初诊2型糖尿病患者疾病态度对短期胰岛素泵强化治疗后血糖控制的影响

摘要

目的:探讨初诊2型糖尿病患者对疾病的态度对短期胰岛素泵强化治疗后血糖控制的影响.方法:118例持续皮下胰岛素输注(CSII)治疗后获得临床缓解的初诊2型糖尿病患者完成1年随访,分别于基线期、出院后3个月、6个月、1年使用密西根糖尿病管理评定量表(DCP)评价患者对糖尿病的态度(包括积极态度、消极态度、自我护理能力、自我管理重要性认识、自我管理坚持性认识),并检测患者糖化血红蛋白水平( HbA1c)水平,采用Spearman相关分析探讨患者对疾病态度与HbA1c水平的相关性.结果:65例缓解期≥1年患者为缓解组,53例缓解期＜1年患者为治疗失效组；缓解组患者初中文化的比例明显低于治疗失效组,大学或以上文化的比例明显高于治疗失效组(P＜0.05).经过2周CSII治疗后两组患者血糖指标均明显改善,缓解组患者CSII治疗后的空腹血糖(FPG)和餐后2h血糖(2 hPG)低于治疗失效组,伴随胰岛素第一时相分泌(AIR)值高于治疗失效组(P＜0.05).随访期内缓解组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线升高,并高于同时期的治疗失效组(P＜0.05),消极态度得分逐渐降低,并低于同时期的治疗失效组(P＜0.05),而治疗失效组患者积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分较基线下降,消极态度得分则始终维持较高的水平；Spearmen相关分析显示,除0个月外,各随访期HbA1c水平与积极态度、自我护理能力、自我管理重要性认识和坚持性认识得分呈显著负相关,与消极态度得分呈正相关.结论:糖尿病患者对疾病的态度对初诊糖尿病患者CSII后血糖控制具有重要影响,因此应重视对初诊2型糖尿病患者进行心理教育,使患者形成良好的管理疾病的态度,进而更好的控制病情,维持理想的生存质量.%Objective; To follow and explore the effects of attitudes toward diabetes on glucose control in patients with newly diagnosed type 2 diabetes mellitus after short-term continuous subcutaneous insulin infusion ( CSII). Methods: One hundred and eighteen patients who have achieved clinical remission after CSII finished the follow-up. All the patients completed Diabetes Care Profile (DCP) questionnaires on attitudes toward diabetes (including positive attitude, negative attitude, care ability, importance of care and self-care adherence) and collected the value of HbAlc on baseline and the 3 rd, 6th, 12 th month. Results; Sixty five patients who maintained remission for more than 1 year were defined as remission group, 53 patients who relapsed within 1 year were defined as non-remission group. It showed that the proportions of patients with higher educational attainment in remission group were significantly higher than those in non-remission group (P <0. 05). Better glycemic control and greater restoration of AIR after 2-week CSII were found in remission group than in non-remission group (P < 0. 05). Patients in the remission group exhibited higher mean scores in positive attitude, importance of care, care ability and self-care adherence but lower scores in negative attitude. The differences were significant from baseline and even enlarged throughout the follow-up ( P < 0. 05 ). Spearman correlation study also showed that positive attitude, importance of care, care ability and self-care adherence were negatively, while negative attitude was positively correlated to HbA,c level. Conclusions; Patients'attitudes toward diabetes played an important role in glycemic control in patients with newly diagnosed type 2 diabetes mellitus after short-term CSII treatment.