应用胰岛素泵治疗1型糖尿病患儿不同依从性的原因与对策

Reasons and Countermeasures for Different Compliances of Insulin Pump Therapy in Children with Type 1 Diabetes

目的探讨应用胰岛素泵治疗1型糖尿病(T1DM)患儿不同依从性的原因与对策。方法对2000年1月-2008年12月在天津市儿童医院收治的T1DM患者278人次,采用自行设计的T1DM胰岛素泵治疗调查问卷,分析影响糖尿病患者胰岛素治疗依从性的原因,并探讨相应的对策。结果T1DM患者278人次中,85.25%(237人次)同意胰岛素泵治疗,14.75%(41人次)拒绝胰岛素泵治疗。<3岁患者中58.33%(21人次)同意胰岛素泵治疗,>3岁患者中89.26%(216人次)同意胰岛素泵治疗,差异有统计学意义(χ2=23.83,P<0.01);第1次接触胰岛素泵者208人次中82.69%(172人次)同意胰岛素泵治疗,曾使用胰岛素泵或是否接触过使用胰岛素泵的患者中92.86%(65人次)同意胰岛素泵治疗,差异有统计学意义(χ2=4.30,P<0.05)。同意胰岛素泵治疗者与拒绝胰岛素泵治疗者对T1DM的认识得分(t=2.11,P<0.05)和对胰岛素泵的认识得分(t=10.53,P<0.01)的差异均有统计学意义。在治疗过程中由同意改为拒绝胰岛素泵治疗的主要原因为患者有异物感、使用过程中出现故障、发生低血糖;由拒绝改为同意的主要原因:未用胰岛素泵的情况下血糖控制不理想,同时住院的应用胰岛素泵的患者与之交流,期望血糖得到更好的控制。结论健康教育、心理行为干预、使用指导、疗效对比、正规熟练的操作可提高治疗的依从性。

Objective To analyze rate of and reasons for not undertaking insulin pump therapy in children with type 1 diabetes（T1DM） and explore potential countermeasures.Methods Two hundred and seventy-eight persons of T1DM,diagnosed in Tianjin Children′s Hospital from Jan.2000 to Dec.2008,were assigned to fill in a questionnaire on T1DM and insulin pump therapy.Reasons for different compliances were analyzed and strategies were explored.Results Eighty-five point twenty-five percent of the children（237 persons） undertook the therapy and 14.75%（41 persons） refused.In the group of younger than 3 years,58.33%（21 persons）accepted the therapy,while in the group of older than 3 years,89.26%（216 persons） undertook it,consequently there was statistically significant difference（χ2=23.83,P0.01）.Eighty-two point sixty-nine percent（172 persons） of the 208 persons who had not heard of the therapia used the instrument,and 92.86%（65 persons） of the children who had employed it before or known the patients who had employed it agreed to the treatment,which suggest statistically significant difference（χ2=4.30,P0.01）.The children who had the remedial action compliantly were more knowledgeable of T1DM（t=2.11,P0.05） and the therapy（t=10.53,P0.01）.The causes of discontinuing the pumps were discomfort,malfunction,episode of hypoglycaemia,and so on.The reasons of compliancy were owing to poor glucose control,comparison with the ones having insulin pump therapy,expecting tight glycemic control,and so on.Conclusions Intensive education programme,psychological intervention,application guidance,curative effect contrast,professional and proficient operation are recommended for children with T1DM,since they can achieve better compliance and prognosis.