第2型糖尿病病人醫囑遵從與主客觀睡眠品質對血糖控制相關性之研究

第2型糖尿病與其所延伸健康問題威脅著台灣民眾的健康，本研究旨在探討第2型糖尿病病人之醫囑遵從性(藥物、飲食與運動)、主客觀睡眠品質對血糖控制之相關性，以立意取樣中部某醫學中心之第2型糖尿病人共65位進行研究。主觀睡眠品質以匹茲堡睡眠品質指標量表(PSQI)測量，客觀睡眠品質以腕動計(wrist actigraphy)測量72小時(24小時*3天)，以遵醫囑行為問卷評量藥物、飲食與運動之遵從性，且最近半年糖尿病控制相關生化值(HbA1c)以病歷查閱方式取得資料。所得資料以SPSS 17.0套裝軟體進行統計分析。研究結果得知本研究族群血糖控制不佳，糖化血色素(HbA1c)平均為8.1±1.8%；飯前血糖值(AC sugar)平均為165.5±47.7mg/dl，且HbA1c＞6.5﹪佔83.1%。主觀睡眠品質之PSQI平均分數為為6.8±4.5分，主觀睡眠品質不佳者(PSQI＞5分)佔44.6%，夜尿為無法維持睡眠穩定之主因；客觀睡眠品質之睡眠時數(TST)平均為6.7小時，睡眠效率(SE)為75.7%，睡眠潛伏期(SL)為33.2分鐘、半夜醒來總時間(WASO)為65.5分鐘。在醫囑遵從性方面，服藥控制得分最高(3.8分)，飲食控制次之(3.3分)，適當運動最差(2.5分)，服藥控制越佳其糖化血色素(HbA1c)控制越佳(χ2=5.03，p=.021)。以線性迴歸分析結果發現，年齡、糖尿病罹病年數、服藥控制平均分數(F=7.21，R2=0.27，p<.010)及主觀睡眠品質(PSQI)(F=6.82，R2=0.32，p<.010)與血糖控制相關。個案年齡每增加1歲則糖化血色素(HbA1c)減少0.1%；罹病 年限每增加1年，則糖化血色素(HbA1c)增加0.1%；服藥控制平均分數增加1分，則糖化血色素(HbA1c)減少1.3%；PSQI總分每增加1分則糖化血色素(HbA1c)增加0.1%。 主觀睡眠品質的好壞影響糖尿病人的血糖控制，本研究結果提供臨床照護者將主觀睡眠品質評估納入糖尿病人血糖控制的重要依據。

Type 2 diabetes induced health problems threaten our health. The purpose of this study was to explore behavioral compliance (medication, diet, and exercise), and subjective and objective sleep quality on glycemic control in patients with type 2 diabetes. A purpose sampling and cross-sectional design was used in this study. Subjects were recruited from the Endocrinology and Metabolism outpatient clinics of a medical center. A total of 65 participant completed this study. The Pittsburg Sleep Quality Index (PSQI) and 72-hour of wrist actigraphy were used to assess subjective sleep quality and objective sleep patterns, respectively. The Diabetic Compliance Questionnaire was used to assess patient compliance in medication, diet, and exercise. Glycemic control was assessed by the fasting sugar (AC sugar) and hemoglobin A1c (HbA1c). SPSS 17.0 software package was used to for statistical analysis. Results show that 83.1% of diabetic patients had poor glycermic control (HbA1c> 6.5%) with an average of 8.1 ± 1.8% in HbA1c and 165.5 ± 47.7mg/dl in AC sugar. About half (44.6%) of participants had poor sleep quality (PSQI> 5) with a mean PSQI score of 6.8 ± 4.5. Nocturia is the main reason to disturb sleep. Objective sleep measured from wrist actigraphy show that participants had 6.7 hours of total sleep time, 75.7% of sleep efficiency, 33.2 minutes of sleep latency (SL), and 65.5 minutes of wakening after sleep onset (WASO), which indicate poor sleep quality. In diabetes compliance, the highest score was medication (3.8) followed by diet control (3.3) and exercise (2.5), indicate the worst compliance in exercise. Correlation result shows that the better medication compliance, the better HbA1c control (χ2 = 5.03 , p =.021). Linear regression analysis shows medication control (F = 7.21, p <.010) and subjective sleep quality (PSQI) (F = 6.82, p <.010) affected glycemic control after controlling for age and duration of diabetes. HbA1c reduced 1.3% for every 1 point increase in medication compliance. HbA1c increased 0.1% for every 1 point increase in the PSQI score. Subjective sleep quality influence glycemic control in patients with diabetes. The findings of this study indicate subjective sleep quality assessment is important in helping better glycemic control in patients with diabetes.