臺灣博碩士論文加值系統

研究背景與目的：
自我管理是第二型糖尿病長期照護重要一環，隨著疾病持續時間增長，使用更多種降血糖藥物聯合治療以達血糖控制，然而藥物複雜性可能對生活品質及治療滿意度產生影響，使之成為當前重視的議題。已知研究表明胰島素的使用有較低的病患生活品質及治療滿意度，鑒於臺灣大多數病患以口服降血糖藥物為主，並且現行類似的研究甚少，缺乏臺灣族群使用口服降血糖藥物所造成生活品質與臨床治療效果評估證據，使得目前臨床決策者乃依賴國外研究數據作為決策依據。本研究旨評估臺灣第二型糖尿病患者使用metformin合併其他口服降血糖藥物對健康生活品質與治療滿意度影響，並探討影響之因子。
研究方法：
本研究為橫斷面研究，於高雄長庚紀念醫院之內分泌暨新陳代謝科門診，以結構式問卷記名方式進行資料收集，採用臺灣版糖尿病依賴性生活品質問卷Audit of Diabetes-Dependent Quality of Life (ADDQOL) 與台灣民眾對於口服降血糖藥物的滿意度問卷Chinese version of the Satisfaction with Oral Anti-Diabetic drugs (C-SOADAS)評估接受metformin合併其他OADs之第二型糖尿病病患的生活品質與治療滿意度，分析在使用OADs種類數目不同的族群分別在不同問卷所得分數，針對於收案期間有加上新OAD種類之族群，評估加藥後短期對糖尿病生活品質與治療滿意度影響。此外，用單變量及多變量分析來探討影響生活品質與治療滿意度的因子
研究結果：
這項研究共收入153名T2DM病患，平均年齡(標準差)為60.4(10.1)歲、平均糖尿病持續時間為9.2(5.7)年，約60%為男性，在使用不同OAD品項數(使用2種、3種、超過3種OADs)的分布如下：42.5%、30.7%、26.8%，研究族群的平均生活品質問卷分數為-2.11，其中接受超過3種OADs之健康生活品質相較於其它治療組是較低的，各組間沒有達統計學上顯著差異。平均治療滿意度總分為20.5分，在接受2種OADs藥物組合的治療滿意度高於其它治療組合，三組之間達統計學上顯著差異(p<0.001)。研究結果發現影響健康生活品質和治療滿意度各有差異，T2DM患有高血壓且有使用降血壓藥物者與ADDQOL得分顯著相關，而自我血糖監測習慣、HbA1c與使用OAD顆粒數顯著預測C-SOADAS得分。此外，有加上新OAD的族群對於ADDQOL得分的差異沒有顯著差別，而對於C-SOADAS得分顯著提升。
研究結論：
總的來說，臺灣在接受不同OADs種類數之第二型糖尿病病患對健康生活品質的影響之間無顯著差異，然而使用超過3種OADs的病患則顯著有較低的治療滿意度。本研究發現高血壓是預測健康生活品質重要因子，而預測治療滿意度因子包含HbA1c、自我血糖監測及藥物複雜度，並且在針對增加新OAD之短期對生活品質影響似乎是很小的，但會降低治療的滿意度，可能是由於增加藥物複雜性所導致。
本研究為分析 T2DM 的病患自我報告結果提供了當地證據，然而對於僅接受OAD病患之生活品質與治療滿意度相關研究並不多，未來在不同人群相關研究有更多研究者投入，以歸納出對於此類型患者提高照護品質的最佳治療建議。

Background and study aim:
Self-management is an important part of long-term care for type 2 diabetes (T2DM). As the duration of disease increases, more oral antidiabetic drugs (OADs) are used in combination to achieve blood sugar control. However, the complexity of OADs regimen may have a heavy impact on quality of life and treatment satisfaction and becomes an issue of current attention. Studies have shown that the use of insulin is associated with lower quality of life and treatment satisfaction in patient with T2DM. In Taiwan, patients with T2DM mainly take OADs and only few relevant domestic studies are focus on evaluation, we lack data for evidence to evaluate the quality of life and clinical treatment effect regarding OADs usage in Taiwanese. Therefore, clinical decision makers currently could only take foreign research data as reference for decision-making. The purpose of this study was to evaluate the effect of metformin combined with other OADs on quality of life and treatment satisfaction and explore the influencing factors in Taiwanese patients with type 2 diabetes.
Methods:
This study was a cross-sectional study conducted at the outpatient department of Metabolism and Endocrinology in Kaohsiung Chang Gung Memorial Hospital. Data were collected by the Registered Structured Questionnaires with Audit of Diabetes-Dependent Quality of Life (ADDQOL-19) and Chinese version of the Satisfaction with Oral Anti-Diabetic drugs (C-SOADAS) and used to evaluate the quality of life and treatment satisfaction of patients with type 2 diabetes who received metformin combined with other OADs, Scores collected from different questionnaires of patients who obtained different types and numbers of OADs were analyzed. For group of patients who received new OAD types added on during the study period, the short-term impact of dosing addition on quality of life and treatment satisfaction were also evaluated. In addition, univariate and multivariate analyses were used to explore factors affecting quality of life and treatment satisfaction
Results:
A total of 153 patients with T2DM were included in this study, the mean age (standard deviation) was 60.4 (10.1) years, the mean diabetes duration was 9.2 (5.7) years, and approximately 60% participants were male. The mean quality of life score was -2.11 for study population and the distribution of patients with different types and numbers of OADs (using 2, 3, and more than 3 OADs) was as follows: 42.5%, 30.7% and 26.8%. Among them, the quality of life in patients who received more than 3 OADs was lower compared to other groups, and no statistically significant difference between the groups. The results of treatment satisfaction for patients received the two OADs group was statistically higher than other treatment groups, and there was astatistically significant difference among the three groups (P<0.001). The results of this study found that the factors of quality of life and treatment satisfaction were different. Patients with T2DM and hypertension who took antihypertensive agens was significantly associated with ADDQOL score, while self-monitoring of blood glucose, HbA1c and the number of OADs significantly predicted C-SOADAS score. In addition, the groups with the added new OAD did not have significantly worse in ADDQOL score, but significantly improved the total C-SOADAS score.

Conclusion:
In conclusion, there were no significant difference impact on diabetes dependent quality of life among metformin based T2DM patients who received other oral anti-diabetic drugs in Taiwan, whereas patients who used more than 3 classes of OAD had significantly lower satisfaction for treatment. This study found that hypertension was an important predictor of healthy quality of life, and the predictors of treatment satisfaction included HbA1c, self-monitoring of blood glucose and drug complexity, but the short-term impact of the new OAD dosing addition on quality of life seems to be small, but it will decrease treatment satisfaction, it may be due to drug complexity increased.
The study provided local evidence for analyzing the patient’s self-reporting outcomes with T2DM. However, there are not many studies related to quality of life and treatment satisafaciton in patients who receive OAD treatment only. In the future, it needs more researchers to invest in studies of different populations to summarize the best treatment recommendations for improving the quality of life and satisfaction for T2DM.

中文摘要 I
ABSTRACT IV
致謝 VII
表目錄 VIII
圖目錄 X
縮寫名稱 XI
第一章、介紹 1
第二章、文獻回顧 4
2.1 第二型糖尿病介紹 4
2.1.1 定義 4
2.1.2 流行病學與風險因素 4
2.1.3 診斷標準 6
2.1.4第二型糖尿病之藥物治療 7
2.1.5用於第二型糖尿病之口服降血糖用藥33,34 9
2.2糖尿病病人之健康相關生活品質評估 14
2.2.1健康相關生活品質定義 14
2.2.2健康相關生活品質的測量 15
2.2.3台灣中文版糖尿病相關生活品質量表 16
2.2.4糖尿病健康生活品質之應用 18
2.3 糖尿病病人之治療滿意度評估 20
2.3.1 糖尿病治療滿意度之測量 20
2.3.2 臺灣中文版口服降血糖藥物治療滿意度量表 21
2.3.3糖尿病治療滿意度之應用 22
第三章、研究目的及目標 25
第四章、研究方法 26
4.1研究對象 26
4.2納入條件 26
4.3 排除條件 30
4.4 納入日期定義 30
4.5 受訪方法 30
4.5.1 若對象為收案日無加入新的OAD者 30
4.5.2 若對象為收案日有加入新的OAD者 30
4.6 藥物暴露定義 31
4.7評估工具 32
4.7.1 ADDQoL 32
4.7.2 SOADAS 34
4.8納入分析的變項 36
4.8.1 個人基本資料 36
4.8.2 疾病基本資料 36
4.8.3 藥物處方訊息 38
4.9 研究終點 38
4.9.1主要結果 38
4.9.2次要結果 38
4.10 統計分析 38
4.11 研究倫理規範 39
第五章、研究結果 40
5.1研究族群 40
5.2研究族群之基本特性 41
5.2.1所有研究對象之基本特性 41
5.2.2 不同OADs品項數組別之基本特性 42
5.3問卷之相關性 49
5.3.1 ADDQoL相關性 49
5.3.2 ADDQoL與C-SOADAS之相關性 50
5.4第二型糖尿病病人之生活品質問卷統計結果 54
5.4.1所有研究族群之生活品質 54
5.4.2 不同OADs品項數組別之生活品質 55
5.5 第二型糖尿病病人口服降血糖藥物治療滿意度統計結果 60
5.5.1 研究族群所有病人之治療滿意度 60
5.5.2 不同OADs品項數組之治療滿意度 60
5.6需加上新口服降血糖藥物第二型糖尿病病人之加藥後生活品質與治療滿意度問卷統計結果 65
5.6.1 新加入OADs後之生活品質 65
5.6.2 新加入OADs後之治療滿意度 68
5.7 影響第二型糖尿病病人生活品質與治療滿意度的重要因子 71
5.7.1研究族群所有第二型糖尿病病人之影響生活品質因子 71
5.7.2研究族群所有第二型糖尿病病人之影響治療滿意度因子 75
第六章、討論 79
6.1 研究族群之基本特性 81
6.1.1 所有研究族群之基本特性 81
6.2.1 不同OADs品項數組別之基本特性 84
6.2問卷之相關性 85
6.2.1 ADDQoL相關性 85
6.2.2 ADDQoL與C-SOADAS之相關性 87
6.3第二型糖尿病病人之生活品質 87
6.3.1 所有研究族群之生活品質 87
6.3.2 不同OADs品項數研究族群之生活品質 92
6.3.3 加入新OADs研究族群之生活品質 94
6.4 第二型糖尿病病人之治療滿意度 94
6.4.1 所有研究族群之治療滿意度 94
6.4.2 不同OADs品項數研究族群之治療滿意度 97
6.4.3 需加入新OADs研究族群之治療滿意度 99
6.5影響第二型糖尿病病人生活品質與治療滿意度的重要因子 100
6.5.1研究族群所有第二型糖尿病病人之影響生活品質因子 100
6.5.2研究族群所有第二型糖尿病病人之影響治療滿意度因子 103
6.6 強度與限制 104
6.7 致謝 錯誤! 尚未定義書籤。
第七章、結論 107
第八章、參考文獻 108
附錄 124

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