The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico
The relative effect of self-management practices on glycaemic control in type 2 diabetic patients in Mexico
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DOI：
10.1179/174592006x110950
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发表时间：
2006-06-01
期刊：
影响因子：
1.3
通讯作者：
Weller, Susan C.
中科院分区：
文献类型：
--
作者：
Garcia De Alba Garcia, Javier E.;Dallo, Florence J.;Weller, Susan C.
目的：在这项研究中，我们考察了在发生并发症的高危人群中自我管理活动对血糖控制的相对影响。方法：从墨西哥瓜达拉哈拉的墨西哥塞古罗社会研究所(IMSS)家庭医学诊所(n=800)抽取被诊断为持续至少1年的糖尿病患者。人口统计学、临床和健康行为变量被用来预测血糖控制的好或差，用血红蛋白A1C(A1C)来衡量。结果：大多数(72.24%)患者的血糖控制差(A1C>；=7.0)。高血糖与糖尿病病程较长[优势比(OR)=2.40，95%可信区间(CI)1.39，4.14]、与糖尿病有一级亲属关系(OR=1.52；95%CI为1.06，2.19)、服用胰岛素等抗糖尿病药物(OR=7.88，95%CI为2.42，25.63)等因素显著相关。在控制了这些变量后，降低高血糖可能性的唯一自我管理变量是遵循特殊饮食(OR=0.49；95%CI为0.32，0.76)。此外，抑郁对自我管理有重要影响，因为抑郁症状水平较低的人更有可能遵循饮食和锻炼。讨论：尽管这一人群中的患者几乎无法控制与血糖控制相关的许多因素，但饮食是一个重要的例外。然而，由于抑郁症对节食的不利影响，抑郁症的管理和饮食教育对这一人群都很重要。
Objective: In this study, we examined the relative impact of self-management activities on glycaemic control in a population at high risk for developing complications.Methods: Patients diagnosed with diabetes mellitus of at least 1 year in duration at 30 years of age or older were sampled from the Instituto de Mexico Seguro Social (IMSS) Family Medicine Clinics in Guadalajara, Mexico (n=800). Demographic, clinical and health behaviour variables were used to predict good/poor glycaemic control, as measured by haemoglobin A1c (A1C).Results: Most (72.24%) patients had poor control (A1C >= 7.0). Hyperglycaemia was significantly associated with factors not under patient control, such as having diabetes for a longer time [odds ratio (OR)=2.40, 95% confidence interval (CI) 1.39, 4.14], having a first-degree relative with diabetes (OR=1.52; 95% CI 1.06, 2.19), and being prescribed anti-diabetic medications, e.g. insulin (OR=7.88, 95% CI 2.42, 25.63). After controlling for these variables, the only self-management variable that reduced the likelihood of hyperglycaemia was following a special diet (OR=0.49; 95% CI 0.32, 0.76). Furthermore, depression had an important effect on self-management, as those with lower levels of depressive symptoms were more likely to follow a diet and exercise.Discussion: While patients in this population have little control over many factors associated with glycaemic control, an important exception is diet. However, because of the adverse effect of depression on dieting, both depression management and dietary education are important for this population.