Povezanost i uticaj bihejvioralnih i psiholoških faktora na metaboličku kontrolu obolelih od dijabetesa melitusa tipa 2
Sažetak
Uvod/Cilj. Postizanje dobre metaboličke kontrole, koja ima ključnu ulogu u redukciji ili prevenciji makrovaskularnih i mikrovaskularnih komplikacija dijabetesa melitusa (DM), zahteva kontinuiranu angažovanost bolesnika u upravljanju njihovom bolešću. Ta kontinuirana angažovanost, koja čini DM tipa 2 (T2DM) jednom od najzahtevnijih bolesti, kako fizički tako i emocionalno, u određenim periodima života može postati preteška i dovesti do emocionalnog distresa (simptomi depresije i distres povezan sa DM) i pogoršavanja metaboličke kontrole. Cilj rada bio je da se ispitaju povezanost i uticaj bihejvioralnih i psiholoških faktora na metaboličku kontrolu bolesnika sa T2DM. Metode. Istraživanje je sprovedeno kao deskriptivno-analitička studija preseka metodom slučajnog uzorka. U istraživanje su bila uključena 324 bolesnika sa T2DM. Vrednosti biohemijskih parametara metaboličke kontrole merene su standardnim laboratorijskim metodama. Krvni pritisak je meren u dva vremena i računata je aritmetička sredina. Vršena su antropometrijska merenja i računat je indeks telesne mase. Standardizovanim upitnicima ispitivani su stavovi bolesnika prema medikamentoj adherentnosti, adherentnost prema dijetetskim preporukama, nivo fizičke aktivnosti, prisustvo simptoma depresije i nivo distresa povezanog sa DM. Rezultati. Ciljne vrednosti parametara metaboličke kontrole dostiglo je 21.6% ispitanika. Kao prediktori loše metaboličke kontrole, multivarijantnom analizom identifikovani su gojaznost, neadherentnost prema dijetetskim preporukama, terapija insulinom, nizak nivo fizičke aktivnosti i klinički značajan distres povezan sa DM. Zaključak. Rutinska primena upitnika korišćenih u ovoj studiji u inicijalnom stadijumu ili kritičnim fazama pogoršanja bolesti, omogućila bi procenu stavova bolesnika i znanja o bihejvioralnim determinantama upravljanja DM i blagovremeno otkrivanje psiholoških problema povezanih sa njima. Realno bi bilo očekivati da takav sveobuhvatni, holistički pristup može doprineti boljoj metaboličkoj kontroli bolesnika sa T2DM i nižoj incidenciji komplikacija.
Reference
1. Albuquerque C, Correia C, Ferreira M. Adherence to the therapeutic regime in person with type 2 diabetes. Procedia Soc Behav Sci 2015; 171: 350‒8.
2. Rakočević I, Miljuš D, Božić Z. Incidence and mortality of diabetes in Serbia, 2019. Belgrade: Institute of Public Health in Serbia „Dr. Milan Jovanović Batut“; 2020. http://www.
/>batut.org.rs/download/publikacije/dijabetes 2019.pdf. Accessed January 24, 2021.
3. Saeedi P, Petersohn I, Salpea P, Malanda B, Karuranga S, Unwin N, et al. Global and regional diabetes prevalence estimates for 2019 and projections for 2030 and 2045: results from the International Diabetes Federation Atlas, 9th edition. Diabetes Res Clin Pract 2019; 157: 107843.
4. Huayanay-Espinoza IE, Guerra-Castanon F, Lazo-Poras M, Castaneda-Guaqrderas A, Thomas NJ, Garcia-Guarniz AL, et al. Metabolic control in patients with type 2 diabetes mellitus in a public hospital in Peru: a cross-sectional sudy in a low-middle income country. Peer J 2016; 4: e2577.
5. American Diabetes Association. 10. Cardiovascular disease and risk management: standards of medical care in diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S103‒23.
6. American Diabetes Association. 6. Glycemic targets: standards of medical care in diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S61‒70.
7. Rucket IA, Schunk M, Holle R, Schipf S, Volzke H, Kluttig A, et al. Blood pressure and lipid management fall far short in persons with type 2 diabetes: results from DIAB-CORE consortium including six German population-based studies. Cardiovasc Diabetol 2012; 11: 50.
8. American Diabetes Association. Improving care and promoting health in populations: Standards of Medical Care in Diabetes - 2019. Diabetes Care 2019; 42(Suppl 1): S7‒12.
9. American Diabetes Association. 6. Standards of medical care in diabetes - 2018. Diabetes Care 2018; 41(Suppl 1): S55‒64.
10. Fritz H, Di Zazzo-Miller R, Bertran EA, Pociask F D, Tarakji S, Arnetz J, et al. Diabetes self-management among Arab Americans: patients and provider perspectives. BMC Int Health Hum Rights 2016; 16: 22.
11. Stark Casagrande S, Fradkin JE, Saydah SH, Rust KF, Cowie C. The prevalence of meeting A1C, blood pressure and LDL goals among people with diabetes,1988-2010. Diabetes Care 2013; 36(8): 2271‒9.
12. Hood S, Irby-Shasanmi A, de Groot M, Martin E, LaJoie S. Understanding diabetes-related distress characteristics and psychosocial support preferences of urban African American adults living with type 2 diabetes. Diabetes Educ 2018; 44(2): 144‒57.
13. Jeong M, Reifsnider E. Associations of Diabetes-Related Distress and Depressive Symptoms With Glycemic Control in Korean Americans With Type 2 Diabetes. Diabetes Educ 2018; 44(6): 531‒40.
14. American Diabetes Association. 8. Obesity Management for the Treatment of Type 2 Diabetes: Standards of Medical Care in Diabetes-2019. Diabetes Care 2019; 42(Suppl 1): S81‒9.
15. Prado-Aguilar CA, Martinez YV, Segovia-Bernal S, Reyes Martinez R, Arias-Ulloa A. Performance of two questionnaires to measure treatment adherence in patients with type 2 diabetes. BMC Public Health 2009; 9: 38.
16. Asaad G, Sadegian M, Lau R, Xu Y, Soria-Contreras DC, Bell RC, et al. The Reliability and Validity of the Perceived Dietary Adherence Questionnaire for People with Type 2 Diabetes. Nutrients 2015; 7(7): 5484‒96.
17. Ayele AA, Emiru YK, Tiruneh SA, Ayele BA, Gebremariam AD, Tegegn HG. Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital. Clin Diabetes Endocrinol 2018; 4: 21.
18. Stetson B, Schlundt D, Rothschild C, Floyd JE, Rogers W, Mokshagundam SP. Development and validation of The Personal Diabetes Questionnaire (PDQ): a measure of diabetes self-care behaviors, perceptions and barriers. Diabetes Res Clin Pract 2011; 91(3): 321‒32.
19. Majdan M, Krajcovicova L, Perkarickova J, Cherechees R, O’Mullane M. Predictors of depressive symptoms in patients with diabetes in Slovakia. Int J Psychiatry Med 2012; 44(4): 351‒66.
20. Fisher L, Hessler DM, Polonsky WH, Mullan J. When is diabetes distress clinically meaningful?: establishing cut points for the Diabetes Distress Scale. Diabetes Care 2012; 35(2): 259‒64.
21. Hu H, Hori A, Nishiura C, Sasaki N, Okazaki H, Nakagawa T, et al. HbA1c, blood pressure, and lipid control in people with diabetes: Japan epidemiology collaboration occupational health study. PloS ONE 2016; 11(7): e0159071.
22. Bała MM, Płaczkiewicz-Jankowska E, Leśniak W, Topór-Mądry R, Jankowski M, Grzeszczak W, et al. Under The Patronage Of Diabetes Poland For The Aretaeus-2 Study Group. Management and treatment goals in Polish patients with type 2 diabetes of more than ten years' duration - results of ARETAEUS2-Grupa Study. Endokrynol Pol 2014; 65(3): 158‒68.
23. Haghighatpanah M, Nejad ASM, Haghighatpanah M, Thunga G, Mallayasamy S. Factors that Correlate with Poor Glycemic Control in Type 2 Diabetes Mellitus Patients with Complications. Osong Public Health Res Perspect 2018; 9(4): 167‒74.
24. Chew BH, Sherina MS, Hassan NH. Association of diabetes-related distress, depression, medication adherence, and health-related quality of life with glycated hemoglobin, blood pressure, and lipids in adult patients with type 2 diabetes: a cross-sectional study. Ther Clin Risk Manag 2015; 11: 669‒81.
25. Ayele AA, Tegegn HG, Ayele TA, Ayalew MB. Medication regimen complexity and its impact on medication adherence and glycemic control among patients with type 2 diabetes mellitus in an Ethiopian general hospital. BMJ Open Diabetes Res Care 2019; 7(1): e000685.
26. Semenkovich K, Brown ME, Svrakic DM, Lustman PJ. Depression in type 2 diabetes mellitus: prevalence, impact, and treatment. Drugs 2015; 75(6): 577‒87.
27. Cols-Sagarra C, Lopez-Simarro F, Alonso-Fernandez M, Mancera-Romero J, Perez-Unanua P, Mediavilla-Bravo JJ, et al. Work Group of Diabetes SEMERGEN (Sociedad Española de Médicos de Atención Primaria). Prevalence of depression in patients with type 2 diabetes attended in primary care in Spain. Prim Care Diabetes 2016; 10(5): 369‒75.
28. Sonmez A, Yumuk V, Haymana C, Demirci I, Barcin C, Kıyıcı S, et al. TEMD Study Group. Impact of Obesity on the Metabolic Control of Type 2 Diabetes: Results of the Turkish Nationwide Survey of Glycemic and Other Metabolic Parameters of Patients with Diabetes Mellitus (TEMD Obesity Study). Obes Facts 2019; 12(2): 167‒78.
29. Ormazabal V, Nair S, Elfeky O, Aguayo. Association between insulin resistance and the development of cardiovascular disease. Cardiovasc Diabetol 2018; 17: 122.
30. Campbell MD, Babic D, Bolcina U, Smirčić-Duvnjak L, Tankova T, Mitrakou A, et al. High level of clinical inertia in insulin initiation in type 2 diabetes across Central and South-Eastern Europe: insights from SITIP study. Acta Diabetol 2019; 56(9): 1045‒9.
31. Wake AD. Antidiabetic Effects of Physical Activity: How It Helps to Control Type 2 Diabetes. Diabetes Metab Syndr Obes 2020; 13: 2909‒23.