고혈압을 동반한 당뇨병 환자의 자율신경병 증상과 자가관리활동
Diabetic Neuropathy Symptoms and Self-Care Activities in Hypertensive Type-2 Diabetic Patients
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Purpose: This study aimed to provide basic data to enhance self-nursing ability by investigating the symptoms of autonomic neuropathy and self-management activities in patients with diabetes accompanying hypertension. Methods: Subjects were 113 type-2 diabetic patients who were diagnosed as hypertensive in two primary medical institutions and taking anti-hypertensive treatments. The existence of postural hypotension was evaluated by blood pressure and pulse rate, and the subjective symptoms of autonomic neuropathy and self-management activities were checked by structured questionnaires. The collected data were analyzed by chi-square test, Fisher’s exact test, t-test, Wilcoxon rank sum test and analysis of covariance. Results: Postural hypotension occurred in 4.4% of the subjects. Urinary frequency and dizziness during postural changes were the most frequent symptoms of autonomic neuropathy, and 57.5% of the subjects complained of symptoms in two or more domains. The group with autonomic neuropathy symptoms showed higher age, higher living stress, and fewer self-management activities in the diet and foot management domains as compared to the group without autonomic neuropathy symptoms. Conclusion: From these results, we learned that strengthening education on self-management for diet and foot management and customized interventions considering age and living stress are required through early identification of the symptoms of autonomic neuropathy in patients with diabetes accompanying hypertension
Abstract
Purpose: This study aimed to provide basic data to enhance self-nursing ability by investigating the symptoms of autonomic neuropathy and self-management activities in patients with diabetes accompanying hypertension. Methods: Subjects were 113 type-2 diabetic patients who were diagnosed as hypertensive in two primary medical institutions and taking anti-hypertensive treatments. The existence of postural hypotension was evaluated by blood pressure and pulse rate, and the subjective symptoms of autonomic neuropathy and self-management activities were checked by structured questionnaires. The collected data were analyzed by chi-square test, Fisher’s exact test, t-test, Wilcoxon rank sum test and analysis of covariance. Results: Postural hypotension occurred in 4.4% of the subjects. Urinary frequency and dizziness during postural changes were the most frequent symptoms of autonomic neuropathy, and 57.5% of the subjects complained of symptoms in two or more domains. The group with autonomic neuropathy symptoms showed higher age, higher living stress, and fewer self-management activities in the diet and foot management domains as compared to the group without autonomic neuropathy symptoms. Conclusion: From these results, we learned that strengthening education on self-management for diet and foot management and customized interventions considering age and living stress are required through early identification of the symptoms of autonomic neuropathy in patients with diabetes accompanying hypertension
참고문헌 (30)
- Applegate, W. B, "Prevalence of postural hypotension at baseline in the systolic hypertension in the elderly program (SHEP) cohort", Journal of American Geriatrics Society, 39(11), pp.1057~1064 (1991)
- 백명화, "당뇨병환자의 자기간호행위와 대사조절 - 2005년 국민건강영양조사에 의한 -", 가정간호학회지, 15(2), pp.106~114 (2008), 한국가정간호학회
- Chun, S. W, "Summary of the update to the diabetic neuropathy management guidebook", Diabetes & Metabolism Journal, 13(3), pp.115~123 (2012)
- 최경애, "노인 당뇨병환자의 자기관리 실태 및 방해요인", Diabetes and Metabolism Journal, 32(3), pp.280~289 (2008), 대한당뇨병학회
- Chun, J. H, "Self-care and related factors in patients with diabetes", Diabetes, 23(2), pp.193~206 (1999)
- Colosia, A. D, "Prevalence of hypertension and obesity in patients with type 2 diabetes mellitus in observational studies: a systematic literature review", Diabetes, Metabolic Syndrome and Obesity, 6, pp.327~338 (2013)
- Davidson, M. B, "Integrating nurse-directed diabetes management into a primary care setting", The American Journal of Managed Care, 16(9), pp.652~656 (2010)
- Ferrannini, E, "Diabetes and hypertension : the bad companions", The Lancet, 380(9841), pp.601~610 (2012)
- Han, H. J, "Autonomic dysfunction in the eldery : postural hypotension & related symptoms", Journal of the Korean Academy Family Medicine, 19(12), pp.1368~1379 (1998)
- 형희경, "맞춤형 방문건강관리사업 노인대상자의 고혈압군, 당뇨군, 고혈압 ․ 당뇨군별 건강상태 및 건강행태 비교", 지역사회간호학회지, 22(1), pp.11~21 (2011), 한국지역사회간호학회
- Kim, C. J, "Cardiovascular risk level and self-care activities according to stage of change for exercise in diabetic elders with metabolic syndrome", Journal of Korean Gerontological Nursing, 9(1), pp.5~13 (2007)
- Kim, K. N, "Changes in autonomic nervous function over a five-year period in type 2 diabetic patients", The Journal of Wonkwang Medical Science, 14(2), pp.211~220 (1998)
- 고승현, "한국인 제2형 당뇨병환자에서 심혈관계 자율신경병증의 특성", Diabetes and Metabolism Journal, 30(3), pp.226~235 (2006), 대한당뇨병학회
- 고남경, "제2형 당뇨병 환자의 발궤양 위험, 발관리 지식 및 발관리 수행", 성인간호학회지, 18(1), pp.81~91 (2006), 성인간호학회
- Korea Diabetes Association and Korea Centers for Disease Control and Prevention, "Diabetes fact sheet in Korea" (2013), Korea Diabetes Association and Korea Centers for Disease Control and Prevention
- Lee, B. D, "Hypertension treatment strategy for diabetes mellitus", Journal of the Korean Academy Family Medicine, 22(5), pp.603~608 (2001)
- 이수진, "제2형 당뇨병 노인의 성격유형과 당뇨병 관련 스트레스에 따른 당뇨병 자기관리 행위", 한국노년학, 34(2), pp.229~246 (2014), 한국노년학회
- Liatis, S, "Usefulness of a new indicator test for the diagnosis of peripheral and autonomic neuropathy in patients with diabetes mellitus", Diabetic Medicine, 24(12), pp.1375~1380 (2007)
- 임기보, "일차의료기관을 이용하는 당뇨병 환자들의 자기관리 실태", Korean Journal of Family Medicine, 28(2), pp.106~113 (2007), 대한가정의학회
- Lye, M, "Hemodynamic and neurohumoral responses in elderly patients with postural hypotension", European Journal of Clinical Investigation, 20(1), pp.90~96 (1990)
- Mayberry, L. S, "Stress, depression and medication nonadherence in diabetes : test of the exacerbating and buffering effects of family support", Journal of Behavioral Medicine, 38(2), pp.363~371 (2015)
- Morgan, M. A, "The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial", British Medical Journal open, 3(1), pp.e002171~ (2013)
- Putnam, W, "Hypertension and type 2 diabetes: What family physicians can do to improve control of blood pressure-an observational study", BMC family practice, 12(1), pp.86~ (2011)
- Refaie, W, "Assessment of cardiac autonomic neuropathy in long standing type 2 diabetic women", The Egyptian Heart Journal, 66(1), pp.63~69 (2014)
- Spollett, G. R, "Diabetic neuropathies : diagnosis and treatment", Nursing Clinics of North America, 41(4), pp.697~717 (2006)
- Toobert, D. J, "The summary of diabetes self-care activities measure : results from 7 studies and a revised scale", Diabetes care, 23(7), pp.943~950 (2000)
- Vinik, A. I, "Diabetic cardiac autonomic neuropathy, inflammation and cardiovascular disease", Journal of Diabetes Investigation, 4(1), pp.4~18 (2013)
- Yim, J. H, "The validity of modified Korean-translated BEPSI(Brief Encounter Psychosocial Instrument)as instrument of stress measurement in outpatient clinic", Journal of the Korean Academy Family Medicine, 17(1), pp.42~53 (1996)
- 유수정, "재가 노인의 체위성 저혈압 발생빈도와 위험요인", Journal of Korean Academy of Nursing, 33(2), pp.200~209 (2003), 한국간호과학회
- Yoon, K. H, "The assessment of diabetic autonomic neuropathy in diabetic patients", Diabetes & Metabolism Journal, 14(2), pp.191~202 (1990)