臺灣博碩士論文加值系統

研究目的：本研究旨在研究第二型糖尿病人的三高(血糖、血壓、血脂)達標率與睡眠品質、憂鬱的相關性，以期提供未來提升糖尿病照護品質之參考。

研究方法及資料：本研究採問卷調查方式，受試者為在彰化基督教體系醫院 (包括彰基總院、鹿基分院、南基分院) 就醫，並且已加入『糖尿病醫療給付改善方案』的第二型糖尿病患者，本論文採取的情緒壓力問卷為CES-D (Center for epidemiologic Studies Depression Scale)，睡眠品質問卷為『匹茲堡睡眠品質量表』。經資料蒐集完成並去除無效問卷後，共取得852份資料。以統計軟體SPSS 19.0 for Windows 進行「獨立t 檢定」、「卡方檢定」、「Spearman 等級相關係數分析」、「多元性迴歸分析」。

研究結果：總共852人進行此研究報告，平均糖尿病罹病年為12.6年，糖化血色素小於7.0% 者為48.4% ，血壓控制小於 140/80 mmHg者為57.9%，低密度膽固醇小於 100 mg/dL者為72.8%。糖尿病三高(ABC) 皆達標者為20.5%。平均CES-D score為 8.93 (± 8.04)，≥ 16分以上者 (憂鬱傾向) 為14.4%。平均PSQI score為 5.74 (± 3.72)，>5分者 (睡眠品質不佳) 佔43.2%，平均睡眠時數為6.36 (± 1.35) 小時。血糖、血壓、血脂是否達標，CESD score 與PSQI score皆無差異，ABC達標率與睡眠品質和憂鬱指數無關。多元性迴歸分析結果，影響ABC達標率的因子為年齡、糖尿病罹病年、身體質量指數，而睡眠品質指數、真正的睡眠時數，憂鬱指數都未達顯著性，與ABC達標率無關。

結論與建議：控制糖尿病人的血壓、血糖與血脂可延緩慢性併發症的發生，降低心血管疾病發生率及死亡率，世界各國皆以ABC達標率為糖尿病照護品質指標。本研究結果，不論是睡眠品質或是憂鬱指數皆與ABC達標率無關。原因可能為 (1). 本研究ABC達標率比起國內外一般糖尿病照護機構來的好，特別是血糖與血脂照護這一部分。(2). 台灣醫療因為有全民健保給付的關係，醫療取得方便、便宜，病人較不會感受到疾病帶來的壓力。(3). 民眾對於疾病的認知可能不足，不曉得ABC三項指標所代表的品質涵義，所以不知憂鬱。睡眠品質與憂鬱狀況會影響病人的生活品質與健康，臨床醫療人員仍應多方評估，以期找出高危險群，及早給於藥物與非藥物的治療與衛教，以改善生活品質與減少後續併發症之發生。

Aims: To investigate the associations among the achievement of ABC (HbA1c, blood pressure, and cholesterol) goal and sleep quality, depressive symptoms, of patients with Type 2 diabetes. This study could provide the information to improve the quality of diabetes control.

Methods: Cross-sectional data from 852 patients with Type 2 diabetes who are enrolled in the diabetes shared care system in Taiwan were obtained from an assessment of a diabetes registry at Changhua Christian hospital, Nantou Christian Hospital., and Lukang Branch Hospital in middle Taiwan. Center for epidemiologic Studies Depression Scale (CES-D) were used to measure depressive symptoms. The Pittsburgh Sleep Quality Index (PSQI) was used to derive a score of sleep quality across seven domains. Independent T test, Chi Square (χ2) test, Spearman''s rank correlation coefficient, and multiple regression analysis were used to estimate the associations between sleep quality, depressive symptoms, and the control rate of ABC goals by SPSS 19.0 for Windows.

Results: The average duration of diabetes of the participants was 12.6 years. The level of HbA1c below 7.0% was 48.4%. The control rate of blood pressure under 140/80 mmHg was 57.9%. The rate of LDL level below 100 mg/dL was 72.8%. The achievement of ABC targets was 20.5%. The average of CES-D score was 8.93 ± 8.04. CES-D score ≥ 16 was 14.4%. The average of PSQI score was 5.74 ± 3.72, and PSQI score ≥ 5 was 43.2%. The average duration of sleep was 6.36 ± 1.35 hours. The relationship of CES-D score, PSQI score, sleep quality and the achievement of ABC goals were no significant. Multiple regression analysis showed that age, the duration of diabetes, body mass index effected the the achievement of ABC goals; however, the sleep quality, sleep duration, depression index were no significant.

Conclusion: Well control of hyperglycemia, hypertension, and hyperlipidemia reduce the risk of coronary heart disease, comorbidity and mortality. The control rate of hyperglycemia, hypertension, and hyperlipidemia is crucial for diabetic care. In this study, the association between depression, sleep quality and the the achievement of ABC goals were no significant. However, sleep quality and depressive disorder effect the quality of life and health in diabetes patients. In order to improve the quality of life and reduce the complication of diabetes, clinicians should assess the risk of depression and sleep disorder in patients with diabetes and early intervention.

第一章緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 2
第三節 研究假說 2
第二章 文獻探討 3
第一節 糖尿病的流行病學 3
第二節 糖尿病的相關併發症與治療 4
第三節 糖尿病治療目標 6
第四節 糖尿病與憂鬱相關性 7
第五節 糖尿病與睡眠相關性 8
第三章 研究設計 11
第一節 研究流程 11
第二節 研究工具 12
第三節 研究架構與假設 15
第四節 研究變項與操作型定義 15
第五節 研究對象 18
第六節 分析方法 18
第四章 研究結果 20
第一節 描述性統計分析 20
第二節 推論性統計分析 21
第五章 討論 28
第六章 結論與建議 36
第一節 研究結論與建議 36
第二節 研究限制 36
參考文獻 50
附表一糖尿病臨床照護指引(ADA) 54
附表二 2013糖尿病整合指引 糖尿病人之治療目標 54
附表三 2015糖尿病臨床照護指引 55
附表四 平均血糖值與糖化血色素的對照表 56
附表五 中華民國糖尿病健康促進機構照顧品質調查 57
附錄一 同意臨床試驗證明書 58
附錄二 憂鬱量表 (CES-D) 60
附錄三 匹茲堡睡眠品質量表 61

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