臺灣博碩士論文加值系統

中文摘要
在台灣，糖尿病已成為國人主要的慢性疾病之一。依據行政院衛生署公佈2006年國人十大死亡糖尿病已昇為第四名，死亡率佔7.2%。糖尿病並非是一種單一的疾病，為異質性的多病因疾病，且具不可逆性會導致多種急性、慢性併發症的發生，對人體造成不可逆的傷害，帶給國人的健康威脅及醫療耗用甚鉅。
研究目的將探討2003年至2006年某區域醫院糖尿病患檢驗項目發生率，以瞭解多年期糖尿病患者檢驗項目發生的趨勢。並探討與不同併發症診斷的相關性。透過這個特徵的瞭解，使醫療資源能做最有效的利用，以建立疾病管理之有效指標與策略，進一步提升醫療資源之有效配置及照護品質。
研究結果
一、多年期糖尿病患者不管糖尿病病程時間長短，均以糖化血色素檢驗項目檢驗比率佔第一位，50%以上人次會進行糖化血色素、飯前血糖、飯後血糖、血糖等檢查項目。
二、糖尿病病患檢驗項目與不同併發症診斷具相關性，其中以糖尿病併發高血脂疾患疾病群」呈現以高密度脂蛋白、肌肝酸、三酸甘油酯等項檢查為主。
三、接受尿液微量白蛋白檢查的比率均偏低。為儘早施行腎臟病的保護性治療，糖尿病患個案管理照護應增加尿液微量白蛋白的檢查，以期及早發現問題防止腎臟病惡化。
本研究建議，病程年第10年起應加強監測尿液檢查及血脂檢查並建立為臨床或治療指引的檢驗項目。使醫療院所用最低的成本創造最高的效能達到提高醫療照護品質與降低醫療成本目的。

Abstract

Diabetes Mellitus has become one of the major chronic diseases in Taiwan. According to official documents, it was counted as the fourth of top ten leading cause of death in Taiwan, reaching mortality of 7.2%. Diabetes Mellitus is a multi-etiological disease and causes multiple complications. It will irreversibly cause several acute and chronic conditions, which may threaten the health of residents and the subsequent medical consumptions.

This study analyzed clinical diagnostic items of Diabetes Mellitus patients during their follow-ups in a district hospital during years 2003 to 2006. The trend and association of clinical diagnostic items and complications among chronic Diabetes Mellitus patients were analyzed as to achieve goals of effective case management and resource allocations. With this finding, the health care providers and policy makers will have better strategy for future management of this disease and therefore improving the quality of care among this specific group of patients.

The findings of this study are summarized as follows.
1. The primary clinical diagnostic items were found to be diabetes related indicators such as HbA1c,fasting plasma glucose, 2-h plasma glucose, and plasma glucose, among chronic Diabetes Mellitus patients with a multi-year history regardless of stages. Almost more than 50% of the visits, physicians will prescribe these items for DM patients to follow up their conditions.
2. The prescribing clinical diagnostic items were highly associated with the subsequent occurrence of complications among chronic DM patients. The most frequently found items were diagnosis of hyperlipidemia including HDL-C, creatinine, and triglyceride.
3. The diagnostic item of micro-albumin was less frequently prescribed in this hospital, which revealed problems of under or delayed diagnosis of nephralgia conditions among these patients.
Suggestions were made from this analysis that clinical guidelines constructed with routine urine diagnosis and items for hyperlipidemia should be planned for DM patients beyond ten-year disease history. The guideline for disease management of such patients will be beneficial simultaneously for care quality and medical cost containmentrs.

目 錄
指導教授推薦書
口試委員會審定書
授權書
誌謝
中文摘要
英文摘要
目錄 .i
圖表目錄.ii
第一章 緒論 1
第一節 研究背景與動機1
第二節 研究目的4
第二章 文獻探討 5
第一節 糖尿病及其相關疾病5
第二節 糖尿病流行病學. 11
第三節 糖尿病實驗室檢查之危險因子.14
第四節 小結20
第三章 研究材料與方法.22
第一節 研究設計.22
第二節 研究假設..23
第三節 研究對象及材料..23
第四節 研究變項.25
第五節 資料處理與分析29
第四章 研究結果...31
第一節 研究樣本描述31
第二節 糖尿病患者與檢驗組合的探索.33
第三節 糖尿病發病史與檢驗相關性分析36
第四節 糖尿病各病程併發症與早期檢驗項目實證分析37
第五章 討論.59
第一節 糖尿病基礎檢查項目結果探討59
第二節 檢驗組合與病程、早期檢驗結果的探討..61
第三節 糖尿病檢驗項目與照護糢式的探討.63
第四節 研究限制.66
第六章 結論與建議68
第一節 結論.68
第二節 建議..70
參考文獻...71
英文部份..71
中文部份.75

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