Anderson B, Ho J, Brackett J, Finkelstein D, Laffel L
Mental Health Unit, Joslin Diabetes Center, Harvard Medical School, Boston, MA 02215, USA.
J Pediatr. 1997 Feb;130(2):257-65. doi: 10.1016/s0022-3476(97)70352-4.
The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control.
A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA1c) (reference range, 4% to 6%).
There were significant differences in the mean HbA1c values between the older (13 to 15 years of age) (HbA1c = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA1c = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R2 = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA1c levels. When the frequency of BGM was zero or once a day, the mean HbA1c level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA1c level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA1c level was 8.3% +/- 0.22.
Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA1c levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.
本研究的目的是确定与胰岛素依赖型糖尿病（IDDM）青少年人群的依从性和代谢控制相关的父母行为，并了解父母参与、血糖监测依从性和血糖控制变量之间的相互关系。
采用横断面设计，调查89名10至15岁患有IDDM的青少年中父母对糖尿病治疗方案任务的参与情况。通过访谈评估父母在血糖监测（BGM）和胰岛素给药方面的参与程度。依从性由医生或护士评估，独立于患者或父母关于依从性的报告。用糖化血红蛋白（HbA1c）（参考范围4%至6%）评估血糖控制情况。
年龄较大（13至15岁）（HbA1c = 8.9%±1.03%）和年龄较小（10至12岁）患者（HbA1c = 8.4%±1.06%）的平均HbA1c值存在显著差异（p < 0.02）。两组青少年患者中，父母对BGM的参与与BGM依从性（每日检查血糖浓度的次数）显著相关。年龄较小的患者比年龄较大的患者更频繁地监测血糖水平，39%的年龄较小的患者每天检查血糖浓度4次或更多次，而年龄较大的组中只有10%（p < 0.007）。在控制年龄、性别、坦纳分期和糖尿病病程的多变量模型中，BGM频率是血糖控制的显著预测因素（R2 = 0.19，p < 0.02）。BGM频率增加与较低的HbA1c水平相关。当BGM频率为零或每天1次时，平均HbA1c水平为9.9%±0.44（标准误）；当BGM频率为每天2或3次时，平均HbA1c水平为8.7%±0.17；当BGM频率为每天4次或更多次时，平均HbA1c水平为8.3%±0.22。
父母对BGM的参与有助于10至15岁IDDM患者更频繁地进行BGM。这种对BGM依从性的提高与更好的代谢控制（即较低的HbA1c水平）相关。这些发现表明，鼓励父母参与10至15岁IDDM患者的BGM可能有助于预防在青春期后期经常出现的、有充分记录的血糖控制和治疗依从性的恶化。
