阿拉伯2型糖尿病患者中抑郁症、糖尿病自我护理活动与血糖控制之间的关联
Association Between Depression, Diabetes Self-Care Activity and Glycemic Control in an Arab Population with Type 2 Diabetes.
作者信息
Al-Ozairi Abdullah, Taghadom Etab, Irshad Mohammad, Al-Ozairi Ebaa
机构信息
Department of Psychiatry, Faculty of Medicine, Kuwait University, Safat, Kuwait.
Al-Amiri Hospital, Ministry of Health, Kuwait City, Kuwait.
出版信息
Diabetes Metab Syndr Obes. 2023 Feb 5;16:321-329. doi: 10.2147/DMSO.S377166. eCollection 2023.
PURPOSE
Poor self-care behavior and depression are associated with worse glycemic control, but the relationship between these variables is poorly reported. The present study aimed to describe self-care behaviors and explore the association between depression, self-care and glycemic control in people with type 2 diabetes in an Arab population.
PATIENTS AND METHODS
This study recruited 446 patients with type-2 diabetes from an outpatient clinic in Kuwait and completed assessments of diabetes self-care using the Summary of Diabetes Self-Care Activities (SDSCA) questionnaire and depression using the Patients Health Questionnaire-9 (PHQ-9) scales. Multiple linear regression models were used to determine the associations between depression, self-care behaviors and glycemic control.
RESULTS
Self-care behaviors were highest for medication taking (92.9%), an average for foot care (61.4%), blood glucose testing (60%) and healthy diet (55.7%), and lowest for exercise (27.1%). Depression, poor self-care activities and poor HbA1c levels were inter-correlated in univariate analysis (< 0.03). In regression analysis, following healthful eating (B= -0.27, < 0.001), general eating plan (B= -0.21, = 0.01), more space carbohydrates evenly throughout the day (B= - 0.17, = 0.03) and exercise at least 30 minutes (B= -0.17, = 0.02) behaviors were associated with better HbA1c levels. However, depression was associated with poor scores of following a general eating plan (B= -0.20, = 0.03), space carbohydrates evenly throughout the day (B= -0.21, = 0.05), and exercising at least 30 minutes (B= -0.24, = 0.03) behaviors. Depression scores were also associated with poor HbA1c levels (B= 0.32, = 0.03). However, this association no longer persists after mutual adjustment with following a healthy diet (B= 0.14, = 0.38) and exercise (B = 0.26, = 0.08) behaviors.
CONCLUSION
Self-care activity was less than fifty percent in people with type 2 diabetes and higher activity was associated with better glycemic control. However, depression adversely affects self-care behaviors. To maintain and achieve glycemic control, diabetes educators might motivate people with type 2 diabetes to enhance their self-care activities, particularly those with depression symptoms and poor compliance with self-care activities.
目的
自我护理行为不佳和抑郁与血糖控制较差有关，但这些变量之间的关系鲜有报道。本研究旨在描述阿拉伯人群中2型糖尿病患者的自我护理行为，并探讨抑郁、自我护理与血糖控制之间的关联。
患者与方法
本研究从科威特的一家门诊诊所招募了446名2型糖尿病患者，使用糖尿病自我护理活动总结（SDSCA）问卷完成糖尿病自我护理评估，并使用患者健康问卷-9（PHQ-9）量表评估抑郁情况。采用多元线性回归模型来确定抑郁、自我护理行为与血糖控制之间的关联。
结果
服药的自我护理行为比例最高（92.9%），足部护理（61.4%）、血糖检测（60%）和健康饮食（55.7%）的比例为中等，运动的比例最低（27.1%）。在单变量分析中，抑郁、自我护理活动不佳和糖化血红蛋白（HbA1c）水平不佳相互关联（<0.03）。在回归分析中，遵循健康饮食（B = -0.27，<0.001）、总体饮食计划（B = -0.21，=0.01）、全天更均匀地分配碳水化合物（B = -0.17，=0.03）以及至少运动30分钟（B = -0.17，=0.02）的行为与更好的HbA1c水平相关。然而，抑郁与总体饮食计划（B = -0.20，=0.03）、全天均匀分配碳水化合物（B = -0.21，=0.05）以及至少运动30分钟（B = -0.24，=0.03）的行为得分较低有关。抑郁得分也与HbA1c水平不佳相关（B = 0.32，=0.03）。然而，在与遵循健康饮食（B = 0.14，=0.38）和运动（B = 0.26，=0.08）行为进行相互调整后，这种关联不再存在。
结论
2型糖尿病患者的自我护理活动比例低于50%，较高的自我护理活动与更好的血糖控制相关。然而，抑郁会对自我护理行为产生不利影响。为了维持和实现血糖控制，糖尿病教育者可能需要激励2型糖尿病患者增强自我护理活动，尤其是那些有抑郁症状且自我护理活动依从性差的患者。
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