糖尿病患者の眼科受診のアドヒアランス — 緑内障患者との比較

Adherence to follow-up visits of diabetic patients as compared to glaucoma patients

要約　目的：糖尿病患者の外来受診のアドヒアランスを調査し，緑内障患者の受診状況と比較した。

対象と方法：2013年1月までの4年間に当院を受診し，次回診察を予約した糖尿病患者344名と，緑内障または高眼圧患者491名を対象とし，24か月間の受診率を調査した。糖尿病患者群は男性189名，女性155名であり，緑内障患者群は男性217名，女性274名であった。平均年齢は，糖尿病患者群が65.6±11.2歳，緑内障患者群が71.1±11.1歳であった。受診のたびに経過観察と治療の必要性を説明し，糖尿病眼手帳または緑内障手帳を手渡した。

結果：脱落患者は，糖尿病患者群では49名（14.3％）であり，緑内障患者群の29名（6.0％）と比較して有意に多かった（p＜0.0001）。糖尿病患者群では，脱落患者は脱落しなかった患者と比較して有意に若年であり，視力が良好であった（いずれもp＜0.0001）。脱落患者では16名（32.7％）に網膜症があり，脱落しなかった患者では148名（50.1％）に網膜症があり，脱落患者が有意に少数であった（p＜0.0001）。脱落患者では32名（65.3％）が2回目の診察を受診せず，26名（53.1％）に以前に糖尿病治療の中断歴があり，脱落しなかった53名（18.0％）よりも有意に高率であった（p＜0.001）。

結論：糖尿病患者の受診のアドヒアランスは，緑内障患者よりも有意に不良であった。自覚症状が乏しい患者が脱落しやすく，経過観察と治療の重要性を十分に説明する必要があると思われた。

Abstract　Purpose：To report the state of adherence to scheduled visit by diabetic and glaucoma patients.

Cases and Method：This study was made on 344 diabetic and 491 glaucoma patients who were seen by us in the 4 years through January 2013. They were evaluated regarding the follow-up visits during a 2-year period. There were 189 males and 155 females in the diabetes group, and 217 males and 274 females in the glaucoma group. The age averaged 65.6±11.2 years in the diabetes group and 71.1±11.1 years in the glaucoma group. Patients were explained as to the necessity of follow-up at each visit. They were handed with diabetes or glaucoma handbook.

Results：In the diabetes group, 49 patients（14.3％）dropped out. In the glaucoma group, 29 patients（6.0％）dropped out. The difference was significant（p＜0.0001）. In the diabetes group, those who dropped out were significantly younger and had better visual acuity（p＜0.0001）. Diabetic retinopathy was present in 16 patients（32.7％）and was absent in 148 patients（50.1％）. The difference was significant（p＜0.0001）. Among those who dropped out, 32 patients（65.3％）failed to be present at the next scheduled visit, and 26 patients（53.1％）had a history of dropping out. This rate was higher than in those who did not drop out（p＜0.0001）.

Conclusion：Adherence to scheduled visit was lower in diabetes than in glaucoma patients. Patients with absent subjective symptoms tended to drop out. This finding seemed to show the necessity of explaining the importance of follow-up and treatment.