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インスリン自己注射を行っている血糖コントロール不良糖尿病患者における自己管理上の要因
米澤, みゆき;橋本, 知佳;松下, 通明
Permalink : http://hdl.handle.net/2115/35561
JaLCDOI : 10.14943/34007
KEYWORDS : poor glycemic control;diabetics;self-injection of insulin;self-care;educational nursing intervention;血糖コントロール不良;糖尿病患者;インスリン自己注射;自己管理;看護指導
Abstract
インスリン自己注射施行中の糖尿病患者にアンケート調査を行い血糖コントロール不良要因とその改善に向けた指導方法について検討した。方法は1型および2型の糖尿病患者84名を対象として，1）血糖のコントロール状況，2）インスリン投与方法，3）生活環境要因の3項目について調査し日本糖尿病学会ガイドラインを基に血糖コントロール不良な不良群とそれ以外の良好群の2群に分けて検討した。血糖コントロール不良群では，実際の血糖コントロール不良状況や血糖コントロール目標値の重要性に対する自覚不足があった。インスリン投与方法では，不良群に強化インスリン療法の実施例が有意に少なかった。生活環境要因では，不規則な就業時間による食事摂取不良に伴う適正なインスリン自己注射実施の困難性と外食をすることにより栄養バランスに欠けた食事管理不良が明らかとなった。以上のことから，インスリン自己注射施行中の糖尿病患者に対しては，個々人が各々の血糖コントロール不良要因を自覚し，その要因を改善できるように，具体的な血糖コントロールの指標や対処法を指導するという積極的な介入が重要で、あると考えられた。
The purposes of this study were to clarify the factors which influence on poor glycemic control in diabetic patients with a self-management insulin therapy and to consider the methods of better patient education for good glycemic control. A questionnaire survey was carried out to eighty-four diabetics (type 1 and 2) at the outpatient clinic in the A hospital. The patients were divided into poor and stable control groups according to the guideline for diabetes practice (Japan Diabetes Society). Glycemic control status, dosage and times of insulin therapy, and living environment factors of the patients were evaluated. In the poor control group, most of the patients did not realize their actual inadequate glycemic control status and the importance of an individual targeted value for adequate glycemic control. Less intensive insulin therapy in the poor control group was noted. As living environment factors, difficulties in regular dietary intake and regular insulin injection due to irregular working hours, and in adequate dietary management due to dining out were evident. To achieve good glycemic control in diabetic patients with a self-management insulin therapy, positive nursing intervention to the patients was considered to be important by guiding a proper individual targeted value and by educating proper methods to achieve good glycemic control.
The purposes of this study were to clarify the factors which influence on poor glycemic control in diabetic patients with a self-management insulin therapy and to consider the methods of better patient education for good glycemic control. A questionnaire survey was carried out to eighty-four diabetics (type 1 and 2) at the outpatient clinic in the A hospital. The patients were divided into poor and stable control groups according to the guideline for diabetes practice (Japan Diabetes Society). Glycemic control status, dosage and times of insulin therapy, and living environment factors of the patients were evaluated. In the poor control group, most of the patients did not realize their actual inadequate glycemic control status and the importance of an individual targeted value for adequate glycemic control. Less intensive insulin therapy in the poor control group was noted. As living environment factors, difficulties in regular dietary intake and regular insulin injection due to irregular working hours, and in adequate dietary management due to dining out were evident. To achieve good glycemic control in diabetic patients with a self-management insulin therapy, positive nursing intervention to the patients was considered to be important by guiding a proper individual targeted value and by educating proper methods to achieve good glycemic control.
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