青年 2 型糖尿病患者的糖尿病困扰：TODAY2 研究结果。
Diabetes Distress in Young Adults With Youth-Onset Type 2 Diabetes: TODAY2 Study Results.
机构信息
State University of New York Upstate Medical University, Syracuse, NY.
The Biostatistics Center, George Washington University, Rockville, MD.
出版信息
Diabetes Care. 2022 Mar 1;45(3):529-537. doi: 10.2337/dc21-1689.
OBJECTIVE
To assess the prevalence of high diabetes distress and associated factors in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study cohort of young adults with youth-onset type 2 diabetes.
RESEARCH DESIGN AND METHODS
Participants completed the Diabetes Distress Scale (DDS) at end-of-study visits. Factors examined for association with high distress were demographic (sex, race/ethnicity, age, education, income), medical (HbA1c, BMI, complications), psychological (depressive and anxiety symptoms), and social (number in household, offspring, health care coverage, established with diabetes care provider). Univariate logistic regression identified factors associated with high distress that were controlled for in multivariate logistic regressions.
RESULTS
Of 438 participants, 66% were female (mean age 26.8 years, 18% non-Hispanic White, 37% non-Hispanic Black, 38% Hispanic). High distress (DDS ≥2) was reported by 105 (24%) participants. Subscales identified 40% with high regimen distress and 29.7% with high emotional burden. A greater percentage of those with high distress were female (P = 0.002), diagnosed with hypertension (P = 0.037) and retinopathy (P = 0.005), treated with insulin, had higher HbA1c, and had moderate to severe depressive and anxiety symptoms (all P < 0.001). In multivariate analyses, female sex (P < 0.001), HbA1c (P < 0.001), anxiety symptoms (P = 0.036), and lack of health care coverage (P = 0.019) were associated with high distress, after controlling for potential confounders. Moderate to severe depressive symptoms were associated with high regimen distress (P = 0.018) and emotional burden (P < 0.001); insulin treatment was associated with high emotional burden (P = 0.027).
CONCLUSIONS
Future research should identify modifiable factors associated with high diabetes distress in young adults with youth-onset type 2 diabetes that may inform distress interventions with this medically vulnerable group.
目的
评估青少年 2 型糖尿病治疗选择（TODAY2）研究队列中年轻成年患者的青年发病 2 型糖尿病患者中高糖尿病困扰的患病率及其相关因素。
研究设计和方法
参与者在研究结束时完成糖尿病困扰量表（DDS）。检查与高困扰相关的因素包括人口统计学（性别、种族/族裔、年龄、教育、收入）、医学（HbA1c、BMI、并发症）、心理（抑郁和焦虑症状）和社会（家庭人数、子女、医疗保险覆盖范围、与糖尿病护理提供者建立关系）。单因素逻辑回归确定与高困扰相关的因素，并在多因素逻辑回归中进行控制。
结果
在 438 名参与者中，66%为女性（平均年龄 26.8 岁，18%为非西班牙裔白人，37%为非西班牙裔黑人，38%为西班牙裔）。105 名（24%）参与者报告存在高困扰（DDS≥2）。子量表确定 40%存在高治疗方案困扰，29.7%存在高情绪负担。高困扰者中女性比例较高（P=0.002），诊断为高血压（P=0.037）和视网膜病变（P=0.005），接受胰岛素治疗，HbA1c 较高，且有中度至重度抑郁和焦虑症状（均 P＜0.001）。多因素分析显示，女性（P＜0.001）、HbA1c（P＜0.001）、焦虑症状（P=0.036）和缺乏医疗保险（P=0.019）与高困扰相关，在控制潜在混杂因素后。中度至重度抑郁症状与高治疗方案困扰（P=0.018）和情绪负担（P＜0.001）相关；胰岛素治疗与高情绪负担（P=0.027）相关。
结论
未来的研究应确定与青年发病 2 型糖尿病年轻成年患者高糖尿病困扰相关的可改变因素，这可能为该医学脆弱群体的困扰干预提供信息。
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