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REK, M., Fenwick, E.K., ATL, G., et al.

期刊名称:JAMA Ophthalmology



摘要:重要性:患者对糖尿病自我治疗(DSM)的障碍可能影响他或她患糖尿病视网膜病变(DR)的风险;但分析这种关联的研究很少。目的:旨在探讨亚洲2型糖尿病患者DSM障碍与DR严重程度之间的关系。设计,环境与研究对象:20101228日至2013320日在新加坡国家眼科中心----一家三级眼科研究所进行了一项以横断面临床为基础的研究,新加坡糖尿病治疗项目。排除1型糖尿病患者和眼底图像无法分级患者外,对361名参与者进行了分析。2017720日至98日进行统计分析。使用包含DSM知识,护理获得情况和对医疗保健专业人员信心的一个23项调查问卷评估DSM感知障碍程度。使用Rasch分析来优化量表的心理测量学特性,分数越低表明自我感知障碍程度越高。主要预后指标:使用改良的DR Airlie House分类系统将糖尿病视网膜病变从2-视野视网膜图像分为无DR(早期治疗性糖尿病视网膜病变研究10-15级,154例),轻度至中度DR20-43级, 112例)和严重DR(≥53级和/或临床明显黄斑水肿; 95例)。使用多项Logistic回归模型来评估感知障碍与受影响最严重眼DR严重程度之间的关联。结果:在361名受试者中,女性105人,男性256人,平均年龄[SD]57 [8] 岁。DSM的感知障碍程度较大与任何程度的DROR1.32,95CI 1.06-1.66),轻度至中度DROR1.30,95CI 1.01-1.68 )和严重的DROR1.36; 95CI1.03-1.79)较高的OR值独立相关。这种关联与糖尿病控制(血红蛋白A1c,血压和血脂水平),视力和社会经济指标无关。结论和意义:这些结果表明更大的感知障碍与DSM的严重程度独立相关。尽管需要纵向数据,但这些发现表明,循证干预措施可以降低患者,医师和系统相关的糖尿病护理障碍,有助于降低DR风险。

Importance:A patients perceived barriers to diabetes self-management (DSM) may affect his or her risk of diabetic retinopathy (DR); however, few studies have examined this association.Objective:To examine the association between perceived barriers to DSM and the severity spectrum of DR in Asian patients with type 2 diabetes.Design, Setting, and Participants:A cross-sectional clinic-based study, the Singapore Diabetes Management Project, was conducted from December 28, 2010, to March 20, 2013, at the Singapore National Eye Centre, a tertiary eye care institute. After excluding patients with type 1 diabetes and ungradable fundus images, 361 participants were included in the analyses. Statistical analysis was conducted from July 20 to September 8, 2017.Exposure:The degree of perceived barriers to DSM was assessed using a 23-item questionnaire comprising items about knowledge of DSM, access to care, and confidence in health care professionals. Rasch analysis was used to optimize the scale’s psychometric properties, with lower scores indicating a higher degree of self-perceived barriers.Main Outcomes and Measures:Diabetic retinopathy was graded from 2-field retinal images into categories of no DR (Early Treatment Diabetic Retinopathy Study levels 10-15; n = 154), mild to moderate DR (levels 20-43; n = 112), and severe DR (levels 53 and/or presence of clinically significant macular edema; n = 95) using the modified Airlie House classification system of DR. Multinomial logistic regression models were used to assess the association between perceived barriers and severity of DR in the worse-affected eye.Results:Among the 361 participants (105 women and 256 men; mean [SD] age, 57 [8] years), a greater magnitude of perceived barriers to DSM was independently associated with higher odds of having any DR (odds ratio, 1.32; 95% CI, 1.06-1.66), mild to moderate DR (odds ratio, 1.30; 95% CI, 1.01-1.68), and severe DR (odds ratio, 1.36; 95% CI, 1.03-1.79). This association was independent of diabetes control (hemoglobin A1c, blood pressure, and lipid levels), presenting visual acuity, and socioeconomic indicators.Conclusions and Relevance:These results suggest that greater perceived barriers to DSM are independently associated with severity of DR. Although longitudinal data are needed, these findings suggest that evidence-based interventions to reduce patient-, practitioner-, and system-related barriers to diabetes care may help reduce the risk of DR.


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