以糖尿病困擾探索糖化血色素變化的縱貫性追蹤研究

研究目的：第二型糖尿病是最常見的糖尿病類型，死亡率居高不下，卻缺乏影響血糖控制的心理相關長期研究。本研究由糖尿病困擾嘗試瞭解第二型糖尿病患者長期的血糖控制。研究方法與資料：採回溯性縱貫研究，追蹤368位定期回診的第二型糖尿病患者一年間的血糖變化，並以逐次糖化血色素及糖化血色素變異性作為長期血糖依據，與橫斷性的糖尿病困擾及背景變項進行相關與階層線性模式等統計分析。研究結果：（1）糖尿病困擾與逐次血糖皆有正相關，但在糖化血色素變異性方面則只與糖化血色素變異分數（下降）低度正相關。（2）階層線性成長模型發現糖尿病困擾在起始階段與糖化血色素具橫斷性的正相關，但長期來看，糖尿病困擾會抑制長期糖化血色素的成長速率。（3）治療方法、罹病年數與逐次血糖皆有正相關。（4）控制飲食及BMI在短期內有助於血糖控制，但長期來看效果較有限。結論與建議：高血糖患者有較高比例出現糖尿病困擾，建議臨床人員著重關心高血糖患者的糖尿病困擾，並留意引導這些困擾如何形成有助於血糖控制的助力，發揮保護因子的效果。

Objective: Type 2 diabetes, the most common form of diabetes, has a high mortality rate, but there is a lack of long-term psychological studies that affect glycemic control. This research was conducted to use diabetes distress to understand long-term glycemic control in patients with type 2 diabetes.Methods and Materials: In this retrospective longitudinal study, 368 patients with type 2 diabetes who were regularly returned to the hospital for 1 year were followed for blood glucose. The long-term blood glucose levels were measured by successive HbA1c and HbA1c variability, which were statistically analyzed with cross-sectional diabetes distress and background, using bivariate correlation and hierarchical linear modeling.Results: (1) The diabetes distress was positively correlated with successive blood glucose, but only slightly positively correlated with the HbA1c variability score(declined) in the aspect of HbA1c variability. (2) The hierarchical linear growth model showed that there was a cross-sectional positive correlation between diabetes distress and HbA1c in the initial stage, but diabetes distress would inhibit the growth rate of HbA1c in the long term. (3) There was a positive correlation between the treatment method, the number of years of disease and successive blood glucose. (4) Controlling diet and BMI could help glycemic control in the short term, but the effect was limited in the long term. Conclusions and Suggestion: Hyperglycemia patients have a higher proportion of diabetes distress. It’s suggested that the clinical staff should care about diabetes distress of patients with hyperglycemia, and try to guide these troubles to help for glycemic control.