初探低血糖處理行為──立即進食與藥物調整之影響因子

Factors associated with immediate food consumption and drug adjustment in hypoglycemia: a preliminary study on hypoglycemia management behaviors

目標：低血糖是糖尿病的急性併發症之一，需要病人立即處理。本研究目的在探討接受胰島素治療之第2型糖尿病患者，影響低血糖立即進食和調整藥物行為之重要因子。方法：採用橫斷式調查研究法，以立意取樣收集218位在台灣南部一家醫學中心、一家地區醫院和3家基層醫療門診，接受胰島素治療，而且經歷過低血糖事件之第2型糖尿病患者為研究對象。採用低血糖知識量表、低血糖恐懼量表和社會支持量表收集資料。資料收集自2016年5月至2018年7月。結果：218位研究對象平均年齡為62.3歲；女性佔51.8％、教育程度以高中或以上者佔83.5％。本研究以AMOS檢視性別、規律運動、低血糖知識、半年內發生低血糖事件的次數、教育程度和社會支持與立即進食和藥物調整等項關係和最佳配適模式。結果發現女性（p＜0.01）、低血糖知識（p＜0.01）和多次發生低血糖事件（p＜0.05）與立即進食有顯著相關；而多次發生低血糖事件（p＝0.01）和社會支持（p＜0.05）與調整藥物有顯著相關，立即進食的總變異量是10.70％和調整藥物的總變異量是4.80％。結論：性別、低血糖知識和多次發生低血糖事件是立即進食的影響因子，而多次發生低血糖事件和社會支持是調整藥物的影響因子。本研究結果可以提供健康照護人員瞭解接受胰島素治療之第2型糖尿病患者，影響低血糖立即進食和調整藥物之重要因子，以作為強化低血糖照護和低血糖管理之實證指引。

Objectives: Hypoglycemia is an acute complication of type 2 diabetes (T2D) that requires immediate self-management by the patient. This study explored the key factors determining immediate food consumption and drug administration adjustment when patients with T2D experience an episode of hypoglycemia following insulin treatment. Methods: This cross-sectional survey enrolled 218 patients with T2D receiving treatment in a medical center, a regional hospital, and three primary medical clinics in southern Taiwan. Data were collected from May 2016 to June 2018. Three questionnaires were used: the Knowledge of Hypoglycemia Scale, Fear of Hypoglycemia Scale, and Social Support Scale. Results: This study included 218 patients (mean age: 62.3 years). More than half were women (51.8%), and most had a junior high school education level or below (83.5%). AMOS was conducted to examine the relationships among sex, education, exercise, knowledge of hypoglycemia, multiple hypoglycemia events, social support, immediate food consumption, and drug adjustment and the best fit model. Female sex (p < .01), knowledge of hypoglycemia (p < .01), and multiple hypoglycemia events (p < .05) were significantly correlated with immediate food consumption. In addition, multiple hypoglycemia events (p = .01) and social support (p < .05) were significantly correlated with drug adjustment. The total variance of immediate food consumption and drug adjustment was 10.7% and 4.8%, respectively. Conclusions: Sex, knowledge of hypoglycemia, and multiple hypoglycemia events are crucial factors affecting immediate food consumption, and multiple hypoglycemia events and social support are crucial factors affecting drug adjustment. These findings may help health care professionals understand the factors that can affect the behaviors of patients with T2D in terms of immediate food consumption and drug adjustment after an episode of hypoglycemia. The results may serve as guidelines to improve hypoglycemia care and education.