Tip 2 diyabetes mellituslu hastalarda psikolojik insülin direnci, anksiyete ve depresyonun incelenmesi
Yükleniyor...
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Selçuk Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Bu çalışmada Tip 2 diyabetli hastalarda psikolojik insülin direnci, anksiyete ve depresyon durumlarının değerlendirilmesi amaçlanmıştır. Gereç ve Yöntem: Bu araştırma kesitsel tipte analitik bir çalışma olarak planlanmıştır. Selçuk Üniversitesi Tıp Fakültesi Aile Hekimliği Diyabet Sağlıklı Yaşam ve Obezite Polikliniğinde Nisan 2020-Ocak 2021 tarihleri arasında kriterleri karşılayan 181 hasta ile yapılmıştır. Çalışmaya katılanlar araştırma hakkında bilgilendirilmiş ve sözlü onamları alınmıştır. Veriler, araştırmacılar tarafından hazırlanan sosyodemografik bilgi formu, İnsülin Tedavisi Değerlendirme Ölçeği (İTDÖ) ve Hastane Anksiyete ve Depresyon Ölçeği (HADÖ) kullanılarak toplanmıştır. Araştırma verileri Statistical Package for the Social Sciences (SPSS) versiyon 22.0 istatistik paket programında değerlendirilmiştir. İstatistiksel anlamlılık p<0,05 olarak kabul edilmiştir. Bulgular: Katılımcıların %47'si (n=85) kadın, %53'ü (n=96) erkek idi. Hastaların yaş ortalaması 55,7±9,5 (31-80) idi. Katılımcıların %56,9'u (n=103) ortaokul ve altında eğitim almışken, %43,1'i (n=78) lise ve üstü eğitim almıştı. Katılımcıların %33,7'si (n=61) insülin tedavisi alırken %66,3'ü (n=120) yalnızca oral antidiyabetik ilaç kullanmaktaydı. Katılımcıların diyabetes mellitusa ek olarak %52,5'inde (n=95) hipertansiyon, %53'ünde (n=96) hiperlipidemi, %12,2'inde ( n=22) koroner arter hastalığı, %13,8'inde (n=25) KOAH/Astım, %1,7'sinde (n=3) kronik böbrek yetmezliği vardı. Katılımcıların %29,8'inin (n=54) geçmişte hipoglisemi, %6,1'inin (n=11) diyabetik ketoasidoz ve/veya hiperglisemik hiperosmolar durum yaşadığı tesbit edilirken kronik komplikasyonlardan nöropati %5,0 (n=9), nefropati %6,6 (n=12), retinopati %9,4 (n=17) diyabetik ayak %5 (n=9), kalp damar hastalığı %7,2 (n=13), cinsel işlev bozukluğu %13,3 (n=24) sıklıkta bulundu. İnsülin kullanıcılarında komplikasyon yaşama sıklığı %50,8 iken OAD kullananlarda %22,5'ti (p<0,001). Komplikasyon yaşayan hastaların HbA1c'leri daha yüksekti(p=0,004). İnsülin kullanan hastalar daha uzun süredir hasta idi (p<0,001). İnsülin kullananların HbA1c'si daha yüksek idi (p<0,001). İnsülin kullananlar daha düzenli şekilde kan şekeri ölçümlerini yapıyordu (p<0,001). Şeker koması geçirmiş hastaların %90,1'i insülin kullanıcısıydı (p<0,001). İTDÖ pozitif tutum puanı ortalaması 9,9±2,1 puan(5-17), İTDÖ negatif tutum puanı ortalaması 45,8±10,4 puan (19-68), İTDÖ toplam puanı ortalaması 55,8±10,9 puan (29-78) idi. Katılımcıların %89,5'i (n=162) insülinin utanç verici olduğunu düşünmüyordu, %74,6'sı (n=135) normoglisemi sağlamada faydalı olduğunu düşünüyordu. Ailesi manevi destek olanların İTDÖ pozitif puanı anlamlı düşük idi (p=0,034). İnsülin kullanan hastaların İTDÖ toplam (p<0,001), İTDÖ negatif (p<0,001) ve İTDÖ pozitif (p<0,010) puanları anlamlı düşüktü. Ailesinde diyabet hastası olan katılımcıların İTDÖ toplam (p=0,005) ve İTDÖ negatif (p=0,004) puanları daha düşüktü. Ailesinde insülin kullanan yakını olan bireylerin İTDÖ toplam puanı (p=0,022) ve İTDÖ negatif puanı (p=0,028) daha düşüktü. Diyabetik ayak ülseri yaşayanların İTDÖ toplam puanı daha düşük idi (p=0,029). Hastaların anksiyete puanı ortalaması 7,0±3,9 puan (0- 19), depresyon puanı ortalaması 6,1±3,7 puan (0-18) idi. HAD-D puanına göre %66,3'ü (n=120) eşik altında kalırken, %33,7'si(n=61) eşik üstünde olup, depresyon açısından risk altındadır. HAD-A puanına göre %81,8'i (n=148) eşik altında kalırken, %18,2'si (n=33) eşik üstünde olup, anksiyete açısından risk altındadır. Kadınların HAD-D (p=0,016) skorları ve HAD-A skorları (p=0,002) erkeklere göre anlamlı yüksek bulundu. Ortaokul ve altı eğitim alanların HAD-D (p=0,002) ve HAD-A (p=0,015) daha yüksek idi. İnsülin kullanan ve kullanmayanlar arasında depresyon ve anksiyete puanı farkı yoktu (p>0,05). Komplikasyon yaşayanlar daha depresif (p=0,033), daha anksiyetikti (p=0,002). Diyabet süresi uzadıkça insüline negatif bakış azalıyordu (p=0,035). Anksiyete ve depresyon arasında güçlü korelasyon saptandı (r=0,605, p<0,001). Sonuçlar: Hastalarda insülin kullanımına bir direnç olduğu, bu durumun komplikasyonları arttırdığı, kendisi veya yakını insülin kullananların insüline pozitif baktığı görüldü. Toplum sağlığını korumak için hastaların ve sağlık çalışanlarının diyabet ve insülin hakkındaki bilgi düzeylerinin artırılması ve bu konu hakkında daha fazla çalışma yapılması gerektiği görüldü. Diyabetin anksiyete ve depresyon riskini artırması, özellikle komplikasyon yaşayan DM hastalarında bu riskin daha fazla olması sebebiyle psikiyatrik kontrollerin aksatılmaması gerektiği görüldü.
Aims: In this study, it was aimed to evaluate psychological insulin resistance, anxiety and depression in patients with Type 2 diabetes. Materials and Methods: This research was planned as a cross-sectional analytical study. It was conducted in Selcuk University Faculty of Medicine, Family Medicine, Diabetes, Healthy Life and Obesity Outpatient Clinic between April 2020 and January 2021 with 181 patients who met the criteria. Participants were informed about the study and their verbal consent was obtained. The data were collected using the sociodemographic information form prepared by the researchers, the Insulin Treatment Appraisal Scale (ITAS), and the Hospital Anxiety and Depression Scale (HADS). The research data were evaluated by the Statistical Package for the Social Sciences (SPSS) version 22.0 software. Statistical package program. Statistical significance was accepted as p<0.05. Results: 47% (n=85) of the participants were female and 53% (n=96) were male. The mean age of the patients was 55.7±9.5 (31-80). While 56.9% of the participants (n=103) had a secondary school or less education, 43.1% (n=78) had a high school or higher education. While 33.7% (n=61) of the participants were receiving insulin therapy, 66.3% (n=120) were using only oral antidiabetic drugs. In addition to diabetes mellitus, 52.5% (n=95) of the participants had hypertension, 53% (n=96) had hyperlipidemia, 12.2% (n=22) had coronary artery disease, 13.8% (n=25) had COPD/Asthma, and 1.7% (n=3) had chronic renal failure. While it was determined that 29.8% of the participants (n=54) had hypoglycemia in the past, 6.1% (n=11) had diabetic ketoacidosis and/or hyperglycemic hyperosmolar state. Among chronic complications, neuropathy 5.0% (n=9), nephropathy 6.6% (n=12), retinopathy 9.4% (n=17) diabetic foot 5% (n=9), cardiovascular disease 7.2% (n=13), and sexual dysfunction was 13.3% (n=24). While the rate of complications in insulin users was 50.8%, this rate was 22.5% in OAD users (p<0.001). Patients with complications had higher HbA1c (p=0.004). Patients using insulin were diseased for a longer time (p<0.001). HbA1c of insulin users was higher (p<0.001). Those who used insulin were taking blood glucose measurements more regularly (p<0.001). 90.1% of the patients who had diabetic coma were insulin users (p<0.001). ITAS positive attitude mean score was 9.9±2.1 points (5-17), negative attitude mean score of ITAS was 458 ±10.4 points (19-68), total ITAS mean score was 55.8±10.9 points. 89.5% of the participants (n=162) did not think insulin was disgraceful, 74.6% (n=135) thought it was useful in providing normoglycemia. The positive score of ITAS was significantly lower in those whose families had moral support (p=0.034). The scores of the patients who used insulin were significantly lower in the total (p<0.001), negative (p<0.001), and positive (p<0.010) scores of ITAS. Participants with a family history of diabetes had lower total (p=0.005) and negative (p=0.004) scores of ITAS. Individuals who had relatives who used insulin in their family had lower ITAS total score (p=0.022) and a negative score of ITAS (p=0.028). Those who had diabetic foot ulcers had a lower ITAS total score (p=0.029). The mean anxiety score of the patients was 7.0±3.9 points (0-19), and the mean depression score was 6.1±3.7 points (0-18). According to the HAD-D score, 66.3% (n=120) are below the threshold, while 33.7% (n=61) are above the threshold and are at risk for depression. According to the HAD-A score, 81.8% (n=148) are below the threshold, while 18.2% (n=33) are above the threshold and are at risk for anxiety. HAD-D (p=0.016) and scores and HAD-A scores (p=0.002) of women were found to be significantly higher than men. HAD-D (p=0.002) and HAD-A (p=0.015) scores were higher in those who received secondary school or less education. There was no difference in depression and anxiety scores between insulin users and those who did not (p>0.05). Those who experienced complications were more depressed (p=0.033) and more anxious (p=0.002). As the duration of diabetes increased, negative attitude towards insulin decreased (p=0.035). A strong correlation was found between anxiety and depression (r=0.605, p<0.001). Conclusions: It was observed that there was resistance to insulin use in patients, this condition situation increased complications, and those who used insulin themselves or their relatives looked positive to insülin. It was seen that in order to protect public health, the knowledge level of patients and healthcare professionals about diabetes and insulin should be increased and more studies should be done on this subject. It was seen that psychiatric controls should not be disrupted, since diabetes increases the risk of anxiety and depression and this risk is higher especially in DM patients with complications.
Aims: In this study, it was aimed to evaluate psychological insulin resistance, anxiety and depression in patients with Type 2 diabetes. Materials and Methods: This research was planned as a cross-sectional analytical study. It was conducted in Selcuk University Faculty of Medicine, Family Medicine, Diabetes, Healthy Life and Obesity Outpatient Clinic between April 2020 and January 2021 with 181 patients who met the criteria. Participants were informed about the study and their verbal consent was obtained. The data were collected using the sociodemographic information form prepared by the researchers, the Insulin Treatment Appraisal Scale (ITAS), and the Hospital Anxiety and Depression Scale (HADS). The research data were evaluated by the Statistical Package for the Social Sciences (SPSS) version 22.0 software. Statistical package program. Statistical significance was accepted as p<0.05. Results: 47% (n=85) of the participants were female and 53% (n=96) were male. The mean age of the patients was 55.7±9.5 (31-80). While 56.9% of the participants (n=103) had a secondary school or less education, 43.1% (n=78) had a high school or higher education. While 33.7% (n=61) of the participants were receiving insulin therapy, 66.3% (n=120) were using only oral antidiabetic drugs. In addition to diabetes mellitus, 52.5% (n=95) of the participants had hypertension, 53% (n=96) had hyperlipidemia, 12.2% (n=22) had coronary artery disease, 13.8% (n=25) had COPD/Asthma, and 1.7% (n=3) had chronic renal failure. While it was determined that 29.8% of the participants (n=54) had hypoglycemia in the past, 6.1% (n=11) had diabetic ketoacidosis and/or hyperglycemic hyperosmolar state. Among chronic complications, neuropathy 5.0% (n=9), nephropathy 6.6% (n=12), retinopathy 9.4% (n=17) diabetic foot 5% (n=9), cardiovascular disease 7.2% (n=13), and sexual dysfunction was 13.3% (n=24). While the rate of complications in insulin users was 50.8%, this rate was 22.5% in OAD users (p<0.001). Patients with complications had higher HbA1c (p=0.004). Patients using insulin were diseased for a longer time (p<0.001). HbA1c of insulin users was higher (p<0.001). Those who used insulin were taking blood glucose measurements more regularly (p<0.001). 90.1% of the patients who had diabetic coma were insulin users (p<0.001). ITAS positive attitude mean score was 9.9±2.1 points (5-17), negative attitude mean score of ITAS was 458 ±10.4 points (19-68), total ITAS mean score was 55.8±10.9 points. 89.5% of the participants (n=162) did not think insulin was disgraceful, 74.6% (n=135) thought it was useful in providing normoglycemia. The positive score of ITAS was significantly lower in those whose families had moral support (p=0.034). The scores of the patients who used insulin were significantly lower in the total (p<0.001), negative (p<0.001), and positive (p<0.010) scores of ITAS. Participants with a family history of diabetes had lower total (p=0.005) and negative (p=0.004) scores of ITAS. Individuals who had relatives who used insulin in their family had lower ITAS total score (p=0.022) and a negative score of ITAS (p=0.028). Those who had diabetic foot ulcers had a lower ITAS total score (p=0.029). The mean anxiety score of the patients was 7.0±3.9 points (0-19), and the mean depression score was 6.1±3.7 points (0-18). According to the HAD-D score, 66.3% (n=120) are below the threshold, while 33.7% (n=61) are above the threshold and are at risk for depression. According to the HAD-A score, 81.8% (n=148) are below the threshold, while 18.2% (n=33) are above the threshold and are at risk for anxiety. HAD-D (p=0.016) and scores and HAD-A scores (p=0.002) of women were found to be significantly higher than men. HAD-D (p=0.002) and HAD-A (p=0.015) scores were higher in those who received secondary school or less education. There was no difference in depression and anxiety scores between insulin users and those who did not (p>0.05). Those who experienced complications were more depressed (p=0.033) and more anxious (p=0.002). As the duration of diabetes increased, negative attitude towards insulin decreased (p=0.035). A strong correlation was found between anxiety and depression (r=0.605, p<0.001). Conclusions: It was observed that there was resistance to insulin use in patients, this condition situation increased complications, and those who used insulin themselves or their relatives looked positive to insülin. It was seen that in order to protect public health, the knowledge level of patients and healthcare professionals about diabetes and insulin should be increased and more studies should be done on this subject. It was seen that psychiatric controls should not be disrupted, since diabetes increases the risk of anxiety and depression and this risk is higher especially in DM patients with complications.
Açıklama
Anahtar Kelimeler
Anksiyete, Depresyon, Hastane Anksiyete Depresyon Ölçeği, İnsülin Tedavisi Değerlendirme Ölçeği, Tip 2 DM, Psikolojik İnsülin Direnci, Anxiety, Depression, Hospital Anxiety and Depression Scale, Insulin Treatment Appraisal Scale, Type 2 DM, Psychological Insulin Resistance
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Yazıcı, B. (2021). Tip 2 diyabetes mellituslu hastalarda psikolojik insülin direnci, anksiyete ve depresyonun incelenmesi. (Uzmanlık Tezi). Selçuk Üniversitesi, Tıp Fakültesi, Konya.
