2型糖尿病患者诊断年龄与糖尿病心理痛苦的相关性研究  

Association between age at diagnosis and diabetic distress in patients with type 2 diabetes mellitus

作　　者：李日静 汤芳丽 汪文俊 李洮俊 楼青青 Li Rijing;Tang Fangli;Wang Wenjun;Li Taojun;Lou Qingqing(International School of Nursing,Hainan Medical University,Haikou 571199,China;Hainan Provincial Clinical Research Center for Metabolic Diseases,First Affiliated Hospital of Hainan Medical University,Haikou 570102,China;Department of Endocrinology,Taiwan Li′s United Clinic,Pingtung 900,China)

机构地区：[1]海南医科大学国际护理学院,海口571199 [2]海南医学院第一附属医院(海南省)代谢性疾病临床医学研究中心,海口570102 [3]中国台湾李氏联合诊所内分泌科,中国台湾屏东900

出　　处：《中华糖尿病杂志》2024年第9期1013-1019,共7页CHINESE JOURNAL OF DIABETES MELLITUS

基　　金：国家自然科学基金(72164010);海南医学院研究生科研创新课题(HYYB2023A14)。

摘　　要：目的探讨2型糖尿病(T2DM)诊断时年龄与发生糖尿病心理痛苦(DD)的关系。方法本研究为前瞻性队列研究。选取自2002年1月1日开始在中国台湾李氏联合诊所定期随访的3354例T2DM患者作为研究对象。根据T2DM诊断年龄将患者分为<40岁组(青年组,488例),40~59岁组(中年组,2055例),≥60岁组(老年组,811例)。收集患者的一般资料(年龄、性别、吸烟史、饮酒史、家族史、糖尿病病程、经济收入、文化程度、婚姻状况、运动情况)、临床指标[体重指数(BMI)、收缩压(SBP)、舒张压(DBP)、血红蛋白(Hb)、糖化血红蛋白(HbA_(1c))等],以及疾病特征(是否有睡眠障碍、是否有DD、是否合并并发症)和药物(降压药物、调脂药物、降糖药物、胰岛素)使用情况。采用糖尿病相关问题(PAID)量表判断T2DM患者是否患有DD。组间比较采用方差分析、Kruskal-wallis H秩和检验和χ^(2)检验。采用Cox回归分析法分析DD的影响因素,以及诊断年龄与DD之间的关系。结果三组患者糖尿病家族史、睡眠情况、调脂药物的使用比例组间比较差异无统计学意义(P>0.05)。相比于中年组和老年组,青年组T2DM患者的糖尿病病程更长,使用胰岛素、吸烟史、饮酒史的比例更高,BMI、HbA_(1c)、Hb水平更高,差异均具有统计学意义(P<0.05)。以诊断年龄、性别、病程、BMI、经济情况、运动习惯、HbA_(1c)、血红蛋白、婚姻状况、教育程度、药物使用为自变量,以是否发生DD为因变量,进行多因素Cox回归分析,结果显示,诊断年龄较小、女性、BMI是发生DD的危险因素(HR值分别为0.962、1.820、1.037,均P<0.05)。随访结束后,青年组、中年组、老年组发生DD的例数分别为41、96、23例。在校正病程、性别、经济收入、文化程度、婚姻状况、BMI、HbA_(1c)、用药情况、血红蛋白、睡眠情况、合并并发症后,Cox回归分析结果显示,青年组发生DD的风险为老年组的3.260倍(Objective To investigate the relationship between age at diagnosis of type 2 diabetes mellitus(T2DM)and diabetes distress(DD)in adults with T2DM.Methods This study was a prospective cohort study.A total of 3354 T2DM patients were enrolled at Taiwan region Li′s United Clinic from January 1,2002.According to the age of T2DM diagnosis,the patients were divided into<40 years old group(young group,488 cases),40-59 years old group(middle-aged group,2055 cases),and≥60 years old group(elderly group,811 cases).General data(age,sex,smoking history,drinking history,family history,diabetes course,economic income,educational level,marital status,and physical activity)and clinical indicators[body mass index(BMI),systolic blood pressure(SBP),diastolic blood pressure(DBP),hemoglobin(Hb),glycated hemoglobin A 1c(HbA_(1c)),etc.]of the patients were collected.And the characteristics of the disease(whether there are sleep disorders,DD,complications)and medication(antihypertensive drugs,lipid-regulating drugs,hypoglycemic drugs,insulin).The problem areas in diabetes(PAID)scale was used to determine whether T2DM patients had DD.One-way analysis of variance(ANOVA),Kruskal-Wallis H rank sum test andχ^(2) test were used to compare between groups.Cox regression analysis was used to analyze the influencing factors of DD and the relationship between age at diagnosis and DD.Results There were no significant differences in family history of diabetes,sleep status and proportion of lipid-regulating drugs used among the three groups(P>0.05).Compared with the middle-aged group and the elderly group,T2DM patients in the young group had a longer duration of diabetes,a higher proportion of insulin use,smoking history and drinking history,and a higher level of BMI,HbA_(1c) and Hb with statistical significance(P<0.05).Multivariate Cox regression analysis was conducted with age at diagnosis,sex,disease course,BMI,economic status,exercise habits,HbA_(1c),hemoglobin,marital status,education level and drug use as independent variables and whether DD

关 键 词：糖尿病 2型 糖尿病心理痛苦 诊断年龄 回归分析 

分 类 号：R587.1[医药卫生—内分泌]