探索第二型糖尿病血糖控制的心理社會因素

研究目的：本研究旨在探索第二型糖尿病患者之壓力、憂鬱、糖尿病困擾、家庭支持與血糖控制之間的關係，並進一步以糖化血色素（HbA1c）作為血糖控制指標，了解壓力、憂鬱、糖尿病困擾與家庭支持的影響路徑。研究方法與資料：本研究採橫斷式設計，以問卷方式收集以下資料：個人基本與臨床資料、壓力知覺量表、病人健康狀況問卷、中文版糖尿病困擾量表、家庭支持量表。研究對象來源以中部某醫學中心的門診病人為主，受試者為第二型糖尿病患者，平均年齡為59.87歲，罹患糖尿病的時間平均為10.35年，BMI平均為26.05，回收有效樣本共366筆。以相關、階層迴歸及結構方程模式進行統計分析。研究結果：結果顯示：（1）糖尿病患者的血糖控制僅與憂鬱、糖尿病困擾有正相關，與壓力、家庭支持則無關；（2）糖尿病患者的憂鬱會影響血糖控制，糖尿病困擾在兩者之間扮演中介角色；（3）糖尿病患者的憂鬱會透過糖尿病困擾的完全中介影響其血糖控制。結論與建議：憂鬱與糖尿病困擾是影響第二型糖尿病血糖控制的重要心理因素，糖尿病困擾更是憂鬱與血糖控制的中介角色。建議臨床人員在第二型糖尿病的照護上，須多加留意憂鬱與糖尿病困擾對血糖控制的影響，尤其是患者對於管理糖尿病的負向情緒。必要時針對患者的具體困擾事件提供支持與協助，藉此提升糖尿病困擾之血糖控制，進而有效促進糖尿病之健康結果。

Objective : This research aims to explore the relationship between stress, depression, diabetes distress, family support and the glycemic control among the patients who suffer from type 2 diabetes mellitus, and furthermore discuss the impact of stress, depression, diabetes distress and family support regarding the glycemic control as the outcome variable.Methods and Materials : Cross-Sectional survey were used in this research, data were collected with questionnaire. Stress was assessed by the Perceived Stress Scale -10. Depression was assessed by Patient Health Questionnaire-9. Diabetes Distress was assessed by Chinese version of the Diabetes Distress Scale. Family Support was assessed by Family Support Scale. The 366 subjects are mainly outpatients with type 2 diabetes mellitus, the average age was 59.87-years old, duration of diabetes were 10.35-years and the average BMI were 26.05. This research uses the bivariate correlation, hierarchical regression and structural equation modeling for statistics and analysis。Results : The results show:(1) Positive correlation between glycemic control and depression、diabetes distress;(2) Depression affect the glycemic control, while diabetes distress plays the role as mediator;(3) Depression affect the diabetes distress, then influence the glycemic control. Conclusions and Suggestion: Depression and diabetes distress are important psychological factors affecting glycemic control in type 2 diabetes. Diabetes distress plays a mediational role in depression and glycemic control. It is recommended that clinical staffs must keep an eye on the influence for glycemic control affected by depression and diabetes distress, applying the support and assist their specific distress event if necessary.