Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus
Parental involvement in diabetes management tasks: Relationships to blood glucose monitoring adherence and metabolic control in young adolescents with insulin-dependent diabetes mellitus
复制标题
DOI：
10.1016/s0022-3476(97)70352-4
复制
发表时间：
1997-02-01
影响因子：
5.1
通讯作者：
Laffel, L
中科院分区：
文献类型：
--
作者：
Anderson, B;Ho, J;Laffel, L
目的：本研究的目的是确定与胰岛素依赖型糖尿病（IDDM）青少年人群的依从性和代谢控制相关的父母行为，并了解父母参与、血糖监测依从性和血糖控制变量之间的相互关系。采用横断面设计，调查89名10 ~ 15岁的胰岛素依赖型糖尿病青少年父母参与糖尿病治疗的情况。父母参与血糖监测（BGM）和胰岛素管理的水平进行了评估，通过访谈。由医生或护士进行依从性评估，独立于患者或父母的依从性报告。用糖化血红蛋白（HbA（Ic））评估血糖控制（参考范围，4%至6%）。老年组与对照组之间的平均HbA（Ic）值存在显著差异，（13至15岁）（HbA（Ic）= 8.9% +/- 1.03%）和年轻（10至12岁）患者（HbA（Ic）= 8.4% +/- 1.06%）（p < 0.02）。在两组青少年患者中，父母参与BGM与对BGM的依从性（每日检查血糖浓度的数量）显著相关。年轻患者比老年患者更频繁地监测血糖水平，39%的年轻患者每天检查血糖浓度4次或更多次，而老年组仅为10%（p < 0.007）。在控制年龄、性别、坦纳分期和糖尿病病程的多变量模型中，BGM频率是血糖控制的重要预测因子（R（2）= 0.19，p < 0.02）。BGM频率增加与HbA（Ic）水平降低相关。当BGM频率为零或每天一次时，平均HbA（Ic）水平为9.9% ± 0.44（SE）;当BGM频率为每天两次或三次时，平均HbA（Ic）水平为8.7% ± 0.17;当BGM频率为每天四次或四次以上时，平均HbA（Ic）水平为8.3% ± 0.22。父母参与BGM支持10至15岁的IDDM患者更频繁的BGM。这种增加的对BGM的坚持与更好的代谢控制（即，HbA（Ic）水平较低）。这些研究结果表明，鼓励父母参与10至15岁的IDDM患者的BGM可能有助于防止血糖控制和治疗依从性的恶化，这往往发生在青春期后期。
Objectives: The goal of this study was to identify parental behaviors that relate to adherence and metabolic control in a population of young adolescents with insulin-dependent diabetes mellitus (IDDM), and to understand the interrelationships among the variables of parental involvement, adherence to blood glucose monitoring, and glycemic control.Study design: A cross-sectional design was used to investigate parental involvement in diabetes regimen tasks in 89 youth, aged 10 to 15 years, with IDDM. Levels of parental involvement in blood glucose monitoring (BGM) and insulin administration were evaluated through interviews. Assessment of adherence was made by physicians or nurses, independent of patient or parent reports of adherence. Glycemic control was assessed with glycosylated hemoglobin (HbA(Ic)) (reference range, 4% to 6%).Results: There were significant differences in the mean HbA(Ic) values between the older(13 to 15 years of age) (HbA(Ic) = 8.9% +/- 1.03%) and younger (10 to 12 years) patients (HbA(Ic) = 8.4% +/- 1.06%) (p < 0.02). Parental involvement in BGM was significantly related to adherence to BGM (number of blood sugar concentrations checked daily) in both groups of adolescent patients. The younger patients monitored their blood glucose levels more frequently than did the older patients, 39% of the younger patients checked sugar concentrations four or more times daily compared with only 10% of the older group (p < 0.007). In a multivariate model controlling for age, gender, Tanner staging, and duration of diabetes, the frequency of BGM was a significant predictor of glycemic control (R(2) = 0.19, p < 0.02). Increased frequency of BGM was associated with lower HbA(Ic) levels. When the frequency of BGM was zero or once a day, the mean HbA(Ic) level was 9.9% +/- 0.44 (SE); when the frequency of BGM was two or three times a day, the mean HbA(Ic) level was 8.7% +/- 0.17; and when the frequency of BGM was four or more times daily, the mean HbA(Ic) level was 8.3% +/- 0.22.Conclusions: Parental involvement in BGM supports more frequent BGM in 10- to 15-year-old patients with IDDM. This increased adherence to BGM is associated with better metabolic control (i.e., lower HbA(Ic) levels). These findings suggest that encouraging parental involvement in BGM with 10- to 15-year-old patients with IDDM may help to prevent the well-documented deterioration in glycemic control and adherence to treatment that often occurs in later adolescence.