糖尿病患者の自己管理を困難にさせた要因

Factors Causing Negative Effect on the Self-Care of Patients with Diabetes Mellitus

要旨

　本研究では，東京都内の一医療機関において，受診している患者層および患者のかかえる問題に相違があると思われる3部門の糖尿病患者を把握し，自己管理上の問題をもつ患者について，自己管理を困難にさせた要因を明らかにすることを目的とした．

　調査を実施した病院は，入院部門・外来部門のほかに糖尿病クリニックをもっている．これら3ヶ所で糖尿病と診断された患者すべて（延べ465人）を対象として，診療記録から患者のプロフィールおよび糖尿病の状態を調査した．さらに，自己管理上の問題をもつ患者について，心理社会的情報を看護記録から追加収集し，分析を試みた．

　患者の年齢は50代が最も多かった．70歳以上の老人層は入院群に多く，特に女性では，40.9％を占めていた．

　自己管理上の問題があり糖尿病のコントロールも悪い患者は，入院群・クリニック群の333人中108人（32.4％）であった．また，ほとんどの患者は「食事療法に関する問題」をもっていた．自己管理を困難にさせた要因は，①理解力の不足，②知識の不足，③病識の欠如，④意志の弱さ，⑤職業上の制約，⑥家族の支援の不足，等であった．

Abstract

　The goals of this study are 1) to describe the profile difference among the diabetic patients under different clinical service in one hospital in Tokyo and 2) to identify influential factors among the patients with problems on their self-care.

　The data were collected from the patients in the inpatient and outpatient departments, and special clinic in the public health department in the hospital. The data were based on the charts of those patients who were diagnosed as having diabetes mellitus. The items investigated were demographic data and disease status. The number of samples totaled 465 charts. As for the patients identified having the problems with their self-care, psychosocial information was obtained further from the charts. Then the analyses of the data and the information obtained were carried out.

　The peak age of the patients was in their fifties. There were many more people over 70 years old among the hospitalized patients: 40.9 % of women patients were over 70 years old.

　32.4%of the inpatient and clinic patients had the problems with self-care and they had a poor control over diabetes. Most of the self-care problems were related to diet therapy. The factors causing negative effect on the self-care were: (1) low level of understanding, (2) lack of knowledge about diabetes, (3) lack of self-awareness being diabetes, (4) lack of selfrestraint in carrying out daily regimen, (5) occupational difficulties, (6) lack of family support, and so on.