제 1형 당뇨병 소아 청소년의 학교 내 인슐린 자가 주사 실태 조사 = Insulin Self-injection in School by Children with Type 1 Diabetes Mellitus

다국어 초록 (Multilingual Abstract)

Purpose: Patients with type 1 diabetes have difficulty controlling diabetes during adolescence. Active self-management of diabetes in school during adolescence is essential for type 1 diabetic adolescents to successfully adapt to school and shift toward a healthy adulthood. This research examined insulin self-injection in school by diabetic adolescents and the correlation between the control of blood sugar and school adaptation.
Method: Forty adolescents (aged 10–18 years) who were receiving care for type 1diabetes in pediatric divisions of two university hospitals in the Incheon and Bucheon area from July 2011 to May 2012 were surveyed.
Results: Of the intense insulin treatment group (33/40), self-administration of insulin took place outside (22/33, 67%) and inside (11/33, 33%) restrooms. There was no significant difference in hemoglobin A1c between the two groups (P =0.7).
60% of those that had self-injected themselves within the restroom had not exposed their diabetes with more than 5 friends, while only 23% of those that had self-injected themselves outside the restroom had not exposed their diabetes with more than 5friends, showing statistic significance between the two groups (P =0.02). There was also a significant difference in the frequency of experiencing depression: 91% for the group with self-injection in the restroom and 45% for the group with self-injection outside the restroom (P =0.02).
Conclusion: Thirty-three percent of diabetic adolescents administered insulin in the restroom. These diabetic adolescents were reluctant to discuss the disease with others and had a higher frequency of experiencing depression. Thus, schools need to provide active support and care for students with type 1 diabetes.

국문 초록 (Abstract)

목적: 1형 당뇨병 환자는 청소년기에 당뇨병의 조절이 쉽지 않다. 1형 당뇨병 청소년기에 학교에서의 적극적인 당뇨병자가 관리는 1형 당뇨병 청소년의 성공적인 학교생활 적응과 건강한 성인기로의 이행에 필수적이라 할 수 있다. 이 연구에서는 1형 당뇨병 청소년들의 학교 내 인슐린 자가 주사에 대한 실태 조사를 통하여 환아의 혈당 조절과 학교 생활적응과의 연관성을 보고자 하였다.
방법: 2011년 7월부터 2012년 5월까지 인천, 부천지역의 2개 대학병원 소아 청소년과에서 1형 당뇨병으로 관리 받는10-18세 연령의 소아 청소년 40명을 대상으로 설문지를 통해 학교 내에서 인슐린 자가 주사 실태를 파악하고 학교 적응을 평가하였다.
결과: 인슐린 집중 치료군(33/40) 중 화장실 외 투약군과 화장실 투약군은 각각 67% (22/33), 33% (11/33)였다. 화장실 외 투약군과 화장실 투약군 간에 당화혈색소에는 의미 있는 차이를 보이지 않았다. 화장실 투약군에서 당뇨병 공개친구 수 5명 미만이 60%였으며 화장실 외 투약군에서는 23%로 의미 있는 차이가 있었다(P =0.02). 우울증 경험빈도는화장실 투약군 91%, 화장실외 투약군 45%로 의미 있는 차이가 있었다(P =0.02).
결론: 화장실에서 인슐린을 투약하는 환자는 33%로 또래 집단에 질환을 덜 공개하는 경향을 보였고 우울증을 경험하는 빈도가 높았다. 학교에서의 1형 당뇨병 관리에 대한 적극적인 지지 체계가 필요하다.

참고문헌 (Reference)

1 신윤미, "만성적인 신체질환을 가진 아동의 정서 및 행동문제" 대한소아내분비학회 17 (17): 1-9, 2012

2 권은영, "가족환경 및 부모의 양육행동이 제1형 당뇨병 환아의 혈당 관리 및 우울 증상에 미치는 영향" 대한소아내분비학회 14 (14): 100-109, 2009

3 Wodrich DL, "Type 1 diabetes mellitus and school: a review" 12 : 63-70, 2011

4 Helgeson VS, "The role of friendship in the lives of male and female adolescents: does diabetes make a difference?" 40 : 36-43, 2007

5 Garrison MM, "The impact of psychiatric comorbidities on readmissions for diabetes in youth" 28 : 2150-2154, 2005

6 "The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. The Diabetes Control and Complications Trial Research Group" 329 : 977-986, 1993

7 Amillategui B, "Special needs of children with type 1 diabetes at primary school: perceptions from parents, children, and teachers" 10 : 67-73, 2009

8 Skinner TC, "Social support and personal models of diabetesin relation to self-care and well-being inadolescents with type I diabetes mellitus" 21 : 703-715, 1998

9 Moussa MA, "Social and psychological characteristics of Kuwaiti children and adolescents with type 1 diabetes" 60 : 1835-1844, 2005

10 Chien SC, "Self-care problems of adolescents with type 1 diabetes in southern Taiwan" 22 : 404-409, 2007

11 Pendley JS, "Peer and family support in children and adolescents with type 1 diabetes" 27 : 429-438, 2002

12 Eaton RP, "Normal insulin secretion: the goal of artificial insulin delivery systems?" 3 : 270-273, 1980

13 Kovacs M, "Major depressive disorder in youths with IDDM. A controlled prospective study of course and outcome" 20 : 45-51, 1997

14 Lloyd CE, "Lancashire RJ, Harris T, Daniels JE, Barnett AH. Association between stress and glycemic control in adults with type 1 (insulin-dependent) diabetes" 22 : 1278-1283, 1999

15 Blanz BJ, "IDDM is a risk factor for adolescent psychiatric disorders" 16 : 1579-1587, 1993

16 Taras H, "Chronic health conditions and student performance at school" 75 : 255-266, 2005

17 Silverstein J, "Care of children and adolescents with type 1 diabetes: a statement of the American Diabetes Association" 28 : 186-212, 2005

18 Wagner J, "Brief report: glycemic control, quality of life, and school experiences among students with diabetes" 31 : 764-769, 2006

19 Akbaş S, "Association between emotional and behavioral problems and metabolic control in children and adolescents with Type 1 diabetes" 32 : 325-329, 2009

20 Klingensmith G, "American Diabetes Association. Care of children with diabetes in the school and day care setting" 26 (26): 131-135, 2003

21 이영준, "1형 당뇨병을 가진 소아와 청소년에서 란투스 치료의 혈당 조절에 대한 효과" 대한소아과학회 50 (50): 565-569, 2007

22 신충호, "1985-2000년에 15세 미만 한국인에서 발생한 1형 당뇨병의 역학적 특징" 대한소아과학회 51 (51): 569-575, 2008