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Nursing Science 2025
老年糖尿病患者用药偏差危险因素的Meta分析
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Abstract:
目的：通过Meta分析确定老年糖尿病患者用药偏差的危险因素。方法：计算机检索中国知网、万方、维普、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library、Embase、CINAHL，检索时限为建库至2025年2月，由2名研究者独立进行文献筛选、质量评价和数据提取，采用RevMan 5.4软件进行Meta分析。结果：共纳入23篇文献(中文文献8篇，英文文献15篇)，包含39项相关危险因素，Meta分析结果显示：服药种类[OR = 1.55, 95%CI (1.13, 2.12), P = 0.006]、服药依从性[OR = 2.33, 95%CI (1.70, 3.31), P < 0.00001]、服药自我效能[OR = 0.57, 95%CI (0.48, 0.69), P < 0.00001]、对疾病的认识程度[OR = 2.64, 95%CI (1.84, 3.79), P < 0.00001]、服药频率[OR = 0.77, 95%CI (0.65, 0.91), P = 0.003]、糖尿病自我管理[OR = 0.95, 95%CI (0.92, 0.98), P = 0.001]、痴呆[OR = 0.81, 95%CI (0.74, 0.89), P < 0.0001]、抑郁[OR = 0.91, 95%CI (0.84, 0.99), P = 0.02]、年龄[OR = 0.97, 95%CI (0.96, 0.98)，P < 0.00001]、性别[OR = 1.61, 95%CI (1.27, 2.03), P < 0.0001]、经济水平[OR = 1.72, 95%CI (1.36, 2.19), P < 0.00001]、生活质量[OR = 3.75, 95%CI (1.88, 7.48), P = 0.0002]、共病[OR = 1.36, 95%CI (1.13, 1.64), P = 0.001]为老年糖尿病患者用药偏差的危险因素(P < 0.05)，此外药物储存条件、视力、药物不良反应、对药物的认识、定期复查、焦虑、健康素养、用药信念、体能活动、饮酒、医疗保险类型、社会支持、医患关系纳入文献数量 < 2篇，仅进行描述性分析。结论：老年患者糖尿病患者用药偏差的危险因素较多，护理人员应动态评估糖尿病患者的用药偏差情况，结合多学科协作模式，给予个体化、精准化的干预措施，改善或减少用药偏差。
Objective: To determine the risk factors of medication deviation in elderly patients with diabetes through meta-analysis. Methods: Computer searches were conducted on CNKI, Wanfang, VIP, China Biomedical Literature Database, PubMed, Web of Science, Cochrane Library, Embase and CINAHL from the establishment of the database to February 2025. Literature screening, quality evaluation and data extraction were conducted independently by two researchers, and meta-analysis was performed using RevMan 5.4 software. Results: A total of 23 literatures (8 Chinese literatures and 15 English literatures) were included, including 39 related risk factors. The results of meta-analysis showed: Medication type [OR = 1.55, 95%CI (1.13, 2.12), P = 0.006], medication compliance [OR = 2.33, 95%CI (1.70, 3.31), P < 0.00001], medication self-efficacy [OR = 0.57, 95%CI (0.48, 0.69), P < 0.00001], degree of awareness of the disease [OR = 2.64, 95%CI (1.84,3.79), P < 0.00001], frequency of medication [OR = 0.77, 95%CI (0.65, 0.91), P = 0.003], diabetes self-management [OR = 0.95, 95%CI (0.92, 0.98), P = 0.001], dementia [OR = 0.81, 95%CI (0.74, 0.89), P < 0.0001], depression [OR = 0.91, 95%CI (0.84, 0.99), P = 0.02], age [OR = 0.97, 95%CI (0.96, 0.98), P < 0.00001], gender [OR = 1.61, 95%CI (1.27, 2.03), P < 0.0001], economic level [OR = 1.72, 95%CI (1.36,2.19), P < 0.00001],
| [1] | Sinclair, A., Saeedi, P., Kaundal, A., Karuranga, S., Malanda, B. and Williams, R. (2020) Diabetes and Global Ageing among 65-99-Year-Old Adults: Findings from the International Diabetes Federation Diabetes Atlas, 9th Edition. Diabetes Research and Clinical Practice, 162, Article ID: 108078. https://doi.org/10.1016/j.diabres.2020.108078 |
| [2] | 《健康中国行动——糖尿病防治行动实施方案(2024-2030年)》解读[J]. 中国农村卫生, 2024, 16(8): 9. |
| [3] | 贾文文, 赵慧楠, 戴付敏, 等. 老年糖尿病患者衰弱现状及影响因素研究[J]. 中华护理杂志, 2019, 54(2): 188-193. |
| [4] | 蔡敏, 张耀光, 谢学勤, 等. 我国60岁及以上老年人口养老意愿及选择居家养老的影响因素分析[J]. 中国医院统计, 2021, 28(4): 351-356. |
| [5] | 于业波, 黄镇, 吴一波, 等. 2型糖尿病患者的用药依从性与生存质量的关系及自我效能的调节作用[J]. 中华疾病控制杂志, 2024, 28(2): 228-232. |
| [6] | 薛文俊. 老年2型糖尿病患者医院-家庭过渡期用药偏差现况及影响因素研究[D]: [硕士学位论文]. 兰州: 兰州大学, 2020. |
| [7] | Ducoffe, A.R., York, A., Hu, D.J., Perfetto, D. and Kerns, R.D. (2016) National Action Plan for Adverse Drug Event Prevention: Recommendations for Safer Outpatient Opioid Use. Pain Medicine, 17, 2291-2304. https://doi.org/10.1093/pm/pnw106 |
| [8] | Puljak, L., Ramic, I., Arriola Naharro, C., Brezova, J., Lin, Y., Surdila, A., et al. (2020) Cochrane Risk of Bias Tool Was Used Inadequately in the Majority of Non-Cochrane Systematic Reviews. Journal of Clinical Epidemiology, 123, 114-119. https://doi.org/10.1016/j.jclinepi.2020.03.019 |
| [9] | Moskalewicz, A. and Oremus, M. (2020) No Clear Choice between Newcastle-Ottawa Scale and Appraisal Tool for Cross-Sectional Studies to Assess Methodological Quality in Cross-Sectional Studies of Health-Related Quality of Life and Breast Cancer. Journal of Clinical Epidemiology, 120, 94-103. https://doi.org/10.1016/j.jclinepi.2019.12.013 |
| [10] | 张亚斌, 苟玲, 裴菊红, 等. 老年人尿失禁危险因素的Meta分析[J]. 中国护理管理, 2020, 20(6): 872-880. |
| [11] | Mendes, R., Martins, S. and Fernandes, L. (2019) Adherence to Medication, Physical Activity and Diet in Older Adults with Diabetes: Its Association with Cognition, Anxiety and Depression. Journal of Clinical Medicine Research, 11, 583-592. https://doi.org/10.14740/jocmr3894 |
| [12] | Moreno, J.A., Gimeno, M.A., Poblador, P.B., et al. (2019) Adherence to Treatment of Hypertension, Hypercholesterolaemia and Diabetes in an Elderly Population of a Spanish Cohort. Medicina Clínica (English Edition), 153, 1-5. https://doi.org/10.1016/j.medcle.2018.10.026 |
| [13] | Xu, N., Xie, S., Chen, Y., Li, J. and Sun, L. (2020) Factors Influencing Medication Non-Adherence among Chinese Older Adults with Diabetes Mellitus. International Journal of Environmental Research and Public Health, 17, Article No. 6012. https://doi.org/10.3390/ijerph17176012 |
| [14] | Park, K., Kim, J., Kim, B., Kam, S., Kim, K., Ha, S., et al. (2010) Factors That Affect Medication Adherence in Elderly Patients with Diabetes Mellitus. Korean Diabetes Journal, 34, 55-65. https://doi.org/10.4093/kdj.2010.34.1.55 |
| [15] | Marinho, F.S., Moram, C.B.M., Rodrigues, P.C., Leite, N.C., Salles, G.F. and Cardoso, C.R.L. (2018) Treatment Adherence and Its Associated Factors in Patients with Type 2 Diabetes: Results from the Rio De Janeiro Type 2 Diabetes Cohort Study. Journal of Diabetes Research, 2018, Article ID: 8970196. https://doi.org/10.1155/2018/8970196 |
| [16] | Al-Azayzih, A., Kanaan, R., Altawalbeh, S., Al-Qerem, W. and Smadi, S. (2023) Medication Adherence and Its Associated Determinants in Older Adults with Type 2 Diabetes and Cardiovascular Comorbidities. Patient Preference and Adherence, 17, 3107-3118. https://doi.org/10.2147/ppa.s437013 |
| [17] | Jannuzzi, F.F., Cintra, F.A., Rodrigues, R.C.M., São-João, T.M. and Gallani, M.C.B.J. (2014) Medication Adherence and Quality of Life among the Elderly with Diabetic Retinopathy. Revista Latino-Americana de Enfermagem, 22, 902-910. https://doi.org/10.1590/0104-1169.3477.2494 |
| [18] | Lim, D. and Woo, K. (2025) Medication Adherence and Related Factors among Older Adults with Type 2 Diabetes Who Use Home Health Care. Geriatric Nursing, 61, 270-277. https://doi.org/10.1016/j.gerinurse.2024.11.014 |
| [19] | Yang, H., Wu, F., Gui, M., Cheng, Y. and Zhang, L. (2023) The Role of Medication Adherence in the Association between Depressive Symptoms and Quality of Life in Older Adults with Type 2 Diabetes Mellitus. BMC Geriatrics, 23, Article No. 196. https://doi.org/10.1186/s12877-023-03929-8 |
| [20] | Thorpe, C.T., Gellad, W.F., Good, C.B., Zhang, S., Zhao, X., Mor, M., et al. (2015) Tight Glycemic Control and Use of Hypoglycemic Medications in Older Veterans with Type 2 Diabetes and Comorbid Dementia. Diabetes Care, 38, 588-595. https://doi.org/10.2337/dc14-0599 |
| [21] | Wu, P. and Liu, N. (2016) Association between Patients’ Beliefs and Oral Antidiabetic Medication Adherence in a Chinese Type 2 Diabetic Population. Patient Preference and Adherence, 10, 1161-1167. https://doi.org/10.2147/ppa.s105600 |
| [22] | Sharma, R., Chhabra, M., Vidyasagar, K., Rashid, M., Fialova, D. and Bhagavathula, A.S. (2020) Potentially Inappropriate Medication Use in Older Hospitalized Patients with Type 2 Diabetes: A Cross-Sectional Study. Pharmacy, 8, Article No. 219. https://doi.org/10.3390/pharmacy8040219 |
| [23] | Huong, D.T.L., Hang, N.T., Ly, N.K., Nhat, N.H., Huong, N.T.L., Hue, L.T.P., et al. (2023) Determination of Drug-Related Problems among Type 2 Diabetes Outpatients in a Hospital in Vietnam: A Cross-Sectional Study. PLOS ONE, 18, e0289825. https://doi.org/10.1371/journal.pone.0289825 |
| [24] | Chin, S.S., Lau, S.W., Lim, P.L., Wong, C.M. and Ujang, N. (2023) Medication Adherence, Its Associated Factors and Implication on Glycaemic Control in Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study in a Malaysian Primary Care Clinic. Malaysian Family Physician, 18, Article No. 14. https://doi.org/10.51866/oa.88 |
| [25] | Lee, C.S., Tan, J.H.M., Sankari, U., Koh, Y.L.E. and Tan, N.C. (2017) Assessing Oral Medication Adherence among Patients with Type 2 Diabetes Mellitus Treated with Polytherapy in a Developed Asian Community: A Cross-Sectional Study. BMJ Open, 7, e016317. https://doi.org/10.1136/bmjopen-2017-016317 |
| [26] | 郝杰, 于翰. 130例老年2型糖尿病患者长期用药依从性的调查与分析[J]. 中国医院药学杂志, 2019, 39(16): 1687-1690. |
| [27] | 薛文俊, 牛晓丹, 王艳红. 老年2型糖尿病患者医院-家庭过渡期用药偏差的调查研究[J]. 中华护理杂志, 2021, 56(2): 225-232. |
| [28] | 张锦云, 张丽芹, 陶美霞, 等. 老年2型糖尿病患者用药依从性现状及影响因素分析[J]. 实用预防医学, 2024, 31(11): 1382-1385. |
| [29] | 王剑, 马陈芳, 丁嘉寅, 等. 老年高血压合并糖尿病患者服药依从性的影响因素[J]. 中华高血压杂志, 2022, 30(11): 1085-1089. |
| [30] | 王文慧, 王晓玲. 老年糖尿病患者口服降糖药物用药依从性的影响因素分析[J]. 中国医药导刊, 2015, 17(6): 634-636. |
| [31] | 崔王飞, 井明霞, 李小菊, 等. 老年糖尿病患者药物依从性影响因素的因子分析[J]. 中国老年学杂志, 2019, 39(20): 5098-5101. |
| [32] | 常陆, 蒋梦蝶, 王梦莹, 等. 老年糖尿病患者医院-家庭过渡期用药偏差的影响因素[J]. 中华老年医学杂志, 2022, 41(4): 433-437. |
| [33] | 郭爱珍, 金花, 茅俭波, 等. 上海市杨浦区社区中老年2型糖尿病患者服药依从性及其影响因素调查分析[J]. 同济大学学报(医学版), 2023, 44(4): 588-593. |
| [34] | 赵林博, 黄欢欢, 肖峰, 等. 医院-家庭过渡期老年多重用药患者服药偏差现状调查[J]. 护理学杂志, 2023, 38(6): 121-126. |
| [35] | 张华倩, 陈芹, 薛梦婷, 等. 缺血性脑卒中患者医院-家庭过渡期用药偏差及相关因素分析[J]. 护理学杂志, 2023, 38(19): 16-20. |
| [36] | 吕英, 沙丽艳. 老年慢性病共存患者服药依从性现状及影响因素分析[J]. 全科护理, 2024, 22(18): 3482-3486. |
| [37] | 张怡, 韩雪, 蔺建宇. 老年2型糖尿病患者血糖控制达标情况及服药依从性研究[J]. 华南预防医学, 2021, 47(6): 727-730. |
| [38] | 姜晓雯. 老年2型糖尿病患者健康素养与服药依从性关系: 服药信念的中介作用[D]: [硕士学位论文]. 济南: 山东大学, 2021. |
| [39] | Yao Jr, J.J. (2109) It’s a Matter of Perspective: The Role of Aging Expectations and Self-Efficacy towards Engagement in Healthy Lifestyles among Older Adults. Asian/Pacific Island Nursing Journal, 4, 116-122. https://doi.org/10.31372/20190403.1057 |
| [40] | Tan, F.C.J.H., Oka, P., Dambha-Miller, H. and Tan, N.C. (2021) The Association between Self-Efficacy and Self-Care in Essential Hypertension: A Systematic Review. BMC Family Practice, 22, Article No. 44. https://doi.org/10.1186/s12875-021-01391-2 |
| [41] | 张振香, 何福培, 张春慧, 等. 慢性病共病患者服药依从性潜在类别及其影响因素分析[J]. 中国全科医学, 2022, 25(31): 3904-3913. |
| [42] | 彭一航, 方琴, 谢莉玲, 等. 不同类型养老机构老年人服药依从性调查[J]. 中国护理管理, 2020, 20(3): 348-354. |
| [43] | 龙琴, 周婷婷, 龚萍, 等. 社区慢性病患者安全用药管理地图的构建与应用[J]. 护理学杂志, 2024, 39(22): 107-111. |
| [44] | 彭一航, 谢莉玲, 陈娇娇, 等. 重庆市养老机构老年人用药现状及影响因素[J]. 护理研究, 2019, 33(22): 3836-3842. |
| [45] | 林勇军. 焦虑抑郁对高血压患者服药依从性的影响[D]: [硕士学位论文]. 福州: 福建医科大学, 2020. |
| [46] | Dempe, C., Jünger, J., Hoppe, S., Katzenberger, M., Möltner, A., Ladwig, K., et al. (2013) Association of Anxious and Depressive Symptoms with Medication Nonadherence in Patients with Stable Coronary Artery Disease. Journal of Psychosomatic Research, 74, 122-127. https://doi.org/10.1016/j.jpsychores.2012.12.003 |
| [47] | 文皓, 汪世秀, 吕静, 等. 老年慢性病患者医院-家庭过渡期安全用药管理的研究进展[J]. 护理学杂志, 2023, 38(19): 117-121. |
| [48] | 尚彬, 罗彩凤, 吕妃, 等. 社区慢性病共病老年患者心理困扰的潜在类别分析[J]. 中华护理杂志, 2023, 58(22): 2768-2776. |
| [49] | 高敏, 李晓娜, 时永利, 等. 老年慢性病患者用药体验对用药依从性的影响研究[J]. 中国全科医学, 2025, 28(11): 1309-1314. |
| [50] | Manteuffel, M., Williams, S., Chen, W., Verbrugge, R.R., Pittman, D.G. and Steinkellner, A. (2014) Influence of Patient Sex and Gender on Medication Use, Adherence, and Prescribing Alignment with Guidelines. Journal of Women’s Health, 23, 112-119. https://doi.org/10.1089/jwh.2012.3972 |
| [51] | 陈希, 严青华, 吴菲, 等. 上海市社区高血压患者服药依从性现况及其影响因素分析[J]. 现代预防医学, 2022, 49(1): 72-76. |
