제 1형 당뇨병 소아 청소년의 학교 내 인슐린 자가 주사 실태 조사
Insulin Self-injection in School by Children with Type 1 Diabetes Mellitus
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목적: 1형 당뇨병 환자는 청소년기에 당뇨병의 조절이 쉽지 않다. 1형 당뇨병 청소년기에 학교에서의 적극적인 당뇨병자가 관리는 1형 당뇨병 청소년의 성공적인 학교생활 적응과 건강한 성인기로의 이행에 필수적이라 할 수 있다. 이 연구에서는 1형 당뇨병 청소년들의 학교 내 인슐린 자가 주사에 대한 실태 조사를 통하여 환아의 혈당 조절과 학교 생활적응과의 연관성을 보고자 하였다. 방법: 2011년 7월부터 2012년 5월까지 인천, 부천지역의 2개 대학병원 소아 청소년과에서 1형 당뇨병으로 관리 받는10-18세 연령의 소아 청소년 40명을 대상으로 설문지를 통해 학교 내에서 인슐린 자가 주사 실태를 파악하고 학교 적응을 평가하였다. 결과: 인슐린 집중 치료군(33/40) 중 화장실 외 투약군과 화장실 투약군은 각각 67% (22/33), 33% (11/33)였다. 화장실 외 투약군과 화장실 투약군 간에 당화혈색소에는 의미 있는 차이를 보이지 않았다. 화장실 투약군에서 당뇨병 공개친구 수 5명 미만이 60%였으며 화장실 외 투약군에서는 23%로 의미 있는 차이가 있었다(P =0.02). 우울증 경험빈도는화장실 투약군 91%, 화장실외 투약군 45%로 의미 있는 차이가 있었다(P =0.02). 결론: 화장실에서 인슐린을 투약하는 환자는 33%로 또래 집단에 질환을 덜 공개하는 경향을 보였고 우울증을 경험하는 빈도가 높았다. 학교에서의 1형 당뇨병 관리에 대한 적극적인 지지 체계가 필요하다.
Abstract
Purpose: Patients with type 1 diabetes have difficulty controlling diabetes during adolescence. Active self-management of diabetes in school during adolescence is essential for type 1 diabetic adolescents to successfully adapt to school and shift toward a healthy adulthood. This research examined insulin self-injection in school by diabetic adolescents and the correlation between the control of blood sugar and school adaptation. Method: Forty adolescents (aged 10–18 years) who were receiving care for type 1diabetes in pediatric divisions of two university hospitals in the Incheon and Bucheon area from July 2011 to May 2012 were surveyed. Results: Of the intense insulin treatment group (33/40), self-administration of insulin took place outside (22/33, 67%) and inside (11/33, 33%) restrooms. There was no significant difference in hemoglobin A1c between the two groups (P =0.7). 60% of those that had self-injected themselves within the restroom had not exposed their diabetes with more than 5 friends, while only 23% of those that had self-injected themselves outside the restroom had not exposed their diabetes with more than 5friends, showing statistic significance between the two groups (P =0.02). There was also a significant difference in the frequency of experiencing depression: 91% for the group with self-injection in the restroom and 45% for the group with self-injection outside the restroom (P =0.02). Conclusion: Thirty-three percent of diabetic adolescents administered insulin in the restroom. These diabetic adolescents were reluctant to discuss the disease with others and had a higher frequency of experiencing depression. Thus, schools need to provide active support and care for students with type 1 diabetes.
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