한국산업보건학회지, 제27권제4호 (2017) ISSN 2384-132X(Print) ISSN 2289-0564(Online) https://doi.org/10.15269/jksoeh.2017.27.4.380 Original Article 교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 이영숙 1 ㆍ피영규 2 ㆍ이사우 3* 1 대구한의대학교보건대학원, 2 대구한의대학교보건학부, 3 대구한의대학교간호학과 Changes in HbA1c According to Education & Consultation Intervention of Type 2 Diabetes Workers Young Suk Lee 1 ㆍYoung Gyu Phee 2 ㆍSa-Woo Lee 3* 1 Graduate School of Daegu Haany University 2 Faculty of Health Science, Daegu Haany University 3 Dept. of Nursing, Daegu Haany University ABSTRACT Objectives: The purpose of this study was to investigate changes in HbA1c through an education and consultation intervention with diabetic workers. Methods: The participants were 65 workers with Type 2 diabetes. The data were collected from May to October 2014 using questionnaires. The intervention program included six monthly sessions on exercise, dietary habits, stress management, and diabetes knowledge. Changes in HbA1c were evaluated. The data were analyzed using descriptive statistics and paired t-tests with SPSS WIN23.0. Results: The mean of HbA1c was 7.67% before intervention and 7.28% after intervention, and this difference was statistically significant (P<0.01).The mean level of HbA1c was significantly different depending on job position, working hours, work duration, and smoking habit. Conclusion: In conclusion, these findings support the usefulness of intervention programs in reducing HbA1c. Therefore, appropriate intervention programs involving exercise, dietary habits, stress management and diabetes knowledge should be developed and provided to diabetic workers. Key words: diabetes, HbA1c, intervention, worker I. 서론제2형당뇨병은인슐린저항성과함께베타세포의인슐린분비장애를나타내는질병으로인슐린분비및작용의결함에의해발생된다 (ADA, 1997). 제2형당뇨병은주로 30세이후에발병하고, 비만인사람에게많이나타나는질병으로전세계당뇨병인구의 90% 이상을차지한다 (WHO, 2003). 우리나라는국민중 30세이상의 12.4% 인 400만명정도가당뇨병을 앓고있는것으로추정하고있으며 (KDA, 2011), 당뇨병유병률은만 30세이상의경우 2001년 8.6% 에서 2012년 9.0% 로최근 10년간 0.4% 정도증가되는경향을보이고있다 (MoHW, 2012). 또한통계청에서발표한사망원인통계결과에따르면당뇨병사망률은인구 10만명당 21.0명으로나타났다 ( 통계청, 2013). 당뇨병은우리나라사망원인 5위를차지하는질환으로당뇨병의적절한관리는중요한보건의료문제로부각되었다 (KDA, 2011). *Corresponding author: Sa-Woo Lee, Tel: 053-819-1888, Fax: 053-819-1209, E-mail: lsw531@dhu.ac.kr Dept. of Nursing, Daegu Haany University. 1 Hannydae-ro, Gyeongsan-si, Gyeongbuk 38610 Received: December 3, 2017, Revised: December 22, 2017, Accepted: December 23, 2017 This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License(http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. 380
교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 381 당뇨병은일단발생하면질병의경과조절은어느정도가능하나완치가어렵고평생치료와자기관리를요하는질환이다. 제대로관리가이루어지지않을경우우리몸의여러장기와조직에동시다발적으로문제를유발하고, 계속진행될경우많은합병증을야기하게된다 (Moon, 2012). 따라서당뇨병은꾸준한약복용과혈당확인을통한혈당관리가중요한질병으로치료의지속성을높이기위한중재방안역시대부분환자의자기관리행동을높이는데초점을맞추고있으며, 가장많이사용되는중재방안은교육이다 (WHO, 1999). 당뇨병교육은환자의치료측면에서뿐만아니라예방차원에서도이루어져야하며 (Park & Kim, 1994), 질병관리에대한지식과기술을익혀서스스로관리해야하므로질병에대한교육및상담은중요하다 (Shin & Park, 2002). 당화혈색소 (HbA1c) 란혈중에포도당이결합된혈색소를의미하고, 지난 2 3개월간의평균혈당치를대변하는지표로서전반적인당뇨병관리의주요지표로이용된다. 당뇨병진단기준은 6.5% 미만이고, 당화혈색소정상수치는 4 6% 미만이다 (KDA, 2012). 대규모의전향적인연구인 DCCT(The Diabetes Control and Complication Trial) 와 UKPDS(UK Prospective Diabetes Study) 에서정상에가까운적극적인혈당조절은지속적으로당뇨병성합병증인망막병증, 신증, 신경병증등미세혈관합병증과대혈관합병증의발생및진행을낮춘다는결과를제시하였다 (DCCT 1993; UKPDS, 1998a). 또한, DCCT에서당화혈색소를 8.0% 에서 7.2% 로낮추면망막병증의진행을 40 50% 늦출수있다고보고하였으며, UKPDS에서는당화혈색소의수치를 1% 감소시키면미세혈관합병증은 37%, 심근경색은 14% 감소된다고보고하였다. 적극적이고엄격한혈당조절은합병증의발생을예방하며, 발생된합병증의진행속도를늦출수있는가장효과적인방법으로보고하였다 (DCCT 1995, UKPDS, 1998b). 이렇듯당뇨병의혈당조절에있어당화혈색소는혈당조절유무를확인하는지표로써당뇨병및합병증진단에매우유용하게사용된다 (KDA, 2013). 그동안당뇨병환자를대상으로당화혈색소의변화와관련된연구 (Yoo, 2003; Chung, 2005; Moon, 2012; Park, 2012) 는많이진행되어져왔지만근로자를대상으로한연구는드문실정이다. 또한당뇨병 에대한교육은당뇨병환자의관리를위해가장기본적이고중요한부분을차지하며, 당뇨병환자의관리행위를향상시키고당화혈색소를유의하게개선시키는것으로보고되고있다 (Song et al., 2005; Jang et al., 2006). 근로자역시장시간근무, 업무과중및신체활동부족등으로제2형당뇨병이증가되고있는실정이다. 따라서본연구는교육및상담중재에따른제2형당뇨병근로자의당화혈색소변화를살펴보고자하였다. Ⅱ. 대상및방법 1. 연구대상본연구는 2014년 5월부터 10월까지대구광역시및경상북도에위치한사업장에서제2형당뇨병질환자 80명을편의표본추출하였다. 대상자는일반건강진단결과후당뇨병유소견자로판정받은근로자로한정하였다. 그후연구의취지와목적에대해충분한설명을하고교육및상담을진행하였다. 모집단 80 명중자료가불충분하거나휴무, 퇴사및출장등총 6회의교육및상담을충족하지못하여탈락한 15명을제외하고총 65명을최종분석자료로사용하였다. 2. 연구방법 1) 설문조사및당화혈색소자료수집설문은연구대상자의인구사회학적특성과질병관련특성, 업무관련특성등은구조화된설문지를통해확인하였다. 자료수집과정에서대상자가느끼는불편함을최소화하기위하여자기기입식설문방법으로진행하였고, 대상자들에게자료의익명성과비밀보장에대하여충분히설명하였다. 교육및상담을시작하기전에당화혈색소자료를 1개월간수집하였고, 교육및상담후에당화혈색소변화를확인하기위하여중재이후당화혈색소결과를다시수집하였다. 당화혈색소자료는대상자가정기적으로병원을방문하여 3개월마다검사한임상검사지자료를활용하였다. 2) 교육및상담중재교육및상담은 5월부터 10월까지매월정기적으로방문하여개인별로실시하였다. 교육내용은당뇨 http://www.kiha.kr/
382 이영숙ㆍ피영규ㆍ이사우 병예방과관리, 식습관개선, 운동실천, 스트레스관리, 혈당관리위한사계절당뇨식단과식품교환표에따른개인별열량섭취량계산통해맞춤식식단정보를제공하였다. 상담내용은현재의식습관, 운동유무, 스트레스상태를확인하고, 교육을통한당뇨병에관한지식향상을통해스스로조절하고실천할수있도록동기부여를하였다. 매월당뇨병예방과관리등총 7종교육자료를지급하고, 이를활용하여총 6회의교육과상담을진행하였다. 3. 자료의분석수집된자료는 SPSS Program(Version 23.0K, USA) 을이용하여분석하였다. 일반적특성과질병관련특성, 업무관련특성은기술통계를활용하여빈도와백분율 (%) 로표시하였다. 교육및상담중재전 후당 화혈색소변화비교를위하여 paired t-test를실시하였다. Ⅲ. 연구결과 1. 연구대상자의일반적특성 1) 인구사회학적특성연구대상자는총 65명으로남자가 76.9%(50명 ) 로많았고, 연령은 50대 (36.9%, 24명 ), 60대 (35.4%, 23 명 ) 에많이분포되어있었다 (Table 1). 기혼이 87.7% (57명) 로대부분이었고, 교육수준은고졸이하가 53.8%(35명 ) 로가장많이차지하였다. 월소득은 200 300만원미만이 43.1%(28명 ) 로가장많았고, 직급은사원이 44.6%(29명 ) 로대부분이었다. 근무년수는 4년미만이 16.9%(11명 ), 4년이상 6년미만이 13.8% Table 1. Sociodemographic characteristics of subjects Variables Classification No. of subjects Percentage(%) Sex Male 50 76.9 Female 15 23.1 Age(years) <30 2 3.1 30 39 12 18.5 40 49 24 36.9 50 59 23 35.4 60 4 6.2 Marital status Married 57 87.7 Unmarried 8 12.3 Education level Below high school 35 53.8 College 13 20.0 University above 17 26.2 Income(10,000 KRW) <200 11 16.9 200 299 28 43.1 300 499 20 30.8 500 6 9.2 Job position Employee 29 44.6 Manager 9 13.8 Section chief 16 24.6 Dept. head 7 10.8 Executive 4 6.2 Work duration(years) <4 11 16.9 4 6 9 13.8 7 9 9 13.8 9 36 55.4 http://www.kiha.kr
교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 383 Table 2. Disease characteristics of subjects Variables Classification No. of subjects Percentage(%) DM diagnosis period(years) <5 42 64.6 5 9 14 21.5 10 14 5 7.7 15 4 6.2 Smoking Yes 25 38.5 No 40 61.5 Use of drugs Yes 52 80.0 No 13 20.0 Drinking Yes 45 69.2 No 20 30.8 Complications Yes 4 6.2 No 61 93.8 Family history Father 13 20.0 Mother 13 20.0 Brothers & sisters 8 12.3 Grandparents 1 1.5 No 30 46.2 DM education experience Yes 16 24.6 No 49 75.4 (9명), 7년이상 9년미만이 13.8%(9명 ) 및 9년이상이 55.4%(36명 ) 로나타났다. 2) 질병관련특성연구대상자의질병관련특성으로당뇨의이환기간은 5년미만이 42%(42명 ) 로가장많았고, 흡연자는 38.5%(25명 ) 로나타났다 (Table 2). 약물복용중인대상자는 80.0%(52명 ) 로모두경구혈당강하제를사용하고있었으며, 음주자는 69.2%(45명 ) 로확인되었다. 합병증은고혈압인경우가 6.2%(4명 ) 이었고, 93.8%(61명 ) 는합병증이없었다. 질병에대한가족력은부모 40.0%(26명 ), 형제 자매 12.3%(8명 ), 조부 1.5%(1명 ) 이었고, 없는경우가 46.2%(30명 ) 로나타났다. 당뇨교육의경험이있는경우는 24.6%(16명 ) 이었고 75.4%(49 명 ) 는교육경험이없는것으로조사되었다. 3) 업무관련특성업무관련특성으로하루근무시간이 8시간초과하는대상자가전체 80.1%(52명 ) 로대부분을차지하였다 (Table 3). 고용형태로는정규직이 89.2%(58명 ) 로 Table 3. Work characteristics of subjects Variables Classification No. of subjects Percentage(%) Working hours 8 13 20.0 9 10 25 38.5 11 12 17 26.2 >12 10 15.4 Employment position Non regular 7 10.8 Regular 58 89.2 Occupational classification Service 5 7.7 Production 34 52.4 Office 20 30.8 Others 6 9.2 http://www.kiha.kr/
384 이영숙ㆍ피영규ㆍ이사우 Table 4. Changes in HbA1c before and after intervention Before intervention After intervention Variable No. of subjects P-value Mean±S.D. Mean±S.D. HbA1c(%) 65 7.67±1.50 7.28±1.19 0.001 대부분이었고, 계약직이 10.8%(7명 ) 이었다. 근무직종은생산직이 52.4%(34명 ) 로가장많았고, 일반사무직 30.8%(20명 ), 서비스직 7.7%(5명 ) 및기타 9.2%(6 명 ) 로나타났다. 2. 교육및상담중재전 후특성별당화혈색소의변화최초당화혈색소 (7.67%) 에비해 6개월간교육및상담중재후당화혈색소 (7.28%) 가통계적으로유의하게감소하였다 (P<0.01). 1) 인구사회학적특성에따른당화혈색소의비교인구사회학적특성에따른당화혈색소전 후값을비교한결과성별에서는남녀모두당화혈색소가유의하게감소되었고, 연령별로는 40대가 7.86% 에서 7.37% 로 50대가 6.94% 에서 6.75% 로유의하게감소한것으로나타났다 (Table 5). 학력은고졸이하가 7.63% 에서 7.25% 로감소하였고, 월소득은 300만원에서 500만원미만을제외하고모두유의한당화혈색소감소가있었다. 직급에서는사원이 7.89% 에서 7.30% 로감소되었고, 근무년수는 9년미만에서통 Table 5. Changes in HbA1c before and after intervention by sociodemographic characteristics Variables Classification No. of subjects Before intervention Mean(%)±S.D. After intervention Mean(%)±S.D. P-value Sex Male 50 7.64±1.44 7.28±1.20 0.047 Female 15 7.68±1.54 7.27±1.20 0.001 Age(years) <30 2 7.55±0.07 6.95±0.78 0.500 30 39 12 8.76±2.35 8.19±1.91 0.102 40 49 24 7.86±1.45 7.37±1.06 0.001 50 59 23 6.94±0.43 6.75±0.50 0.036 60 4 7.45±1.08 7.25±0.76 0.875 Marital status Married 57 7.50±1.33 7.22±1.34 0.008 Unmarried 8 8.88±2.21 7.78±1.55 1.000 Education level Below high school 35 7.63±1.32 7.25±0.76 0.001 College 13 7.70±1.55 7.43±1.32 0.053 University above 17 7.71±1.88 7.19±1.33 0.106 Income(10,000 KRW) <200 11 8.88±2.24 7.71±1.52 0.002 200 299 28 7.53±1.37 7.27±1.20 0.007 300 499 20 7.48±1.14 7.22±1.07 0.091 500 6 6.92±0.35 6.78±0.80 0.001 Job position Employee 29 7.89±1.67 7.30±1.21 0.002 Manager 9 7.37±1.27 7.31±0.88 0.352 Section chief 16 7.60±1.18 7.35±1.05 0.107 Dept. head 7 7.80±2.12 7.56±1.95 0.313 Executive 4 6.80±0.34 6.35±0.13 0.250 Work duration(years) <4 11 8.44±2.06 7.52±1.54 0.025 4 6 9 7.78±1.14 7.12±0.88 0.008 7 9 9 8.58±2.16 8.09±1.85 0.016 9 36 7.18±0.96 7.05±0.84 0.052 http://www.kiha.kr
교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 385 Table 6. Changes in HbA1c before and after intervention by disease characteristics Variables Classification N Before intervention After intervention Mean(%)±S.D. Mean(%)±S.D. P-value DM diagnosis period(years) <5 42 7.70±1.63 7.28±1.30 0.002 5 9 14 7.08±0.60 6.99±0.80 0.031 10 14 5 8.96±1.92 7.98±1.40 0.185 15 4 7.73±0.95 7.41±0.78 0.250 Smoking Yes 25 7.70±1.68 7.57±1.47 0.061 No 40 7.64±1.41 7.10±1.05 0.001 Use of drugs Yes 52 7.50±1.27 7.07±0.81 0.001 No 13 8.34±2.13 8.13±1.93 0.019 Drinking Yes 45 7.60±1.41 7.34±1.25 0.002 No 20 7.83±1.72 7.16±1.05 0.002 Complications Yes 4 7.57±1.27 6.88±0.51 0.250 No 61 7.68±1.53 7.31±1.22 0.001 Family history Father 13 8.03±2.37 7.57±1.38 0.349 Mother 13 7.62±1.12 7.48±1.15 0.070 Brothers & sisters 8 7.21±1.23 7.10±1.15 0.547 Grandparents 1 9.00 8.00 1.000 No 30 7.61±1.27 7.10±1.17 0.001 DM education experience Yes 16 7.20±0.85 6.88±0.59 0.001 No 49 7.82±1.64 7.41±1.31 0.173 계적으로유의하게감소하였다 (P<0.05). 2) 질병관련특성에따른당화혈색소의비교질병관련특성에따라당화혈색소전 후비교한결과당뇨병의이환기간이짧을수록당화혈색소가감소하는경향을보였다 (Table 6). 흡연은흡연자에비해비흡연자에게당화혈색소감소가높았고, 음주 는음주여부와상관없이모두유의하게감소되었다. 합병증이없는경우당화혈색소가중재전 7.68% 에서 7.31% 로유의하게감소되었고, 가족력이없는경우중재전 7.61% 에서 7.10% 로유의하게감소되었다. 당뇨교육을받지않은경우당화혈색소변화는차이를보이지않았으나당뇨교육경험이있는군에서는중재전 7.20% 에서중재후 6.88% 로유의한 Table 7. Changes in HbA1c before and after intervention by work characteristics Variables Classification No. of subjects Before intervention Mean(%)±S.D. After intervention Mean(%)±S.D. P-value Working hours 8 13 7.65±1.44 7.18±1.18 0.001 9 10 25 7.12±0.90 6.89±0.79 0.022 11 12 17 8.31±1.88 7.64±1.20 0.029 >12 10 7.93±1.77 7.80±1.72 0.551 Employment position Occupational classification Non regular 7 7.06±0.45 6.64±0.41 0.031 Regular 58 7.74±1.57 7.36±1.23 0.001 Service 5 7.78±2.31 7.94±1.78 0.813 Production 34 7.52±1.14 7.22±0.93 0.001 Office 20 7.97±1.61 7.22±1.09 0.001 Others 6 6.60±0.90 6.50±0.24 0.875 http://www.kiha.kr/
386 이영숙ㆍ피영규ㆍ이사우 감소를보였다 (P<0.05). 3) 업무관련특성에따른당화혈색소의비교업무관련특성에따른당화혈색소전 후값을비교한결과는하루근무시간이 12시간미만에서당화혈색소가중재전 8.31% 에서 7.64% 로유의하게감소되었고 (P<0.01), 12시간초과하는경우에는유의한차이가없는것으로나타났다 (Table 7). 고용형태는모두당화혈색소가유의한감소를보였으며, 근무직종에서도생산직, 일반사무직모두유의한감소를보였다 (P<0.05). Ⅳ. 고찰당뇨병교육은환자의치료측면뿐만아니라예방차원에서도이루어져하며 (Park & Kim, 1994), 질병관리에대한지식과기술을익혀서스스로관리해야하므로질병에대한교육및상담은중요하다 (Shin & Park, 2002). 당뇨병에대한교육은당뇨병환자의관리행위를향상시키고당화혈색소를유의하게개선시키는것으로보고되고있다 (Song et al., 2005; Jang et al., 2006; Kim et al., 2007). 본연구에서교육여부에따라당화혈색소변화를살펴본결과당뇨교육을받지않은경우당화혈색소변화는차이를보이지않았으나당뇨교육경험이있는군에서는중재전 7.20% 에서중재후 6.88% 로유의한감소를보였다. 그러나중재전당뇨병교육경험여부를확인한결과 24.6% 로조사되었는데이는 Moon(2012) 의연구결과 37.3%, Park et al.(2007) 이조사한 39.4% 에비해다소낮은수준으로나타났다. 따라서근무시간동안이동이쉽지않은근로자에대하여당뇨병교육이제공될수있는다양한방안마련이필요한것으로판단된다. 국민건강통계를살펴보면 2008년부터 2012년까지만 30세이상을대상으로당뇨병관리현황을파악한결과인지율은전체 72.7%( 남자 69.2%, 여자 77%) 이었으며, 치료율은전체 61.4%, 남자 57.6%, 여자 65.9% 로여자보다남자에서인지율과치료율이낮았고, 특히남자 30대의인지율은 32.8% 치료율은 26.5% 로다른연령에비해매우낮은것으로조사되었다 (MoHW, 2013). 본연구에서도교육및상담중 재후인구학적특성에따른당화혈색소전 후비교한결과성별은남성에비해여성의당화혈색소감소가높았고, 연령별로는 40대와 50대의경우당화혈색소감소가교육및상담중재후에유의하게감소하였으나 30대는그차이가유의하지않게나타나유사한결과를보였다. 또한결혼여부의경우기혼자가미혼자에비해당화혈색소가유의하게감소하였고, 직급은근로자가, 근무경력은 10년미만인경우가 10 년이상에비해높은수준으로감소효과를보여당뇨에대한교육및상담중재는선택과집중이필요한것으로생각된다. 질병관련특성에따라당화혈색소의전 후를비교했을때당뇨병의이환기간이짧을수록당화혈색소가감소가뚜렷하게나타났으며, 흡연자에비해비흡연자에게서더욱많은당화혈색소감소가있었다. 또한합병증이없고가족력이없는경우당화혈색소가유의하게감소되는경향을보였다. 따라서교육및상담과정에금연의중요성을인지시킬필요가있으며, 고혈압과같은합병증과가족력은확인하여야하고, 당뇨병의이환기간이짧은근로자를집중적으로교육을할필요가있다. 업무관련특성에따른당화혈색소전 후비교한결과하루근무시간이 12 시간미만에서당화혈색소가중재전 8.31% 에서 7.64% 로유의하게감소되었고, 12시간초과하는경우에는유의한차이가없는것으로나타났다. 그러나하루근무시간이 8시간초과하는대상자가전체 80.1%(52명 ) 로나타나제2형당뇨병근로자의경우초과근무를제한하는것이바람직할것으로판단된다. 본연구는교육및상담의중재를통해제2형당뇨병근로자의당화혈색소의변화를살펴보고자하였다. 그결과연구대상자 65명중교육및상담중재전평균당화혈색소는 7.67% 이었고중재후평균당화혈색소는 7.28% 로유의한감소가있었다. 그러나이는대한당뇨병학회진료지침의조절목표인 6.5% 미만에는못미치는결과로나타났다 (KDI, 2012). 현재우리나라당뇨병환자가가장많이이행하고있는행위는운동이다 (Min et al., 2005). 그러나규칙적인운동은당뇨병환자의관리중가장잘이루어지지않는영역이며 (Jang & Han, 2004; Choi et al., 2008), 지속적인실천의어려움이보고된바있다 (Nelson et http://www.kiha.kr
교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 387 al, 2002). 본연구에서도직장의생산량증대및납품기간단축의변화로인한야근등근무시간의증가로인해지속적인운동실천이어려운대상자도있는것으로확인되었다. 이는 Yoo(2003) 가주장한바와같이장시간의근무가운동부족을야기하는것으로운동을수행하지않는원인을파악하고, 운동수행및운동지속에대한교육이필요하며, 개별적인맞춤형운동중재방안을마련해줄필요가있을것이다. 당뇨병환자는규칙적인운동과더불어일상생활에서신체활동량을늘리는것이강조되고있음 (King et al, 2006) 을감안할때직장내에서할수있는다양한운동프로그램이모색될필요가있다. 당뇨병의치료와성공여부는스스로당뇨병에대한충분한지식을가지고있어야한다 (Moon, 2012). 생활습관의개선을포함하는당뇨병관리는당뇨병교육을통해환자가질환에대한올바른지식을습득하는것으로부터시작된다 (Gil & Jung, 2005). 선행연구에서당뇨병교육의경험이있는대상자가당뇨병교육을받지않은대상자에비해지식이높다는보고가있다 (Jung, 2005; Lee et al., 2008; Kim & Jang, 2009). 오늘날당뇨병교육은강의형태에서부터 1:1 개인교육으로이루어지고있으며 (Kim et al., 2004; Jang et al., 2006), 당뇨병에대한집체교육보다는위험군에해당하는근로자를선별하여지속적으로 1:1 상담교육을실시하는것이당화혈색소감소에보다효과적이라고생각된다. 또한과식은혈당조절과체중조절이필요한제2형당뇨병환자에게삼가야할식사습관으로교육및상담내용에규칙적인식습관및적절한식사량조절의중요성에대한부분을강조하여중재할필요성이있다 (KDI, 2013). 따라서당뇨병관리에식이조절, 운동이혈당조절에유의한영향을미친다는선행연구 (Lee et al., 2005; Kim et al., 2006) 결과를감안하면효과적인혈당조절을위해서는식이조절과운동실천등의사항이적극적으로개입될필요가있음을알수있었다. 한편, 당뇨병환자에게스트레스가당화혈색소에영향을미친다는보고 (Delamater et al, 1987; Peyrot et al, 1992) 등을감안할때향후다양한스트레스도구와스트레스호르몬등의생리적인지표를이용하여당화혈색소와스트레스의관계를살펴보는연구가필요할것이다. 또한, Lim et al.(2001) 이제시한 바와같이효율적인당뇨병관리를위해의학적인측면뿐만아니라스트레스관리, 즉심리사회적인측면으로의접근까지이루어지는것이필요하다. 이상의연구결과근로자의당뇨병관리를위한당화혈색소감소를위해서는지속적인교육및상담의개입이중요한것으로나타났다. 이를위해운동실천, 식습관, 당뇨병에대한교육, 스트레스관리방안이포함된사업장건강증진프로그램도입과실행이적극적으로권장된다. 본연구의제한점으로는대구, 경북지역일부사업장의제2형당뇨병을가진근로자를편의표본추출하여선정하였고, 교육과상담의순응도가개인별로차이가크므로연구결과를일반화하기에는다소무리가있다. Ⅴ. 결론 본연구는제2형당뇨병근로자 65명을대상으로교육과상담의중재를통하여당화혈색소의전 후변화를비교분석하였다. 그결과근로자들에게현장방문을통한당뇨병에대한교육및상담의중재가당화혈색소감소에유의한효과가있는것으로확인되었다. 따라서당뇨병관리의가장중요한지표인당화혈색소수준을감소시키기위해서는사업장현장방문을통한교육과상담의지속적인개입이필요하다. 또한, 교육및상담의효과를높이기위해서는위험군에해당하는근로자를선별하여 1:1 상담교육을실시하는것이효과적일것으로판단된다. References American Diabetes Association(ADA). Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes care 1997; 20: 1183-1197 Choi KY, Jang SM, Nam HW. Current status of selfmanagement and barriers in elderly diabetic patient background: diabetes has a critical effect on elderly diabetes. J of Kor Diabetes 2008;32(3):280-289 Delamater AM, Kurtz SM, Bubb J, White NH, Santiago JV. Stress and coping in relation to metabolic control of adolescents with type 1 diabetes. Journal of Dev Behav Pediatr 1987;8:136-140 Gil KS, Jung IS. Knowledge, perceived seriousness and http://www.kiha.kr/
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교육및상담중재에따른제 2 형당뇨병근로자의당화혈색소변화 389 UK Prospective Diabetes Study(UKPDS) Group. Effect of intensive blood-glucose control with metformin on complications in over weight patients with type 2 diabetes(ukpds 34). UK Prospective Diabetes Study (UKPDS) Group. Lancet 1998b;352:854-865 World Health Organization. Definition, diagnosis and classification of diabetes mellitus and its complications: report of a WHO consultation: part 1. diagnosis and classification of diabetes mellitus. Geneva, World health Organization, 1999 p. 11-16 World Health Organization(WHO). World Health Report, WHO, 2003. p. 1-4 Yoo HY. Relationship between diet, exercise, stress, and HbA_(1)C among patients with Type 2 diabetes mellitus. Graduate school of Yonsei University. Seoul; Yonsei University Press. 2003. p. 4-7 http://www.kiha.kr/