2型糖尿病の自己管理に関連した文献的考察 : 患者特性分類のためのアセスメントツール開発に向けて

2型糖尿病患者の特性に応じた教育・支援を行うためのアセスメントツールの開発を目指して,自己管理に影響する要因を文献から抽出した.検索方法は,2型糖尿病の自己管理に関連したキーワードを設定し,MEDLINE,CINAHL,医学中央雑誌のデータベース過去10年間を検索した.ヒット件数は,各々1162,860,691件であった.次いで,ADA(American Diabetes Association)Evidence guideline(2002年)の水準を参考に研究デザインを吟味した.その結果,該当する文献は71件で,国内文献が20件あった.有意差を認めた因子を整理したところ86因子あり,「知識・教育」「心理面」「満足度」「個人的要因」「治療」「収入・保険」「関係」の7カテゴリーに分類できた.しかし,介入方法の分類に結びつく因子(特性)や因子間の関係性は不明であり,効果的な介入を導くためのアセスメントツールを開発するためには,これらを検討する必要性が示唆された.

To develop an assessment tool for education and follow-up for type 2 diabetes patients related to their characteristics, a structured literature review was conducted. The method of the review was by key words related to self-management/self-care for type 2 diabetes taken from the database for the past 10 years of MEDLINE, CINAHL, and Japan Medical Abstract Society. One-thousand one- hundred and sixty-two articles were obtained from MEDLINE, 860 from CINAHL, and 691 from the Japan Medical Abstract Society. Research designs were then examined, based on the ADA (American Diabetes Association) Evidence guideline (2002) evidence level. As a result, 71 articles, of which 20 were domestic, were retained. Eighty-six factors were found statistically significant, and were categorized in groups under the headings “knowledge/education", “psychological aspects", “level of satisfaction", “personal factors",“therapy/treatment", “income/insurance", and “family/relationship". Factors/characteristics lead toselecting interventional strategies. However, their overall relations have not been examined yet, whichsuggests that these need to be tested to develop an assessment tool which leads to an effectiveintervention program.