend (94%) and obtain their medications and diabetes equipment and supplies (97%) when needed. Respondents reported less frequent engagement in physical activity (38%), checking of blood pressure (29%) and blood glucose (22%). Previous diagnosis of mental health conditions (β = 9.33, P = .043), Type 1 diabetes (β = 12.92, P = .023), number of diabetes-related comorbidities (β = 3.16, P = .007) and Indian ethnicity (β = 6.65, P = .034) were associated with higher psychological distress. Comorbidities were associated with higher disinhibited eating (β = 2.49, P = .014) while ability to reach their doctor despite not going to the clinic is negatively associated with psychological distress (β = -9.50 P = .002) and barriers to activity (β = -7.53, P = .007).
CONCLUSION
Health services access were minimally affected, but COVID-19 and lockdown had mixed impacts on self-care and management behaviours. Greater clinical care and attention should be provided to people with diabetes with multiple comorbidities and previous mental health disorders during the pandemic and lockdown.
背景
封锁措施的影响可能是广泛的，会影响健康的临床和社会心理方面。本研究旨在评估新加坡的 COVID-19 和部分封锁对糖尿病患者的卫生服务获取、自我护理、行为和心理影响的变化。
方法
我们对糖尿病患者进行了一项横断面在线调查，使用了糖尿病健康状况-18 项问卷（DHP-18）。在单独的模型中，将每个 DHP-18 子量表（心理困扰、抑制性饮食和活动障碍）作为因变量进行分层回归分析。
结果
在 301 名受访者中，45.2%为女性，67.1%为华裔，24.2%年龄在 40 至 49 岁之间，68.4%患有 2 型糖尿病，42.2%仅服用口服药物。在大流行和封锁期间，几乎所有受访者都能够安全地从他们就诊的诊所获得护理（94%），并在需要时获得他们的药物和糖尿病设备和用品（97%）。受访者报告说，他们的身体活动（38%）、血压检查（29%）和血糖检查（22%）的频率较低。以前患有心理健康疾病（β=9.33，P=0.043）、1 型糖尿病（β=12.92，P=0.023）、糖尿病相关合并症的数量（β=3.16，P=0.007）和印度裔（β=6.65，P=0.034）与更高的心理困扰有关。合并症与更高的抑制性饮食有关（β=2.49，P=0.014），而尽管不去诊所也能联系到医生与心理困扰（β=-9.50，P=0.002）和活动障碍（β=-7.53，P=0.007）呈负相关。
结论
卫生服务的获取受到的影响最小，但 COVID-19 和封锁对自我护理和管理行为产生了混合影响。在大流行和封锁期间，应该为患有多种合并症和以前患有心理健康障碍的糖尿病患者提供更多的临床护理和关注。
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