摘要： 背景 糖尿病的發(fā)病風(fēng)險隨著年齡的增加而升高，在中老年人群中，糖尿病前期和糖尿病的患病率分別為40%和10%，良好的血糖監(jiān)測依從性可提高糖化血紅蛋白達標(biāo)率，但農(nóng)村地區(qū)2型糖尿?。═2DM）患者血糖監(jiān)測依從性較差。 目的 調(diào)查河南省中牟縣農(nóng)村地區(qū)中老年T2DM患者血糖監(jiān)測情況，探索影響其血糖監(jiān)測依從性及監(jiān)測次數(shù)的心理、行為因素，為后續(xù)開展針對性干預(yù)試驗以提高農(nóng)村中老年T2DM患者的血糖監(jiān)測依從性提供參考。 方法 采用便利抽樣的方法，于2021-11-02—12選取河南省中牟縣農(nóng)村地區(qū)的中老年T2DM患者作為研究對象進行問卷調(diào)查。采用自行設(shè)計的一般資料問卷調(diào)查患者的基本資料、血糖監(jiān)測情況等，使用五條目正念注意覺知量表（MAAS-5）、廣泛性焦慮障礙量表（GAD-7）、病人健康問卷（PHQ-9）和糖尿病自我管理量表（DSMS）調(diào)查患者的正念水平、焦慮水平、抑郁水平和自我管理能力。采用單因素分析、多因素Logistic回歸分析及負(fù)二項回歸分析探索中老年T2DM患者血糖監(jiān)測及監(jiān)測次數(shù)的影響因素。 結(jié)果 本研究共回收問卷484份，錄入問卷469份，有效回收率為96.9%。469例患者中，不能每月監(jiān)測血糖者占58.8%（276/469），193例監(jiān)測血糖者每月測量血糖的頻次范圍為1~60次，中位數(shù)為2次。多因素Logistic回歸及負(fù)二項回歸分析發(fā)現(xiàn)：存在抑郁（AOR=1.127，P=0.005）、高信息水平（AOR=0.133，P=0.023）、高動機水平（AOR=1.093，P=0.002）為血糖監(jiān)測的促進因素，高年收入（AIRR=2.063，P<0.001）、過去1年內(nèi)飲酒（AIRR=1.569，P=0.011）為血糖監(jiān)測次數(shù)的促進因素；而近6個月吸煙（AOR=0.559，P=0.043）為血糖監(jiān)測的阻礙因素；年齡>60歲（AIRR=0.668，P=0.024）為血糖監(jiān)測次數(shù)的阻礙因素。 結(jié)論 農(nóng)村地區(qū)中老年T2DM患者血糖監(jiān)測狀況較差，建議有關(guān)衛(wèi)生部門加強血糖監(jiān)測知識及技能等健康教育，對低收入人群提供醫(yī)療、財政等社會支持，提高血糖監(jiān)測依從性，以實現(xiàn)對T2DM的有效控制、治療和康復(fù)。

關(guān)鍵詞: 糖尿病，2型, 中老年, 農(nóng)村人口, 血糖自我監(jiān)測, 治療依從性, 影響因素分析

Abstract:

Background

The risk of diabetes mellitus can increase with age, and the prevalence of prediabetes and diabetes mellitus in the middle-aged and elderly adults is 40% and 10%, respectively. Good adherence to blood glucose monitoring improves the rate of glycohemoglobin compliance. However, adherence to blood glucose monitoring is poor in patients with type 2 diabetes mellitus (T2DM) in rural areas.

Objective

To investigate and understand the blood glucose monitoring situation of middle-aged and elderly patients with T2DM aged 45 to 65 years in rural areas of Zhongmou County, Henan Province, explore the psychological and behavioral factors affecting their adherence to blood glucose monitoring and monitoring frequency, so as to provide a reference for targeted interventions to improve the blood glucose monitoring compliance of the middle-aged and elderly patients with T2DM in rural areas.

Methods

Middle-aged and elderly T2DM patients in rural areas of Zhongmou County, Henan Province from November 2 to 12, 2021 were selected to conduct for questionnaire survey by using convenience sampling method. A self-designed general information questionnaire was used to investigate their basic information and blood glucose monitoring. Additionally, the Five-item Mindful Awareness Attention Scale (MAAS-5), Generalized Anxiety Disorder Questionnaire (GAD-7), Patient Health Questionnaire (PHQ-9), and Diabetic Self-management Scale (DSMS) were used to investigate their mindfulness, anxiety, depression, and self-management ability, respectively. Univariate analysis, multivariate Logistic regression and negative binomial regressions were used to explore the influencing factors of situation and frequency of blood glucose monitoring and monitoring frequency in middle-aged and elderly T2DM patients.

Results

A total of 484 questionnaires were collected, and 469 were enrolled in this study, with a recovery rate of 96.9%. Of the 469 patients, 58.8% (276/469) were unable to monitor blood glucose monthly, and the frequency of monthly blood glucose measurements for the 193 patients who monitored blood glucose ranged from 1 to 60 times, with a median of 2 times. Logistic and negative binomial regression analysis showed that depression symptoms (AOR=1.127, P=0.005), high information level (AOR=0.133, P=0.023), and high motivation level (AOR=1.093, P=0.002) were facilitators of blood glucose monitoring; high annual income (AIRR=2.063, P<0.001) and alcohol consumption in the past 1 year (AIRR=1.569, P=0.011) were facilitators of blood glucose monitoring frequency. Smoking in the past 6 months (AOR=0.559, P=0.043) was a barrier of blood glucose monitoring; aged over 60 years (AIRR=0.668, P=0.024) was a barrier of blood glucose monitoring frequency.

Conclusion

The blood glucose monitoring status of middle-aged and elderly T2DM patients in rural areas is relatively poor, therefore, it is recommended that relevant health authorities should strengthen health education such as blood glucose monitoring knowledge and skills, provide medical and financial social support for low-income populations, to improve blood glucose monitoring compliance and achieve effective control, treatment, and rehabilitation of T2DM.

Key words: Diabetes mellitus, type 2, The middle-aged and elderly, Rural population, Blood glucose self-monitoring, Treatment adherence and compliance, Root cause analysis

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