The cost-effectiveness of a psychosomatic medicine-based approach to the treatment of type 2 diabetic patients : a prospective study

目的：采用多种心理测验对2型糖尿病患者的血糖控制与心理社会因素之间的关系进行了前瞻性研究。研究对象和方法：研究对象为304例2型糖尿病患者（男169例，女135例），均为糖尿病门诊患者。所有受试者完成以下自评心理测试：1）糖尿病治疗满意度问卷（DTSQ），2）糖尿病问题领域调查（PAID），3）幸福感问卷，4）状态-特质焦虑量表（STAI），5）Zung抑郁自评量表（SDS），6）自尊量表（SES），7）社会支持量表，8）自我控制量表，9）简明健康状况调查表（SF-36）。在调查完成前6个月内和1年后再次评估患者的平均HbA 1c。结果：基线时平均年龄为61.8±10.7岁，平均糖尿病病程为11.6±8.04年，平均HbA 1c水平为7.30± 1.19%。63名患者（20.7%）仅接受饮食，178名（58.6%）口服降糖药，63名（20.7%）服用胰岛素。253例患者（304例中的83.3%）接受了随访，并在1年后评估了HbA 1c。1年随访时的HbA 1c与治疗方案、年龄、PAID、DTSQ和基线时的自我控制量表显著相关。分层多元回归分析显示，PAID是显着相关的HbA 1c在1年的后续行动，即使调整后的年龄，糖尿病病程，和治疗regiments.Conclusions：PAID与2型糖尿病患者的血糖控制调整后的年龄，糖尿病病程和治疗方案。

Objective : The relation between the glycemic control and psychosocial factors of type 2 diabetic patients was prospectively studied using a variety of psychological tests.Subjects and Methods : Subjects were 304 type 2 diabetic patients (169 males and 135 females) who were treated as out-patients at diabetes clinics. All subjects completed the following self-reporting psychological tests : 1)Diabetes Treatment Satisfaction Questionnaire(DTSQ), 2)Problem Areas in Diabetes Survey(PAID), 3)Well-being Questionnaire, 4)State-Trait Anxiety Inventory(STAI), 5)Zung Self-Rating Depression Scale(SDS), 6)Self-Esteem Scale(SES), 7)Social Support Scale, 8)Self-Control Scale, 9)Short Form-36(SF-36). The patients were assessed for average HbA1c during the six months before survey completion and again 1 year later. Relationships between psychosocial factors obtained by analysis of the psychological tests and HbAlc at the 1year follow-up were determined.Results : At baseline, mean age was 61.8±10.7 years, mean duration of diabetes was 11.6±8.04 years, and mean HbA1c level was 7.30±1.19%. Sixty three patients (20.7%) were placed on diets only, 178(58.6%) took an oral hypoglycemic agent, and 63(20.7% took insulin. Two hundred fifty three patients (83.3% of 304) were followed and assessed for HbA1c after 1 year. HbA1c at the 1 year follow-up was significantly correlated with treatment regimen, age, PAID, DTSQ, and the Self-Control Scale at baseline. Hierarchical multiple regression analysis revealed that PAID was significantly associated with HbA1c at the 1year follow-up, even after adjustment for age, diabetes duration, and treatment regimen.Conclusions : PAID was associated with glycemic control in type 2 diabetic patients after adjustment for age, diabetes duration and treatment regimen.