加纳一家三级医院糖尿病患者血糖控制、生活质量及糖尿病自我管理的预测因素
Predictors of glycemic control, quality of life and diabetes self-management of patients with diabetes mellitus at a tertiary hospital in Ghana.
作者信息
Gyan Kwadwo Faka, Agyenim-Boateng Enoch, Hutton-Mensah Kojo Awotwi, Opare-Addo Priscilla Abrafi, Gyabaah Solomon, Ofori Emmanuel, Asamoah Osei Yaw, Naabo Mohammed Najeeb, Owiredu Michael Asiedu, Tannor Elliot Koranteng
机构信息
Directorate of Medicine, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Department of Family Medicine, Dalhousie University, Yarmouth, Nova Scotia, Canada.
出版信息
PLoS One. 2025 Jul 3;20(7):e0317075. doi: 10.1371/journal.pone.0317075. eCollection 2025.
BACKGROUND
The burden of diabetes mellitus (DM) in Sub-Saharan Africa is high and continues to increase. Effective DM management focuses on key goals such as glycemic control, prevention of complications and improvement of quality of life (QOL). This study therefore assessed predictors of glycemic control, QOL and diabetes self-management (DSM) of patients with DM in a tertiary hospital in Ghana.
METHODS
We conducted a cross-sectional study involving face-to-face interviews of patients with DM attending clinic using structured questionnaires and validated study instruments as well as review of medical records. A multivariable logistic regression analysis was used to identify independent factors associated with good glycemic control, poor QOL and poor DSM practices.
RESULTS
The study involved 360 patients with mean age of 62.5 ± 11.6 years and mean FBG of 9.0 ± 4.8 mmol/L, of which 40.8% had FBG < 7 mmol/L. Patients who were not on insulin(aOR 1.82; 95% CI 1.12-2.96, p = 0.017) were more likely to have good glycemic control. Urban residence (aOR 0.24; 95% CI 0.06-0.87, p = 0.030) was protective of having poor QOL. However, poor DSM(aOR 18.30; 95% CI 7.98-44.5, p < 0.001) and recent hospitalization(within the past 3 months) (aOR 4.58; 95% CI 1.58-13.26, p = 0.005) had higher odds of poor QOL. Patients who were divorced(aOR 6.92; 95% CI 1.24-43.20, p = 0.031) had higher odds of poor DSM, while having attended the clinic for more than 3 years(aOR 0.32; 95% CI 0.13-0.84, p = 0.018) was protective of poor DSM.
CONCLUSION
4 out of 10 patients attending diabetes clinic are well controlled. Not being on insulin is independently associated with good glycemic control. Urban residence, DSM and recent hospitalization are associated with QOL while being divorced and duration in clinic predict DSM. Prevention of acute hospitalizations and promotion of good self-management among patients with diabetes can improve their quality of life.
背景
撒哈拉以南非洲地区的糖尿病负担很高且持续上升。有效的糖尿病管理聚焦于血糖控制、并发症预防及生活质量（QOL）改善等关键目标。因此，本研究评估了加纳一家三级医院中糖尿病患者血糖控制、生活质量及糖尿病自我管理（DSM）的预测因素。
方法
我们开展了一项横断面研究，采用结构化问卷和经过验证的研究工具对门诊糖尿病患者进行面对面访谈，并查阅病历。采用多变量逻辑回归分析来确定与良好血糖控制、不良生活质量及不良糖尿病自我管理行为相关的独立因素。
结果
该研究纳入了360例患者，平均年龄为62.5±11.6岁，平均空腹血糖（FBG）为9.0±4.8 mmol/L，其中40.8%的患者FBG<7 mmol/L。未使用胰岛素治疗的患者（调整后比值比[aOR]为1.82；95%置信区间[CI]为1.12 - 2.96，p = 0.017）更有可能实现良好的血糖控制。城市居住（aOR为0.24；95% CI为0.06 - 0.87，p = 0.030）对不良生活质量具有保护作用。然而，不良的糖尿病自我管理行为（aOR为18.30；95% CI为7.98 - 44.5，p < 0.001）和近期住院（过去3个月内）（aOR为4.58；95% CI为1.58 - 13.26，p = 0.005）与不良生活质量的几率更高相关。离婚患者（aOR为6.92；95% CI为1.24 - 43.20，p = 0.031）出现不良糖尿病自我管理行为的几率更高；而就诊超过3年（aOR为0.32；95% CI为0.13 - 0.84，p = 0.018）对不良糖尿病自我管理行为具有保护作用。
结论
在糖尿病门诊就诊的患者中，十分之四的患者血糖得到良好控制。未使用胰岛素治疗独立与良好的血糖控制相关联。城市居住、糖尿病自我管理行为及近期住院与生活质量相关，而离婚状态和就诊时长可预测糖尿病自我管理行为。预防糖尿病患者急性住院并促进其良好的自我管理可改善他们的生活质量。
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