本研究主要目的在探討胰島素治療及衛教對第2型糖尿病病人之糖尿病認知、胰島素治療態度及糖尿病治療滿意度之影響及短期效果。
研究對象為南部某醫學中心第2型糖尿病病人，共68位，實驗組37位，對照組31位，實驗組接受胰島素治療衛教及轉換胰島素治療，三個月追蹤，有6位退出研究，共62位完成前測及後測問卷。
本研究結果如下：
一、教育程度不同糖尿病治療認知有顯著差異，不識字顯著低於國小、國中、高中、專科/大學以上學歷，國小學歷糖尿病治療認知低於專科/大學以上學歷。
二、研究對象之糖尿病治療認知在預防糖尿病併發症及低血糖部分答對比率較高，關於胰島素的認知不足。
三、第2型糖尿病病人對於胰島素治療普遍存在對個人失敗的感受及對自我注射感到焦慮。大多數糖尿病人認為「使用胰島素，表示我的糖尿病已經變得更差」，其次認為「使用胰島素，表示著我用飲食及口服降血糖藥物來控制我的糖尿病已經失敗」和擔心「我怕用針注射我自己」，已婚者胰島素治療態度的心理阻抗較低。
四、胰島素治療與衛教能提升研究對象糖尿病治療知識，降低對胰島素治療負向態度，對疾病失敗、害怕打針、生活限制、及害怕低血糖負向態度明顯改觀。轉換胰島素治療後，糖尿病治療滿意度增加，認為現在糖尿病的治療比過去滿意，對自己糖尿病情況感到比過去滿意。
胰島素治療與衛教介入能降低負向胰島素治療態度，但提供胰島素治療相關衛教時，需瞭解個案的感受，接納個案的負向情緒及態度，減少胰島素的心理阻抗。

The main purpose of this study was to investigate the influence and short-term effects of the insulin treatment and health education on patients with type 2 diabetes concerning their diabetes knowledge, attitudes of insulin treatment, and satisfaction degrees of diabetes treatment.
The subjects were type 2 diabetic patients in a medical center in southern Taiwan, a total of 68, experimental group 37, control group 31. The experimental group received health education of insulin treatment and conversion to insulin treatment, with three months of tracking. There were six withdrawing from the study. A total of 62 completed pretest and posttest questionnaires.
The results are as follows:
1. Patients of different education levels are significantly different on their awareness of diabetes treatment. Awareness of the illiteracy level is significantly lower than that of the elementary, junior high and senior high school, college / university and above education levels. Awareness of the elementary level is lower than that of the college / university and above education levels.
2. Regarding awareness of diabetes treatment, the subjects perform better in the part of prevention of diabetes complication and the hypoglycemia part, but show insufficient awareness of insulin.
3. For insulin treatment, type 2 diabetic patients show a common sense of self-failure and anxiety of self-injection. The majority of diabetic patients think that "the use of insulin indicates that my diabetes has become worse", and secondly that "the use of insulin indicates that control of my diabetes with diet and oral hypoglycemic agents has failed" and worry that "I fear injecting myself with a needle." Married people have lower psychological resistance to insulin treatment.
4. Insulin treatment and health education can improve knowledge of diabetes treatment of the subjects, and reduce their negative attitude toward insulin treatment with an obvious attitude change in their sense of failure, fear of injection, life limitation, and fear of hypoglycemia. After turning to the insulin therapy, the satisfaction degrees of diabetes treatment have been raised. The patients are more satisfied than they were in the past in their diabetes treatment and their individual condition.
Insulin treatment and health education intervention can reduce the negative attitude toward insulin therapy. However, it is necessary to understand the patients’ feelings, accept their negative emotion and attitude, to reduce their psychological resistance against insulin therapy when providing related health education.

中文部份
行政院衛生署（2008a，7月22日）。臺灣地區主要死亡原因─九十一年與九十年之比較。2008年10月19日取自 http://www.doh.gov.tw/CHT2006/DM/DM2_2.aspx?now_fod_list_no=9579&class_no=440&level_no=4。
行政院衛生署（2008b，7月22日）‧民國96年縣市別死因統計結果‧2008年10月19日取自http://www.doh.gov.tw/CHT2006/DisplayStatisticFile.aspx?d=58880。
吳明隆（2007）。SPSS操作與應用變異數分析實務。台北市：五南。
吳淑華、陳清惠、顏妙芬（2006）。 探討第二型糖尿病患者轉換胰島素注射治療過程之促進與阻礙因素。實證護理，2（1），14－23。
李哲全、傳振宗、吳篤安（2006）。糖尿病的診斷與治療。慈濟醫學雜誌，18（1_s），1－9。
陳玉敏、廖桂美、舒月華、吳梅雪、王素華、蔡惠嬌（2001）。中年糖尿病患個人認知與健康行為之相關性探討。中國醫藥科學雜誌，2（4），315－322。
陳建良、謝昌勳（2008）。第2型糖尿病之藥物。臺灣醫學，12（2），231－238。
陳淑津（2007）。比較合併治療或純胰島素於第二型糖尿病患之血糖控制成效、滿意度與生活品質探討。長庚大學護理學研究所未出版碩士論文，桃園。
張秋純、陳鈺如（2009）。以專案提昇門診糖尿病病患胰島素注射治療之接受度。中山醫學雜誌，20（2），233－245。
蕭淑華、吳達仁（2000）。第2型糖尿病藥物治療之新進展。臺灣醫學，4（1），80－85。

英文部份
American Diabetes Association (2008). Standards of medical care in diabetes--2008. Diabetes Care, 31 (Suppl 1), S12-54.
Bogatean, M. P., & Hancu, N. (2004). People with type 2 diabetes facing the reality of starting insulin therapy: Factors involved in psychological insulin resistance. Practical Diabetes International, 21(7), 247-252.
Bradley, C. (1999). Diabetes treatment satisfaction questionnaire. Change version for use alongside status version provides appropriate solution where ceiling effects occur. Diabetes Care, 22(3), 530-532.
Bradley, C., & Speight, J. (2002). Patient perceptions of diabetes and diabetes therapy: Assessing quality of life. Diabetes Metab Res Rev, 18 Suppl 3, S64-69.
Chuang, L. M., Tsai, S. T., Huang, B. Y., & Tai, T. Y. (2001). The current state of diabetes management in Taiwan. Diabetes Research and Clinical Practice, 54(Supplement 1), 55-65.
Clifford, R. M., Davis, W. A., Cull, C. A., Bruce, D. G., Batty, K. T., & Davis, T. M. (2004). Greater use of insulin by southern European compared with Anglo-Celt patients with type 2 diabetes: The Fremantle Diabetes Study. European Journal Endocrinology, 151(5), 579-586.
Davis, S. N., & Renda, S. M. (2006). Psychological insulin resistance: Overcoming barriers to starting insulin therapy. Diabetes Educator, 32, 146S-155S.
Detournay, B., Raccah, D., Cadilhac, M., & Eschwege, E. (2005). Epidemiology and costs of diabetes treated with insulin in France. Diabetes and Metabolism, 31(3 Pt 2), 3-18.
Funnell, M. M., Kruger, D. F., & Spencer, M. (2004). Self-management support for insulin therapy in type 2 diabetes. Diabetes Educator, 30(2), 274-280.
Harris, S. B., Ekoe, J. M., Zdanowicz, Y., & Webster-Bogaert, S. (2005). Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Research and Clinical Practice, 70(1), 90-97.
Houlden, R., Ross, S., Harris, S., Yale, J. F., Sauriol, L., & Gerstein, H. C. (2007). Treatment satisfaction and quality of life using an early insulinization strategy with insulin glargine compared to an adjusted oral therapy in the management of Type 2 diabetes: The Canadian INSIGHT Study. Diabetes Research and Clinical Practice, 78(2), 254-258.
Kelley, K., & Dempsey, C. (2007). An evaluation of an insulin transfer programme delivered in a group setting. Journal of Clinical Nursing, 16(7B), 152-158.
Koro, C. E., Bowlin, S. J., Bourgeois, N., & Fedder, D. O. (2004). Glycemic control from 1988 to 2000 among U.S. adults diagnosed with type 2 diabetes: A preliminary report. Diabetes Care, 27(1), 17-20.
Kristensen, J. K., Bro, F., Sandbaek, A., Dahler-Eriksen, K., Lassen, J. F., & Lauritzen, T. (2001). HbAlc in an unselected population of 4438 people with type 2 diabetes in a Danish county. Scandinavian Journal of Primary Health Caree, 19(4), 241-246.
Larkin, M. E., Capasso, V. A., Chen, C. L., Mahoney, E. K., Hazard, B., Cagliero, E., et al. (2008). Measuring psychological insulin resistance: Barriers to insulin use. Diabetes Educator, 34(3), 511-517.
Mudaliar, S., & Edelman, S. V. (2001). Insulin therapy in type 2 diabetes. Endocrinology & Metabolism Clinics of North America, 30(4), 935-982.
Nathan, D. M., Buse, J. B., Davidson, M. B., Ferrannini, E., Holman, R. R., Sherwin, R., et al. (2009). Medical management of hyperglycemia in type 2 diabetes: a consensus algorithm for the initiation and adjustment of therapy: A consensus statement of the American Diabetes Association and the European Association for the Study of Diabetes. Diabetes Care, 32(1), 193-203.
NICE (2008). Type 2 diabetes National clinical guideline for management in primary and secondary care. NICE Guideline.
Peragallo-Dittko, V. (2007). Removing barriers to insulin therapy. Diabetes Educator, 33 Suppl 3, 60S-65S.
Peyrot, M., Rubin, R. R., Lauritzen, T., Skovlund, S. E., Snoek, F. J., Matthews, D. R., et al. (2005). Resistance to insulin therapy among patients and providers: Results of the cross-national Diabetes Attitudes, Wishes, and Needs (DAWN) study. Diabetes Care, 28(11), 2673-2679.
Peyrot, M., Rubin, R. R., Lauritzen, T., Snoek, F. J., Matthews, D. R., & Skovlund, S. E. (2005). Psychosocial problems and barriers to improved diabetes management: Results of the Cross-National Diabetes Attitudes, Wishes and Needs (DAWN) Study. Diabetic Medicine, 22(10), 1379-1385.
Polonsky, W. (2007). Psychological insulin resistance: The patient perspective. Diabetes Educator, 33(Suppl 7), 241S-244S.
Polonsky, W. H., Fisher, L., Guzman, S., Villa-Caballero, L., & Edelman, S. V. (2005). Psychological insulin resistance in patients with type 2 diabetes: The scope of the problem. Diabetes Care, 28(10), 2543-2545.
Polonsky, W. H., & Jackson, R. A. (2004). What’s so tough about taking insulin? Addressing the problem of psychological insulin resistance in type 2 diabetes. Clinical Diabetes, 22(3), 147-150.
Raskin, P., Allen, E., Hollander, P., Lewin, A., Gabbay, R. A., Hu, P., et al. (2005). Initiating insulin therapy in type 2 Diabetes: A comparison of biphasic and basal insulin analogs. Diabetes Care, 28(2), 260-265.
Riddle, M. C., Rosenstock, J., & Gerich, J. (2003). The treat-to-target trial: Randomized addition of glargine or human NPH insulin to oral therapy of type 2 diabetic patients. Diabetes Care, 26(11), 3080-3086.
Saaddine, J. B., Cadwell, B., Gregg, E. W., Engelgau, M. M., Vinicor, F., Imperatore, G., et al. (2006). Improvements in Diabetes Processes of Care and Intermediate Outcomes: United States, 1988-2002. Annals of Internal Medicine, 144(7), 465-481.
Snoek, F. J., Skovlund, S. E., & Pouwer, F. (2007). Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes. Health Quality of Life Outcomes, 5, 69.
Stratton, I. M., Adler, A. I., Neil, H. A., Matthews, D. R., Manley, S. E., Cull, C. A., et al. (2000). Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): Prospective observational study. British Medical Journal, 321(7258), 405-412.
Tahrani, A. A., Digwood, S., Lee, C., & Moulik, P. (2007). Evaluation of glargine group-start sessions in patients with type 2 diabetes as a strategy to deliver the service. International Journal of Clinical Practice, 61(2), 329-335.
Tseng, C.-H., Tseng, C.-P., Chong, C.-K., Huang, T.-P., Song, Y.-M., Chou, C.-W., et al. (2006). Increasing incidence of diagnosed type 2 diabetes in Taiwan: Analysis of data from a national cohort. Diabetologia, 49(8), 1755-1760.
Tseng, C. H. (2003). Prevalence and risk factors of peripheral arterial obstructive disease in Taiwanese type 2 diabetic patients. Angiology, 54(3), 331-338.
Tseng, F.-Y., Lai, M.-S., Syu, C.-Y., & Lin, C.-C. (2006). Professional accountability for diabetes care in Taiwan. Diabetes Research and Clinical Practice, 71(2), 192-201.
U.K. Prospective Diabetes Study Group (1995). United Kingdom Prospective Diabetes Study (UKPDS). 13: Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. British Medical Journal, 310(6972), 83-88.
U.K. Prospective Diabetes Study Group (1998). Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK Prospective Diabetes Study (UKPDS) Group. Lancet, 352(9131), 837-853.
Wild, S., Roglic, G., Green, A., Sicree, R., & King, H. (2004). Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care, 27(5), 1047-1053.
Wilson, M., Moore, M. P., & Lunt, H. (2004). Treatment satisfaction after commencement of insulin in Type 2 diabetes. Diabetes Research and Clinical Practice, 66(3), 263-267.