당뇨 환자에서 첫 안저검사를 시행하는 주된 이유 및 관련 요인
Main Reasons for and Associated Factors of the First Fundus Examination in Diabetic Patients
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목적: 당뇨 환자에서 첫 안저검사를 받는 주된 이유 및 이에 관련된 요인에 대해 조사하고자 한다. 대상과 방법: 가천대학교 길병원 안과를 방문한 제2형 당뇨 환자 중 첫 안저검사를 시행한 164명을 대상으로 대면 및 전화 설문을 시행하였다. 결과: 당뇨를 진단 받은 후 첫 안저검사까지 당뇨의 유병기간은 8.3 ± 7.5년이었고 첫 안저검사를 받은 당뇨 환자 중 당뇨망막병증의 유병률은 52.4%로 남녀 간 유의한 차이는 없었다(p=0.118). 첫 안저검사를 받는 주된 이유는 의사추천이 가장 많았으며(53.7%) 주관적 안과 증상(21.3%), 당뇨 교육(14.0%), 가족권유(6.7%), 대중매체의 정보(4.3%) 순이었다. 의사추천에 의해 첫 안저검사를 받은 경우 당뇨의 유병기간이 가장 짧았으며(p＜0.001), 당뇨망막병증의 유병률 및 중증도도 가장 낮았다(p＜0.001, p=0.017). 또한 1차 병원보다는 2, 3차 병원에서 의사추천으로 안저검사를 받는 경우가 더 많았다(p＜0.001). 당뇨 교육과 안 합병증의 인지 여부는 유의한 연관성이 있었다(p＜0.001). 주관적 안과 증상과 당뇨망막병증의 유병률 및 중증도는 유의한 연관성이 없었다(p=0.359). 결론: 주관적 안과 증상과 관계없이 1차 기관에서 당뇨를 진단 받고 치료 받고 있을수록, 나이가 많을수록, 당뇨 교육을 받지 않았을수록 일선 의사들의 더 적극적인 조기 안저검사 추천이 필요하며, 특히 1차 의료기관에서 환자 교육과 함께 안과검진 추천이 확실히이루어져야 하겠다.
Abstract
Purpose: To determine the major reasons that diabetics decide to undergo their first fundus examination, and the factors influencing such reasons. Methods: Of the patients with type II diabetes who presented to the Department of Ophthalmology in Gachon University Gil Medical Center, 164 patients who underwent their first fundus examination after being diagnosed with diabetes were included in the study. Face-to-face and phone interviews with these patients were conducted. Results: The average prevalence period from the diagnosis of diabetes to the first fundus examination was 8.3 ± 7.5 years. Of the diabetics who underwent their first fundus examination, 52.4% had diabetic retinopathy, with no significant difference in prevalence between the male and female patients (p = 0.118). The most common reason for deciding to undergo the first fundus examination was recommendation by a doctor (53.7%). For those patients who received their first fundus examination after recommendation by a doctor, the prevalence period from diabetes was the shortest among all patients (p < 0.001), and the prevalence and severity of diabetic retinopathy were the lowest (p < 0.001 and p = 0.017, respectively). The number of fundus examinations conducted following recommendation by a doctor was significantly higher in secondary and tertiary hospitals than in primary hospitals (p < 0.001). Education on diabetes and knowledge of diabetic ocular complications were found to be significantly correlated (p < 0.001). Conclusions: For patients who are diagnosed with diabetes and treated in primary hospitals, who are older, or who did not receive education on diabetes, recommendation by a doctor for early fundus examination is particularly important regardless of subjective visual disturbance. Moreover, patient education should be offered and ophthalmic examination should be recommended in primary hospitals.
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