治療に難渋する糖尿病患者への新たな心身医学的アプローチ(心身症の発症機序・病態に応じた新たな治療技法の展開)

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The study was done to investigate the effectiveness of the strategy of our psychosomatic approach to the treatment of diabetic patients who have difficulty in adhering to a self-care regimen. Our theraputic program has been applied over the past 7 years to 74 patients with diabetes mellitus who had physiopsychosocial problems. Sixty-six of the patients were NIDDM, and the other 8 were IDDM : mean age 51.2 years, duration of illness 11.1 years, and mean hemoglobin A_1c at admission 9.1%. Data of diabetic patients with physiopsychological problems were compared with that from diabetic patients without such problems admitted our hospital for diabetic education and/or examination for physical complications. The frequency of high depression scores in patients with physiopsychological problems was much higher than that in patients without these problems. When diabetic patients with severe physiopsychological problems were interviewed, common characteristics were : 1) difficulty in developing a good doctor-patient relationship, 2) persecutive disturbance, 3) low self-esteem, and 4) low level of motivation to be successful in self-care. On the basis of these patient characteristics, we designed a psychosomatic therapeutic regimen for diabetic patients with adherence difficulties consisting of 3-steps based upon psychosocial and psychoeducational intervention. Two thirds of the patients were followed at our outpatient clinic and others were followed by their family doctors. Of the patients followed at our clinic, 47% are still in good glycemic control with hemoglobin A_1c less than or equal to 7.0%, whereas only 14% of the patients followed by their family doctors were able to maintain this level. Five of the 74 patients dropped out of the program and, unfortunately, 3 patients followed by family doctors died. In conclusion, psychosomatic treatment of diabetic patients with adherence difficulties as was done in 3-step program at our hospital followed by careful outpatient treatment seems to be effective.
日本心身医学会の論文
1995-01-01

治療に難渋する糖尿病患者への新たな心身医学的アプローチ(心身症の発症機序・病態に応じた新たな治療技法の展開)

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