Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes
Association of diabetes-related emotional distress with diabetes treatment in primary care patients with Type 2 diabetes
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DOI：
10.1111/j.1464-5491.2007.02028.x
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发表时间：
2007-01-01
影响因子：
3.5
通讯作者：
Meigs, J. B.
中科院分区：
文献类型：
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作者：
Delahanty, L. M.;Grant, R. W.;Meigs, J. B.
Aims To characterize the determinants of diabetes related emotional distress by treatment modality（diet only，oral medication only，or insulin）.Methods共有815例2型糖尿病患者完成了糖尿病问题领域（PAID）量表和其他问题。我们将调查数据与糖尿病临床研究数据库联系起来，并使用线性回归模型评估治疗与PAID评分的相关性。结果胰岛素治疗组PAID评分（24.6分）明显高于口服治疗组（17.8分，P < 0.001）和饮食治疗组（14.7分，P < 0.001），但口服治疗组与饮食治疗组之间无差异（P = 0.2）。两组评分保持相似，但差异的统计学显著性降低，并在对糖尿病严重程度、HbA（1c）、体重指数、方案依从性和自我血糖监测进行序贯调整后最终消除。在20个PAID项目中，胰岛素治疗的患者报告的痛苦显著高于口服或饮食治疗的患者。“担心未来”和“内疚/焦虑时......“糖尿病偏离轨道”是所有治疗组中最严重的两个问题（PAID >= 5）。不接受糖尿病的诊断是一个首要关注的口服和饮食治疗的患者，和不明确的管理目标苦恼的饮食treated patient.Conclusions初级保健胰岛素治疗的患者报告更高的糖尿病相关的情绪困扰相比，口服或饮食治疗的患者。更大的痛苦在很大程度上解释了更大的疾病严重程度和自我保健负担。为了改善糖尿病患者的生活质量，临床医生应该解决患者的担忧和内疚感，对糖尿病诊断的不确定接受以及不明确的治疗目标。
Aims To characterize the determinants of diabetes-related emotional distress by treatment modality (diet only, oral medication only, or insulin).Methods A total of 815 primary care patients with Type 2 diabetes completed the Problem Areas in Diabetes (PAID) Scale and other questions. We linked survey data to a diabetes clinical research database and used linear regression models to assess the associations of treatment with PAID score. Results PAID scores were significantly higher among insulin-treated (24.6) compared with oral-treated (17.8, P < 0.001) or diet-treated patients (14.7, P < 0.001), but not different between oral- vs. diet-treated patients (P = 0.2). Group scores remained similar, but the statistical significance of their differences was reduced and ultimately eliminated after sequential adjustment for diabetes severity, HbA(1c), body mass index, regimen adherence, and self-blood-glucose monitoring. Insulin-treated patients reported significantly higher distress than oral- or diet-treated patients on 16 of 20 PAID items. 'Worrying about the future' and 'guilt/anxiety when ... off track with diabetes' were the top two serious problems (PAID >= 5) in all treatment groups. Not accepting diabetes diagnosis was a top concern for oral- and diet-treated patients, and unclear management goals distressed diet-treated patients.Conclusions Primary care patients treated with insulin reported higher diabetes-related emotional distress compared with oral- or diet-treated patients. Greater distress was largely explained by greater disease severity and self-care burdens. To improve diabetes-specific quality of life, clinicians should address patients' sense of worry and guilt, uncertain acceptance of diabetes diagnosis, and unclear treatment goals.