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Expectations about insulin therapy, perceived insulin-delivery system social acceptability, and insulin treatment satisfaction contribute to decreases in insulin therapy self-efficacy in patients with type 2 diabetes after 36 weeks insulin therapy (2型糖尿病患者经过36周的胰岛素治疗后,患者对胰岛素治疗的期望、感知的胰岛素给药装置的社会接受性以及对胰岛素治疗的满意度都可以导致胰岛素治疗自我效能感的下降)

Authors


  • This trial has been registered with ClinicalTrials.gov (Identifier: NCT00377858).

Correspondence

Risa P. Hayes, Global Health Outcomes, Eli Lilly and Company, Lilly Corporate Center, Drop Code 1730, Indianapolis, IN 46285, USA.

Tel: +1 317 276 8846

Fax: +1 317 433 2997

Email: hayes_clarice@lilly.com

Abstract

Background

Self-efficacy plays a critical role in diabetes self-care. Herein we explore factors contributing to decreased insulin therapy self-efficacy in insulin-naïve patients with type 2 diabetes mellitus (T2DM) initiating and managing insulin therapy over 36 weeks.

Methods

The study was conducted within an international, randomized clinical trial comparing two insulin therapies administered by insulin pen in patients with T2DM inadequately controlled with oral antihyperglycemic medications. Patients completed the Self-Efficacy about Insulin Therapy Questionnaire (SEITQ) at baseline and endpoint. Patients also completed patient-reported measures assessing expectations about insulin therapy at baseline and perceptions about insulin therapy and insulin-delivery system (IDS) satisfaction at endpoint. Baseline and endpoint SEITQ scores were compared. Using prespecified criteria, patients were classified as having “decreased” or “no change/improved” insulin self-efficacy. Demographic, clinical, and patient-reported variables were entered into a logistic regression model with decreased insulin self-efficacy (yes or no) as the dependent variable.

Results

Baseline and endpoint SEITQ data were available for 450 insulin-naïve T2DM patients (mean age 59 years; 53% female; 57% Caucasian; mean baseline HbA1c 9.4%; 80.0 mmol/mol). Insulin therapy self-efficacy improved from baseline to endpoint (74.0 vs 77.5; P < 0.001). Logistic regression analysis indicated that lower IDS satisfaction (P < 0.0001), lower IDS social acceptability (P = 0.004), and more positive expectations of insulin therapy (P < 0.0001) were associated with decreased insulin self-efficacy.

Conclusions

A candid discussion between clinicians and their insulin-naïve T2DM patients about the benefits and challenges of insulin therapy may prevent unrealistic expectations that could potentially undermine insulin self-efficacy.

摘要

背景

自我效能感在糖尿病的自我治疗中起着关键的作用。因此我们在既往未使用过胰岛素的2型糖尿病(T2DM)患者中开始使用胰岛素并且治疗36周以上,探讨了其中可导致胰岛素治疗自我效能感下降的因素。

方法

这是一项国际性的随机临床试验,它在口服降糖药控制不佳的T2DM患者中比较了两种不同的通过胰岛素注射笔给药的胰岛素治疗方案。在基线以及终点患者都要完成有关胰岛素治疗自我效能感的问卷(Self-Efficacy about Insulin Therapy Questionnaire SEITQ)。在基线时患者还要完成患者报告的测量值以评估对胰岛素治疗的期望,并且在终点时要完成对胰岛素治疗的认知度以及对胰岛素给药装置(IDS)满意度的调查。比较基线与终点时的SEITQ评分。使用预先设定的标准,患者被分类为胰岛素治疗自我效能感“下降”或者“没有变化/改善”。将人口统计学、临床以及患者报告的变量输入到一个logistic回归模型中,将下降的胰岛素治疗自我效能感(是或否)作为因变量。

结果

在基线与终点时可以得到450名既往未使用过胰岛素的T2DM患者(平均年龄为59岁;53%为女性;57%为白种人;平均基线HbA1c为9.4%/80.0 mmol/mol)的SEITQ数据。从基线至终点患者的胰岛素治疗自我效能感有所改善(74.0 vs 77.5;P < 0.001)。Logistic回归分析结果显示,更低的IDS满意度(P < 0.0001)、更低的IDS社会接受性(P = 0.004)以及更积极的胰岛素治疗期望度(P < 0.0001)都与胰岛素治疗自我效能感下降有关。

结论

临床医生应该对既往未使用过胰岛素的T2DM患者坦率地说明胰岛素治疗的好处与挑战,它可以预防患者产生不切实际的有可能会导致胰岛素治疗自我效能感下降的期望。

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