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1 간호학의지평, 제9권제2호, 2012년 12월 Perspectives in Nursing Science Vol. 9No. 2, , December, 2012 ISSN 지역사회당뇨노인의혈당조절, 자기관리정도와우울 김세안 1 송미순 2 서울대학교간호대학박사과정 1, 서울대학교간호대학 간호과학연구소교수 2 The Relation between Glucose Control, Self-care and Depression in Community Dwelling Older Adults with Diabetes Kim, Se An 1 Song, Misoon 2 1 Doctoral Student, College of Nursing, Seoul National University, Seoul 2 Professor, College of Nursing The Research Institute of Nursing Science, Seoul National University, Seoul, Korea Purpose: The purpose of this study was to examine the relationship between glucose control, diabetes self-care and depression in community dwelling older adults with type 2 diabetes mellitus. Methods: The cross-sectional survey data of 148 older adults at a senior center were analyzed in this study. We collected data on diabetes self-care, depression, and demographics by face-to-face interviews. Blood samples for HbA1C were obtained from the participants. Results: The average duration of diabetes for the participants was 10.6±9.31 years. Fifty percent of the participants had HbA1c higher than 7.0% (mean 7.179%). The level of diabetes self-care was related to depression (r=-.225, p <.01). HbA1c was positively related with the duration of diabetes diagnosis (r=.224, p<.01). The only sub-dimension of diabetes self-care that was related to depression was exercise (r=-.307, p<.01). Conclusion: Only half of the community dwelling older adults with type 2 diabetes had an optimal level of diabetes control. Supported by the evidence, the longer the duration of diabetes since the initial diagnosis, the poorer the glucose control was. Identification and intervention for depression in people with diabetes should be considered to improve diabetes self-care, especially to perform more exercise. Key Words: Diabetes mellitus, Hemoglobin A1c protein, Depression, Self care 서론 1. 연구의필요성경제적발전과더불어우리나라노인인구는점차증가하고있으며, 또한, 생활환경의변화및식습관의변화로비만인구가증가하여만성질환유병률도증가하고있다. 대표적인만성질환인당뇨병은연령이증가할수록유병률이증가하여남 녀모두 70대이후에서는 4명중 1명이당뇨유병자이며, 또한, 당뇨병합병증으로인한사망순위는 2000년 6위에서 2010년 5위로상승한것으로나타나고있다 (Statistics Korea, 2011). 당뇨병은적극적인관리로합병증을예방하거나지연시킬수있고, 수명연장과삶의질에긍정적영향을미치기때문에 (Schram, Baan, & Pouwer, 2009) 자기관리를통한혈당조절은당뇨환자간호에있어서중요한목표이다. 그러나우리 주요어 : 당뇨, 당화혈색소, 우울, 자기관리 Corresponding author: Song, Misoon College of Nursing, Seoul National University, 103 Daehak-ro, Jongno-gu, Seoul , Korea. Tel: , Fax: , msong@snu.ac.kr - 이논문은 2010년도정부의재원으로한국연구재단의지원을받아수행된것임 (No ). - This research was supported by the National Research Foundation of Korea (NRF) funded by Korean Government(No ). 투고일 2012년 10월 18일 / 심사완료일 2012년 12월 19일 / 게재확정일 2012년 12월 21일 c 2012 The Research Institute of Nursing Science Seoul National University

2 지역사회당뇨노인의혈당조절, 자기관리정도와우울 나라의당뇨환자중혈당목표기준인당화혈색소 7% 이하를유지하는환자는 40~43% 정도에그치고있는것으로알려져있다 (Choi et al., 2009). 당뇨병합병증의예방을위해서는우선혈당조절이중요한데이를위해서는약물치료외에식이와생활습관변경등의환자자신이시행하는자기관리가필요하다. 특히, 장기적으로식이와운동을포함한전반적인생활습관을변경하고유지해야하는자기관리이행은환자에게매우어려운과제이지만당뇨환자의간호에서매우중요한부분이다. 만성질환인당뇨병의자기관리이행정도에영향을미치는요인에는신체적, 심리적, 사회적요인등이포함된다. 당뇨환자는일반인에비해우울경향이높게나타나는것으로알려져있고 (Aarts et al., 2009), 우울은흡연, 식이조절실패, 약물복용불이행등의혈당조절과관련된자기관리이행에영향을미쳐합병증발생의위험을증가시킨다 (Lin et al., 2010). 노인의경우일반인보다우울이흔하고, 특히, 만성질환이있는노인은그렇지않은노인보다우울증위험이높으며, 노년기의신체적변화및사회적환경의변화도자기관리를더욱어렵게하는요인이다 (Glasgow, Hampson, Strycker, & Ruggiero, 1997). 그러므로당뇨노인에있어서합병증예방을위해자기관리와혈당조절과관련된중재를계획하기위해서는이러한요인간관계를고려하는것이중요하다. 지금까지우리나라의병원이나보건소를이용하는노인당뇨환자를대상으로한연구결과, 자기간호정도가합병증위험과관련이있었고 (Lee & Kim, 2007), 자기관리실천정도가높을수록당화혈색소가낮았으며 (Park, Lee, Jang, & Oh, 2010), 자가간호에우울이중요요인임을알수있었다 (Kim & Kang, 2008). 그러나자기관리의하부영역중구체적으로어떤영역이당화혈색소나우울에더영향을미치는지에대한연구는부족한실정이다. 또한, 당뇨노인은저혈당발생에취약하고저혈당으로인한이차적인다른문제들이발생할위험이높으며, 당뇨노인에서는사망, 고혈압, 관상동맥질환, 뇌졸중등의동반질환및노인증후군 ( 다약제복용, 우울, 인지장애, 요실금, 낙상, 통증등 ) 과관련된여러기능장애가빈번히동반되기때문 (Yoo & Nam, 1999) 에성인과구별되어야하지만지금까지당뇨관리와관련요인에대한선행연구의대상자는대개 65세이하의성인을포함하는대상자였으며, 대부분병원과보건소등의료기관에서자료가수집되었다. 따라서당뇨노인대부분이지역사회에거주하고있고후기노인이점점증가하고있는현실에맞추어 65세이상의노인중지역사회복지관을이용하 는재가지역사회당뇨노인만을대상으로한연구가필요하며, 혈당조절과자기관리, 우울을포함하는요인간관계를살펴보는본연구는지역사회의당뇨노인의합병증예방을위한당뇨관리중재개발의기초자료로서의미가있을것으로생각된다. 2. 연구목적본연구의목적은지역사회제 2형당뇨노인의혈당조절정도와자기관리, 우울의관계를파악함으로써당뇨노인의합병증예방을위한효율적인간호중재를개발하기위한기초자료를제시하기위함이다. 구체적인목표는다음과같다. 대상자의혈당조절정도, 자기관리, 우울수준을파악한다. 대상자의혈당조절정도, 자기관리, 우울과관련변수들과의상호관련성을파악한다. 대상자의자기관리하부영역과관련변수와의관계를파악한다. 연구방법 1. 연구설계본연구는횡단적으로자료를수집하여지역사회제 2형당뇨노인의혈당조절정도, 자기관리, 우울의관계를알아보기위한서술적상관관계연구이다. 2. 연구대상본연구는서울의 1개노인복지관을방문하는제 2형당뇨노인중연구목적에동의하여연구참여동의서에서명을한 65세이상노인을대상으로하였다. 대상자선정기준은다음과같다. 65세이상노인 제 2형당뇨를진단받고현재경구혈당강하제나인슐린을투약하고있는자 본연구의목적을이해하고참여에동의한자 의사소통이가능하며설문지에응답이가능한자필요한표본수산출을위해 G*Power 프로그램을이용하였으며 ANOVA 분석으로그룹수를 5로하여계산한결과, 효과크기.15, 유의수준.05에서검정력.90을유지하기 Vol. 9 No. 2,

3 김세안 송미순 위한대상자표본수는 125명으로계산되었다. 본연구에서는 148명의자료를분석에사용하였다. 3. 연구의윤리적측면본연구는서울대학교간호대학연구대상자보호심사위원회 (Institutional Review Board) 의승인을받은후자료를수집하였다. 연구대상자에게연구의목적과방법에대해설명한후, 설문과혈액채취에동의한자에한해일대일면담을통한자료수집을시행하였다. 4. 연구도구 1) 당화혈색소 (HbA1c) 대상자의최근 2~3개월간의혈당조절정도를알아보기위한검사로국제임상검사정도관리 CAP (College of American Pathology) 의 LAP (Laboratory Accreditation Program) 에참가하여인증을받은기관에서분석하였다. 미국당뇨병학회 (American Diabetes Association) 에서제시한성인제2형당뇨병환자의조절목표범위는 7% 미만으로이보다낮은경우혈당조절상태가양호한것으로정의하였고, 대한당뇨병학회에서는성인당뇨환자의혈당조절목표를 6.5% 로제시하였으나노인및타질환이동반된경우조절목표를완화할수있다고하였다 (Oh, 2008). 2) 당뇨자기관리대상자의당뇨자기관리정도를측정하기위해 Toobert, Hampson 과 Glasgow 의 SDSCA (Summary of Diabetes Self- Care Activities) (Toobert, Hampson, & Glasgow, 2000) 를한국어로번역한척도 (Chang & Song, 2009) 를사용하였다. SDSCA는지난 7일간식이, 운동, 혈당검사, 약물, 발관리등 5개영역의혈당조절을위해당뇨병환자들에게필요한자가관리내용의일주일간수행일수를기록하여평가하는데, 최저 0점 ( 하루도시행안함 ) 에서최고 7점 ( 매일시행 ) 으로응답하게되어있다. 점수가높을수록당뇨자기관리수행도가높은것이다. 본연구에서 Cronbach's =.667이었다. 3) 우울우울을평가하기위해본연구에서는 the Hoyl GDS-5 (Hoyl et al., 1999) 의한국어문항을사용하였다. 노인우울증을간단하게선별해낼수있는선별검사도구로쓰인 the Hoyl GDS-5는지역사회거주노인을대상으로한연구에서민감도.97, 특이도.85, kappa 값이.81로 SGDS (Short Geriatric Depression Scale) 와유사한진단적타당도가나타났고 (Hoyl et al., 1999), 한국어문항 (Kee & Lee, 1995) 의주요우울증에대한최적절단점은 2점으로나타나 (Lee, S. H. et al., 2009), 2점이상일때우울이라고할수있다. 본연구에서 K-R 20은.767로나타났다. 5. 자료수집자료수집은서울시에위치한 1개노인복지관에서 2011년 7월 11일부터 2011년 8월 28일까지시행되었다. 자료수집은연구자와연구보조원 8명이시행하였다. 연구보조원에게는조사전연구목적, 자료수집시주의해야할사항및설문지작성에관한오리엔테이션을실시하였다. 조사원은복지관에내원한노인중대상자선정기준에맞는대상자를확인하고, 연구참여에동의한대상자와일대일면접방식으로자료를수집하였다. 설문작성이완료된후혈액을채취하여당화혈색소검사를실시하였다. 6. 자료분석수집된자료는 SPSS (PASW Statistics) 18.0 통계프로그램을이용하여분석하였다. 대상자의일반적특성은실수와백분율을산출하였고, 당화혈색소, 자기관리및우울의점수는평균과표준편차로구하였다. 대상자특성에따른당화혈색소수치, 자기관리및우울점수는 t-test 및 ANOVA로분석하였다. 또한, 변수간관계는 Pearson's Correlation Coefficient 분석을사용하였다. 연구결과 1. 대상자의일반적특성및당화혈색소, 자기관리, 우울정도본연구대상자의일반적특성은표 1과같다. 대상자의평균연령은 76.3세이었으며, 대상자들의당뇨로진단받은후경과기간은평균 10.6년이었으며, 년경과한자가 58명 (39.1%) 으로가장많았다. 103명 (69.5%) 의대상자가동반질환을 1~4개가지고있었고, 대상자의평균동반질환개수는 3.3개로나타났다. 대상자들이가진동반질환의종류는 15가지이상이었으며, 고혈압 96 Perspectives in Nursing Science

4 지역사회당뇨노인의혈당조절, 자기관리정도와우울 표 1. 대상자의일반적특성 (N=148) 항목 분류 n (%) or M±SD 성별 남자 108 (73.2) 여자 40(26.8) 나이 교육정도 ( 년 ) 질병기간 ( 년 ) 동반질환개수 동반질환 ( 중복응답 ) 65~74 75~ ~9 10~ ~10 11~ ~2 3~4 5 천식, 갑상선질환, 관절염등 고혈압말초신경장애시력문제고콜레스테롤혈증심장질환뇌졸중위장장애성기능문제신장 / 방광문제호흡곤란발문제우울기타 76.3± (37.5) 82(55.1) 11 (7.4) 61(41.5) 37(25.0) 31(20.7) 19(12.8) 10.6± (39.1) 43(29.1) 29(19.6) 18(12.2) 3.3± (4.1) 51(34.4) 52(35.1) 39(26.4) 99(66.9) 53(35.8) 50(33.8) 44(29.7) 32(21.6) 25(16.9) 21(14.2) 19(12.8) 18(12.2) 15(10.1) 14 (9.5) 13 (8.8) 17(11.5) 이 66.9% 로가장빈도가높았고, 말초신경장애, 시력문제, 고콜레스테롤혈증, 심장질환, 뇌졸중, 위장장애, 성기능문제, 신장 / 방광문제, 호흡곤란, 발문제, 우울, 기타 ( 천식, 갑상선질환, 관절염등 ) 의순서로나타났다. 대상자의당화혈색소및자기관리, 우울정도는표 2와같다. 대상자들의당화혈색소는 5.3~11.8% 의범위이었고, 평균 7.179% 였는데적절한조절범위로생각되는 7.0% 이하인사람이 74명 (50%) 이었다. 자기관리정도는 7점만점에총평균 4.348점으로나타났다. 하부영역별평균점수는 약물투약 이 6.476점으로가장높고, 혈당측정 이 0.848점으로가장낮게나타났다. 우울은 0~5점의범위에서평균 1.142점이었으며, 대상자의 29.7% 가우울범주에속한것으로나타났다. 2. 대상자의당화혈색소, 자기관리, 우울과변수간상관관계본연구에서대상자의성별, 나이, 교육정도, 진단받은시기와같은일반적특성에따른당화혈색소, 자기관리, 우울의정도는유의한차이가없었다. 변수간상관관계분석결과는표 3과같다. 당뇨노인의자기관리와우울의관계는유의한역상관관계를나타내었으며 (r=-.225, p=.006), 당뇨진단시기와당화혈색소의관계가유의한양의상관관계를나타내는것으로조사되었다 (r=.224, p=.006). 3. 대상자의자기관리하부영역및우울과의상관관계대상자의자기관리하부영역과우울의상관관계는표 4와같다. 자기관리하부영역중운동영역은우울과유의한역상관관계가있었으나 (r=-.307, p<.001), 혈당측정, 식이, 발관리, 투약등의하부영역은우울과유의한관계가없었다. 논의본연구는지역사회제2형당뇨노인의혈당조절정도와자기관리, 우울의관계를알아보기위해수행되었다. 본연구는지역사회복지관을방문하는 65세이상의당뇨병으로의사에게서진단받은노인만을대상으로연구를시행하였으며, 대상자의평균나이는 76.29세로, 최근높은증가율을보이는 75세이상후기노인에해당한다 (Statistics Korea, 2011). 대상자들이당뇨진단을받은지는평균 10.6년으로, 유병기간이 5년을초과한자가 60.8% 였다. 대상자의당화혈색소평균수치는 7.179% 였고, 최고 11.8% 까지측정되었다. 당뇨로진단받은후경구혈당강하제나인슐린을투약하지만당화혈색소수치가 7.0 % 이상인대상자가 50% 였다. 본연구에서당뇨진단시기와당화혈색소의관계는유의한양의상관관계를나타내는것으로조사되었는데, 이는 2형당뇨노인에있어당뇨유병기간이길수록생리적으로인슐린부족상태등혈당조절이어려운상태가심화되어 1형당뇨환자와비슷하게 glucose counter-regulatory 체계의문제가생겨당화혈색소를낮게유지하기가어렵게된다는이론 (Alam, Weintraub, & Weinreb, 2006) 을반영한다고볼수있다. 또한, 당뇨병의합병증은이환기간이길어질수록빈도가증 Vol. 9 No. 2,

5 김세안 송미순 표 2. 대상자의당화혈색소, 자기관리, 우울정도 항목분류 n(%) M±SD 당화혈색소 (%) < 자기관리 우울 혈당측정식이조절운동발관리투약합계 정상우울 ( 2) 74(50.0) 74(50.0) 148 (100.0) 4.348± ± ± ± ± ± ± (100.0) 104 (70.3) 44(29.7) 도구범위 범위 측정범위 (N=148) 7.179± ~ ± ± ± ~5 1.12~ ~106 표 3. 당화혈색소, 자기관리, 우울과변수간상관관계 (N=148) 항목 당화혈색소자기관리우울나이교육정도 r(p) r(p) r(p) r(p) r(p) 자기관리 (.366) 우울 (.788) (.006) 나이 (.911).012 (.889) (.514) 교육정도 (.863).007 (.930) (.801) (.358) 질병기간.224 (.006).088 (.287).085 (.304).004 (.961).062 (.451) 표 4. 자기관리하부영역및우울과의상관관계 (N=148) 우울항목 r(p) 자기관리혈당측정 (.897) 식이조절 (.127) 운동 (<.001) 발관리 (.146) 투약 (.805) 가하는데 (Deshpande, Harris-Hayes, & Schootman, 2008), 본연구의대상자의 96% 는동반질환을가지고있는것으로나타났으며, 개인별평균 3.3개의동반질환을가지고있었다. 동반질환으로는고혈압, 말초신경장애, 시력문제, 고콜레스테롤혈증, 심장질환, 뇌졸중등대부분의질환이당뇨와관련된질환 (Deshpande et al., 2008) 이었다. 특히, 본연구대상 자의 66.9% 가고혈압을동반하고있었는데이는우리나라 65 세이상노인의고혈압유병률 60.7% 에비해높은편이다 (Statistics Korea, 2011). 미국의 NDEP (National Diabetes Education Program) 에의하면 (Funnell, 2006) 당뇨합병증예방을위해서는혈당뿐아니라혈압, 콜레스테롤도조절되어야함을강조하고있어서고혈압을잘조절하는것이중요한중재내용으로포함되어야할것이다. 우리나라에서당뇨로인한사망률은매해사망순위 10위안에속하며 2010년에는 5 위인것으로나타나고있으나 (Statistics Korea, 2011), 2, 3위를차지한뇌혈관질환, 심장질환또한, 당뇨합병증과관련이있어실제당뇨와관련한사망률은더높을것으로예상할수있다. 또한, 노인들은노화에따른변화로여러질병을동시에가지고있는경우가일반성인보다더많기때문에 (Wolff, Starfield, & Anderson, 2002), 노인당뇨병환자에게는합병증예방에대한통합적관리의관점을가지고중재를계획하는것이필요하다. 당뇨대상자에대한장기연구로최근당뇨중재의근거가되 98 Perspectives in Nursing Science

6 지역사회당뇨노인의혈당조절, 자기관리정도와우울 는연구인 UKPDS (United Kingdom Prospective Diabetes Study) 연구에서는신규당뇨병진단환자의약물을통한적극적혈당조절은미세혈관합병증의위험도를감소시키는것으로나타났으며, 연구가완료된후 10년간관찰한결과에서도특정치료가유지되지않았음에도불구하고미세혈관합병증및사망의위험도가유의하게감소한것을보였다 (Holman, Paul, Bethel, Matthews, & Neil, 2008). 이는당뇨병초기에적극적인혈당조절의성공이장기적으로합병증예방에도움이될수있음을보여주는것이다. 그러나당뇨가진행된상태이고심혈관병력이있는경우에는적극적인혈당조절이혈관합병증의위험도를유의하게낮추지못하며오히려저혈당의위험에의한해가문제가될수있다 (Emanuele, 2010). 따라서당뇨노인의혈당조절은진단시기및동반질환여부에따라개별화된중재목표를설정하여관리하는것이필요하다. 본연구대상자들의자기관리하부영역중점수가가장높은영역은 약물투약 이었으며, 혈당측정 영역은가장낮은점수를보였는데, 이는이전연구와비교해보았을때 (Lee, 2009; Park et al., 2010), 약물투약에대한점수가가장높고, 혈당측정에대한점수가가장낮은점에서이전연구를지지하였다. 약물투약에점수가높은것은대상자가약물복용을중요하게인지하고있으며약물복용행위가운동이나식이조절, 혈당측정과같이추가적인시간이나노력에대한부담이가장적기때문일것으로생각된다. 혈당측정은평균일주일에한번도잘시행하지않는것으로나타났는데이는본연구의대상자가평균연령 76세이상인지역사회노인들이며, 혈당측정관련물품의구입과관련된경제력부족, 지식부족, 필요성인식부족, 시력저하, 인지기능저하, 기술부족등선행연구에서나타난혈당측정장애요인들이 (Fisher, Kohut, Schachner, & Stenger, 2011) 관련되었을것으로생각한다. 특히, 인슐린치료를받지않는제2형당뇨환자의경우에는자가혈당측정이일반적인관리에비해비용이많이들고삶의질에부정적영향을미친다고생각하기때문에이행이낮은것으로생각된다. 그러나당뇨대상자의혈당조절을위한행동중재중혈당측정의유익성이큰것으로보고되었으므로 (Jones et al., 2003), 노인들에대한혈당검사이행률을높일필요가있다. 노인의경우는시력저하등제한점도고려하여야하므로, 노인에게제공하는자가혈당측정과관련된중재는단체교육보다대상자개개인의상황에맞추어야할것이다. 또한, 모든대상자가같은빈도로혈당측정이필요한것이아니므로개인별필요에따른시행정도를제시하고표준 화된프로토콜을개발할필요가있다. 우울은평균 1.142점으로나타나임상적으로의미가있는기준인 2점보다낮았고, 전체노인의 29.7% 가우울의범주에포함되었다. 우리나라노인의 60.8% 가우울증이있고, 당뇨노인이당뇨병이없는노인에비해우울한정도에유의한차이가있으며 (An, 2011) 당뇨노인이우울성향이강하다는연구결과 (Aarts et al., 2009) 와는달랐는데본연구대상자는복지관을방문하여점심식사, 운동, 모임참여등의사회활동을하는노인들만포함된것이한가지요인으로생각될수있겠다. 그러나이전연구에사용된우울측정도구는본연구의도구와상이하기때문에직접비교를하기에는어려운점이있다. 본연구에서대상자의당화혈색소와자기관리간에유의한상관관계가없는것으로나타나이전연구에서혈당조절과자기관리간관계가있음을보고한연구 (Park et al., 2010) 와상이한결과를보였다. 이는당화혈색소가약 2~3개월의혈당수치를반영하는데비해본연구에서사용한자기관리도구는지난 7일동안의행위에대한내용으로구성되어있어최근에만자기관리를잘시행하였다면당화혈색소와의관계가유의하지않을수있을것이며, 혹은선행연구의대상자에비해본연구의대상자가평균연령 76.29세의고령의노인으로자기관리정도에대한기억이실제와다르게과장되었을가능성도고려할수있다. 또한, 대부분유병기간이 10년이상된대상자로서자기관리보다유병기간에의한혈당조절기능저하가혈당에더영향을미쳤을가능성이있다. 이는적극적치료를해도시간이지나면당화혈색소가증가한다는연구결과 (Wallace & Matthews, 2000) 를반영한다고볼수있다. 본연구대상자의자기관리와우울정도는통계적으로유의한역상관관계가있는것으로나타났다. 특히, 자기관리의세부영역중운동영역이우울과유의한역상관관계가있음을보였다. 자기관리영역중운동이우울과유의한역상관관계가있는것으로나타난것은신체활동이우울발생의위험을낮춘다는연구 (Katariina et al., 2012) 를지지하는결과이며한국에서당뇨노인에게규칙적걷기운동을했을때우울에긍정적인영향을미쳤다는결과와도같은맥락이다 (Sung & Lee, 2010). 그러므로운동을하지않는당뇨노인의경우운동을격려할뿐아니라우울이심한경우적절한우울치료를통해운동을증가시킬수있는방안을고려해야할것이다. 대상자의당뇨유병기간에따른우울점수는진단후 20년까지는우울점수가증가하는양상을보여질병기간이길어질수록우울 Vol. 9 No. 2,

7 김세안 송미순 점수가높아진다는이전연구결과 (Mezuk, Eaton, Albrecht, & Golden, 2008) 를일부반영하였으나, 본연구에서는 20년이상유병기간대상자의수가많지않았고, 간단한우울스크리닝도구인단축형우울도구를사용하였기때문에, 구체적인결과해석을위해서는유병기간에따른우울에대한추후연구가필요하다. 지역사회당뇨노인의합병증예방을위한효율적인간호중재를위해서는체계적인우울사정을통한자기관리이행향상과함께유병기간에따른혈당조절목표수정등의개인별맞춤형중재제공이필요하다. 본연구의제한점으로이연구는서울시 1개복지관을방문하는당뇨노인들을대상으로하여전체당뇨노인집단을대표하기어렵고, 노인과면담을통해수집된자료를분석하였으므로노인의기억력저하에따른정보의정확성에제한이있을수있다. 결론및제언본연구는지역사회당뇨노인의혈당조절정도, 자기관리정도와우울과의관계를알아보고당뇨노인의합병증예방을위한효율적인간호중재개발의기초자료를수집하기위해시행되었다. 본연구결과지역사회당뇨노인의평균당화혈색소는혈당조절의기준이되는 7% 보다높은것으로나타났다. 자기관리하부영역중약물복용을가장잘시행하는것으로나타났고, 혈당측정시행이가장안되는것으로나타났다. 29.7% 의대상자가우울범주에속하였으며, 대상자의자기관리하부영역중운동시행과우울은역상관관계를보였다. 혈당조절정도와자기관리, 우울의상관관계는유의하지않았고, 혈당조절정도와당뇨진단시기는양의상관관계가있는것으로나타났다. 따라서본연구결과를통해지역사회당뇨노인의특성을고려한당뇨관리중재를개발하기위해서는체계적인우울사정과하부영역별자기관리평가및이행증진을위한전략을확인하는연구가필요하며, 당뇨유병기간에따른개인별맞춤형중재프로그램에대한연구가필요함을제언한다. 한편본연구결과는서울시 1개노인복지관을방문하는대상자를조사한결과이므로향후전국적인표집방법을이용한반복적인연구가필요하며, 지역사회당뇨노인의특성및제한점을고려한당뇨자기관리이행측정을위한도구개발이필요함을제언한다. 참고문헌 Aarts, S., Van Den Akker, M., van Boxtel, M. P. J., Jolles, J., Winkens, B., & Metsemakers, J. F. M. (2009). Diabetes mellitus type II as a risk factor for depression: a lower than expected risk in a general practice setting. European Journal of Epidemiology, 24(10), Alam, T., Weintraub, N., & Weinreb, J. (2006). What is the proper use of hemoglobin A1c monitoring in the elderly? Journal of the American Medical Directors Association, 7(3), S60- S64. An, E. M. (2011). The relationship of depression to socioeconomic status, health status, and social support in older adults. Unpublished master's thesis. Yonsei University, Seoul. Chang, S., & Song, M. (2009). The validity and reliability of a Korean version of the summary of diabetes self-care activities questionnaire for older patients with type 2 diabetes. Journal of Korean Academy of Adult Nursing, 21(2), Choi, Y. J., Kim, H. C., Kim, H. M., Park, S. W., Kim, J., & Kim, D. J. (2009). Prevalence and Management of Diabetes in Korean Adults. Diabetes Care, 32(11), Deshpande, A. D., Harris-Hayes, M., & Schootman, M. (2008). Epidemiology of diabetes and diabetes-related complications. Physical Therapy, 88(11), Emanuele, N. (2010). Duration of diabetes, glucose control and cardiovascular risk. Diabetologia, 53(1), Fisher, W. A., Kohut, T., Schachner, H., & Stenger, P. (2011). Understanding Self-monitoring of blood glucose among individuals with type 1 and type 2 diabetes an information? motivation? behavioral Skills Analysis. The Diabetes Educator, 37(1), Funnell, M. M. (2007). 4 Steps to Control Your Diabetes for Life. National Diabetes Education Program. NIH Publication. No Glasgow, R. E., Hampson, S. E., Strycker, L. A., & Ruggiero, L. (1997). Personal-model beliefs and social-environmental barriers related to diabetes self-management. Diabetes Care, 20(4), Holman, R. R., Paul, S. K., Bethel, M. A., Matthews, D. R., & Neil, H. A. W. (2008). 10-year follow-up of intensive glucose control in type 2 diabetes. New England Journal of Medicine, 359(15), Hoyl, M., Alessi, C., Harker, J., Josephson, K., Pietruszka, F., Koelfgen, M., et al. (1999). Development and testing of a five-item version of the Geriatric Depression Scale. Journal of the American Geriatrics Society, 47(7), Jones, H., Edwards, L., Vallis, T. M., Ruggiero, L., Rossi, S. R., Rossi, J. S., et al. (2003). Changes in diabetes self-care behaviors make a difference in glycemic control. Diabetes Care, Perspectives in Nursing Science

8 지역사회당뇨노인의혈당조절, 자기관리정도와우울 (3), Katariina, K., Mauno, V., Hannu, K., Markku, P., Pekka, M., Heikki, O., et al. (2012). Lifetime leisure-time physical activity and the risk of depressive symptoms at the ages of years: The FIN-D2D survey. Preventive Medicine, 54(5), Kee, B. S., & Lee, C. W. (1995). A preliminary study for the standardization of geriatric depression scale in Korea. Journal Of The Korean Neuropsychiatric Association, 34 (6), Kim, S. H., & Kang, H. S. (2008). The relationship between depression, self-care activity and HbA1c in clients with type-2 Diabetes Mellitus. Journal of Korean Academy of Fundamental Nursing, 15(2), Lee, H. J., & Kim, M. S. (2007). The relationship of diet, physical activities, self-efficacy, and self-care with cardiovascular risk factors among clients with type II diabetes. Journal of Korean Academy of Adult Nursing, 19(2), Lee, J. K. (2009). Self-management and its predictors for patients with poorly controlled type 2 diabetes. Journal of Korean Academy of Adult Nursing, 21(5), Lee, S. H., Kang, M. H., Kim, C. E., Lee, J. S., Bae, J. N., & Cho, M. J. (2009). Comparing various short-form geriatric depression scales in elderly psychiatric patients in Korea. Journal of Korean Geriatric Psychiatry, 13(1), Lin, E. H. B., Rutter, C. M., Katon, W., Heckbert, S. R., Ciechanowski, P., Oliver, M. M., et al. (2010). Depression and advanced complications of diabetes. Diabetes Care, 33(2), Mezuk, B., Eaton, W. W., Albrecht, S., & Golden, S. H. (2008). Depression and type 2 diabetes over the lifespan. Diabetes Care, 31(12), Oh, J. Y. (2008). Treatment guideline for diabetes. The Korean Journal of Medicine, 75(3), Park, J. Y., Lee, T. Y., Jang, K. S., & Oh, H. Y. (2010). A Study on Blood glucose level and self management among community dwelling type II diabetes patients. Journal of Korean Academy of Adult Nursing, 22(3), Schram, M. T., Baan, C. A., & Pouwer, F. (2009). Depression and quality of life in patients with diabetes: A systematic review from the European Depression in Diabetes (EDID) research consortium. Current Diabetes Reviews, 5(2), Statistics Korea. (2011). Annual report on the cause of death statistics. from the Korean Statistical Information Service Web site: Sung, K.-W., & Lee, J.-H. (2010). The effects of regular walking exercise on metabolic syndrome, cardiovascular risk factors, and depressive symptoms in the elderly with diabetic mellitus. Journal of Korean Academy of Community Health Nursing, 21(4), Toobert, D. J., Hampson, S. E., & Glasgow, R. E. (2000). The summary of diabetes self-care activities measure: Results from 7 studies and a revised scale. Diabetes Care, 23(7), Wallace, T., & Matthews, D. (2000). Poor glycaemic control in type 2 diabetes: A conspiracy of disease, suboptimal therapy and attitude. Qjm: International Journal of Medicine, 93 (6), Wolff, J. L., Starfield, B., & Anderson, G. (2002). Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Archives of Internal Medicine, 162 (20), Yoo, H. J., & Nam, H. W. (1999). Diabetes mellitus in the elderly. Journal of the Korean Academy Family Medicine, 20, Vol. 9 No. 2,

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