Effects of Daily Life Experience on Blood Glucose Control in Dropout of Diabetes Patients Care : An analysis using hemoglobin-A1c

本研究旨在阐明退出糖尿病治疗计划的糖尿病患者的日常生活经历。在知情同意的情况下，16名中高龄(65岁以下)的糖尿病患者参加了一项基于访谈的调查，这些患者没有接受药物治疗，他们似乎具有可能导致退出治疗计划的特征，并被证实确实退出了治疗计划。对调查结果进行了定性分析。根据与退出治疗方案相关的日常生活经验类型，将患者分为4组：高自我效能感类型(对疾病自我管理有效性的高度认识)、潜在顺从型(有可能恢复就诊的患者)、逃避现实类型(停止就诊以逃避现实的患者)和认知度不足类型(对糖尿病治疗方案认识不足的患者)。日常生活经验涉及四种类型的共同类别和四种类型之间的不同类别。所有四种类型共有的六种类型是与治疗开始有关的三种类别(“通过会诊评估糖尿病”、“实行建议的生活方式”和“就诊时调整工作”)，与退出阶段有关的三种类别(“治疗系统效率低下”和“护理人员以命令的语气进行指导”和“患者低估糖尿病的重要性”)。结果提示，为了鼓励患者继续就诊，护士应了解与治疗方案相关的日常生活体验的个体差异，并为患者提供量身定制的支持。

The present study was undertaken to clarify the daily living experiences of diabetic patients who dropped out of diabetes mellitus treatment programs. Sixteen diabetic patients of middle or high age (below 65 years), who were receiving no drug therapy, who had seemed to have characteristics potentially leading to dropout from treatment programs and who were confirmed to have actually dropped out, were enrolled in an interview-based survey under informed consent. The results of the survey were qualitatively analyzed. The patients were divided into four groups according to the type of daily life experiences associated with dropout from the treatment program : the high self-efficacy type (high awareness of the efficacy of self-management of the disease), the potentially compliant type (patients who have the potential of resuming clinic visits), the escape-from-reality type (patients who stop visiting clinics to escape from reality) and the inadequate recognition type (patients with inadequate recognition about mellitus treatment programs ). Daily life experiences were found to involve categories common to all 4 types and categories different among the 4 types. The six categories common for all 4 types were three categories pertaining to the beginning of treatment ("evaluation of diabetes by consultation", "practice of the advised lifestyle" and "adjustment of job for clinic visits"), three categories pertaining to the dropping out phase ("inefficiency of the treatment system" and "instructions in a tone of command by care providers" and "underestimation of the significance of diabetes by the patient"). Ten categories different among the four types were also extracted.The results suggest that to encourage patients to continue clinic visits, nurses should understand inter-individual differences in daily life experiences related to treatment programs and provide support tailored to individual patients.