Diabetes Distress, Intentional Hyperglycemia at Work, and Glycemic Control Among Workers With Type 1 Diabetes
Diabetes Distress, Intentional Hyperglycemia at Work, and Glycemic Control Among Workers With Type 1 Diabetes
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DOI：
10.2337/dc18-1426
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发表时间：
2019-05-01
期刊：
影响因子：
16.2
通讯作者：
Willaing, Ingrid
中科院分区：
文献类型：
--
作者：
Hansen, Ulla M.;Skinner, Timothy;Willaing, Ingrid
目的探讨工作相关因素、工作相关性糖尿病苦恼(WRDD)、糖尿病苦恼(以糖尿病[付费]-5中的问题范围测量)、工作中故意高血糖(IHW)与血糖控制的关系。研究设计和方法对1030名患有1型糖尿病的在职成年人进行了一项横断面调查，并与丹麦一家糖尿病专科诊所的电子健康记录数据相联系。利用结构方程模型，从拟合指数、统计学意义和理论意义三个方面对两种可选模型进行了比较。结果组合模型对数据的拟合效果最好。WRDD受工作能力、工作中自我管理的机会、被区别对待的机会和工作需求的影响更大。Payed-5受身份担忧、责备和判断的影响更大。Payed-5和WRDD都与更频繁的IHW相关，而IHW反过来又与血糖控制较差相关。结论工作相关因素与WRDD和Pay-5相关。痛苦增加了IHW的频率，这反过来又与血糖控制较差有关。未来的研究应该探索如何在不影响糖尿病护理的情况下平衡糖尿病管理和工作生活。
OBJECTIVE The aim was to explore relationships between work-related factors, work-related diabetes distress (WRDD), diabetes distress (measured by Problem Areas in Diabetes [PAID]-5 scale), intentional hyperglycemia at work (IHW), and glycemic control. RESEARCH DESIGN AND METHODS A cross-sectional survey was conducted with 1,030 working adults with type 1 diabetes and linked with electronic health record data from a specialist diabetes clinic in Denmark. With use of structural equation modeling, two alternative models were compared, based on fit indices, statistical significance, and theoretical meaningfulness. RESULTS A combined model provided the best fit to the data. WRDD was more strongly affected by work ability, opportunity to self-manage at work, being treated differently, and job demands. PAID-5 was more strongly affected by identity concern and blame and judgment. Both PAID-5 and WRDD were associated with more frequent IHW, which was associated in turn with worse glycemic control. CONCLUSIONS Work-related factors are associated with WRDD and PAID-5. Distress increases the frequency of IHW, which is, in turn, associated with worse glycemic control. Future studies should investigate ways to balance diabetes management and work life without compromising diabetes care.