당뇨병 환자의 인슐린 자가 주사 및 자가 혈당측정과 관련된 공포와 혈당조절 및 당뇨병 자가 관리상태
The Impact of Diabetes Fear of Self-injecting (FSI) and Fear of Self-testing (FST) on Glycemic Control and Diabetes Self-management
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연구배경: 당뇨병 환자에서 인슐린 자가 주사 및 자가 혈당측정과 관련된 공포를 확인하고 이것이 혈당조절 및 당뇨병 자가 관리 이행에 미치는 영향을 조사하여 당뇨병 환자의 자가 관리에 도움을 줄 수 있는 방법을 모색하고자 본 연구를 수행하였다. 방법: 인슐린 치료 중인 당뇨병 환자 100명을 대상으로 하여 대상자의 특성, 인슐린 자가 주사 및 자가 혈당측정에 대한 공포정도, 당뇨병 관리의 자가 효능감에 대한 설문을 일대일 면접을 통해 시행하였다. 결과: 대상자의 특성에 따른 주사 관련 공포와 자가 관리 이행 정도의 상관관계를 살펴보면 배우자가 없는 군, 교육수준이 낮은 군에서 주사 관련 공포가 더 높고 자가 관리 이행도 낮았다. 또 인슐린 용량이 30단위 보다 높은 군, 당뇨병 합병증이 있는 군, 혈당검사 횟수가 적은 군에서 주사 관련 공포가 컸다. 당뇨병 자가 관리는 당뇨병 교육 경험이 있을 경우, 혈당 측정기가 있는 군, 혈당검사를 자주 하는 군에서 이행정도가 높았다. 인슐린 자가 주사 할 때의 공포(FSI) 및 자가 혈당측정 할 때 공포(FST)는 서로 관련성이 있어 FSI가 높을수록 FST도 높게 나타났으며 공포점수가 높을수록 자가 관리 이행이 잘 되지 않았으나 당화혈색소와는 유의한 관련성이 없었다. 반면 당뇨병 자가 관리 이행과 당화혈색소는 관련성이 있어 당뇨병 자가 관리가 잘 될수록 당화 혈색소가 낮게 나타나는 양상을 보였다. 결론: 인슐린 주사 치료 중인 당뇨병환자에서, 인슐린 주사 관련 공포가 높을수록 자가 관리 이행정도가 낮았다. 따라서, 주사 관련 공포를 조절하는 것이 자가 관리 이행 정도를 향상시킬 수 있는지, 이를 통해 당뇨병의 경과를 향상시킬 수 있는지에 대한 추후 연구가 필요하리라 생각된다.
Abstract
Background: This study was done to examine the impact of diabetes fear of self-injecting (FSI) and fear of self-testing (FST) on glycemic control and diabetes self-management. Methods: A questionnaire survey was performed in the form of one-on-one interviews with 100 insulin-treated diabetic patients. The questions included subject traits, FSI/FST, and confidence in diabetes self-care (CIDS). Glycemic control was determined by the measurement of glycated hemoglobin (Hemoglobin A1C). Results: The patients who did not have a spouse and were less well educated showed high FSI/FST scores and low CIDS scores. The patients who had taken high quantities of insulin, had diabetes related complications, and performed self-monitoring of blood glucose less frequently showed high FSI/FST scores. The patients who had received diabetes education, possessed glucometer and performed self-monitoring of blood glucose frequently had high CIDS scores. High FSI/FST scores were positively related to each other, negatively related to low CIDS scores and not significantly related to Hemoglobin A1C. On the other hand, a significant correlation was seen between CIDS scores and Hemoglobin A1C. Conclusion: High levels of FSI and/or FST were associated with high diabetes-related distress, poor general well-being, and psychologic comorbidity as well as poorer adherence to the diabetes treatment regimen. It is important in diabetes care to lower injection-related fears and improve diabetes self-management through systematic desensitization, relaxation therapy, the use of pen- type injection device, and proper education such as insulin injection amount adjustment, properties of insulin, and the risk of hypoglycemia for the patients and their families.
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