Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
Division of Diabetes, Endocrinology, and Gastroenterology, University of Manchester, Manchester, UK.
Rev Endocr Metab Disord. 2023 Apr;24(2):221-239. doi: 10.1007/s11154-022-09754-5. Epub 2022 Nov 2.
Diabetic retinopathy, neuropathy, and nephropathy occur in more than 50% of people with diabetes, contributing substantially to morbidity and mortality. Patient understanding of these microvascular complications is essential to ensure early recognition and treatment of these sequalae as well as associated symptoms, yet little is known about patient knowledge of microvascular sequalae. In this comprehensive literature review, we provide an overview of existing knowledge regarding patient knowledge of diabetes, retinopathy, neuropathy, and nephropathy. We also discuss health care provider's knowledge of these sequalae given that patients and providers must work together to achieve optimal care. We evaluated 281 articles on patient and provider knowledge of diabetic retinopathy, neuropathy, and nephropathy as well as predictors of improved knowledge and screening practices. Results demonstrated that patient and provider knowledge of microvascular sequalae varied widely between studies, which may reflect sociocultural or methodologic differences. Knowledge assessment instruments varied between studies with limited validation data and few studies controlled for confounding. Generally, improved patient knowledge was associated with greater formal education, longer diabetes duration, and higher socioeconomic status. Fewer studies examined provider knowledge of sequalae, yet these studies identified multiple misconceptions regarding appropriate screening practices for microvascular complications and the need to screen patients who are asymptomatic. Further investigations are needed that use well validated measures, control for confounding, and include diverse populations. Such studies will allow identification of patients and providers who would benefit from interventions to improve knowledge of microvascular complications and, ultimately, improve patient outcomes.
糖尿病视网膜病变、神经病变和肾病在超过 50%的糖尿病患者中发生，这对发病率和死亡率有很大的影响。患者对这些微血管并发症的了解对于确保早期识别和治疗这些后遗症以及相关症状至关重要，但对于患者对微血管后遗症的了解知之甚少。在这篇全面的文献综述中，我们概述了现有的关于患者对糖尿病、视网膜病变、神经病变和肾病的了解的知识。我们还讨论了医疗保健提供者对这些后遗症的了解，因为患者和提供者必须共同努力，以实现最佳护理。我们评估了 281 篇关于患者和提供者对糖尿病视网膜病变、神经病变和肾病的了解以及提高知识和筛查实践的预测因素的文章。结果表明，患者和提供者对微血管后遗症的了解在研究之间差异很大，这可能反映了社会文化或方法学的差异。知识评估工具在研究之间差异很大，验证数据有限，很少有研究控制混杂因素。一般来说，患者的知识提高与更高的正规教育、更长的糖尿病病程和更高的社会经济地位有关。关于提供者对后遗症的了解的研究较少，但这些研究确定了关于微血管并发症适当筛查实践的多种误解，以及需要对无症状患者进行筛查。需要进一步进行使用经过良好验证的措施、控制混杂因素并包括不同人群的研究。这些研究将有助于确定需要干预措施来提高对微血管并发症的了解并最终改善患者结局的患者和提供者。
