认知程度和自我效能在妊娠糖尿病患者健康生活方式与血糖间的中介效应

Mediating effect of cognition and self-efficacy on healthy lifestyles and blood glucose in patients with gestational diabetes mellitus

目的探讨认知程度和自我效能在妊娠糖尿病(GDM)患者健康生活方式与血糖水平间的链式中介效应。方法选取2017年1月—2020年5月首都医科大学附属北京朝阳医院收治的263例GDM患者,采用密西根糖尿病知识测试问卷(DKT)、一般自我效能感量表(GSES)、健康促进生活方式量表Ⅱ(HPLPⅡ)分别对患者认知程度、自我效能、健康生活方式进行评估,并检测空腹血糖(FPG)、糖化血红蛋白(HbA1c)水平,统计比较不同人口学特征患者FPG、HbA1c水平,采用Pearson分析DKT、GSES、HPLPⅡ评分之间及与FPG、HbA1c水平的相关性,采用依次检验法检验认知程度和自我效能在健康生活方式与血糖水平的链式中介效应,并用Bootstrap法进行验证。结果(1)259例GDM患者FPG水平为(6.35±1.03)mmol/L,HbA1c为(7.81±0.52)%;体质量指数为18.5~24 kg/m^(2)、24~28 kg/m^(2)、≥28 kg/m^(2)的患者及有、无运动习惯患者FPG、HbA1c比较,差异具有统计学意义(P<0.05);(2)259例GDM患者DKT评分为(13.68±8.14)分,GSES评分为(2.05±0.34)分,HPLPⅡ评分为(128.97±20.66)分;Pearson相关性分析显示,DKT(r=–0.540,P<0.001)、GSES(r=–0.380,P<0.001)、HPLPⅡ评分(r=–0.517,P<0.001)均与FPG呈负相关;DKT(r=–0.603,P<0.001)、GSES(r=–0.415,P<0.001)、HPLPⅡ评分(r=–0.482,P<0.001)均与HbA1c呈负相关;(3)DKT评分与GSES(r=0.645,P<0.001)、HPLPⅡ评分(r=0.690,P<0.001)呈正相关,GSES评分与HPLPⅡ评分(r=0.580,P<0.001)呈正相关;(4)中介效应检验程序和中介模型检验得知,认知程度、自我效能是健康生活方式与FPG间的中介变量,认知程度和自我效能在健康生活方式与FPG、HbA1c之间起链式中介效应。结论健康生活方式不仅能直接作用于GDM患者的血糖水平,还能通过认知程度和自我效能的中介效应,认知程度-自我效能的链式中介效应间接作用于血糖控制水平。

Objective To explore the chain mediated effect of cognition and self-efficacy on healthy lifestyles and blood glucose levels in patients with gestational diabetes mellitus(GDM).Methods A total of 263 GDM patients admitted to Beijing Chaoyang Hospital,Capital Medical University from January 2017 to May 2020 were selected.The Michigan Diabetes Knowledge Test Questionnaire(DKT),General Self-Efficacy Scale(GSES),and Health Promoting Lifestyle ProfileⅡ(HPLPⅡ)were used to evaluate patients’cognition,self-efficacy,and healthy lifestyle.The fasting plasma glucose(FPG)and glycosylated hemoglobin(HbA1 c)levels were measured,and the FPG and HbA1 c levels of patients with different demographic characteristics were statistically compared.Pearson was used to analyze the correlation between DKT,GSES and HPLPⅡscores and with FPG and HbA1 c levels.The chain mediating effects of cognitive level and self-efficacy on healthy lifestyle and blood glucose level were tested by sequential test,and verified by bootstrap method.Results(1)The FPG level of 259 GDM patients was(6.35±1.03)mmol/L,and the HbA1 c was(7.81±0.52)%.There were statistically significant differences in FPG and HbA1 c between patients with body mass index of 18.5–24 kg/m^(2),24-28 kg/m^(2),≥28 kg/m^(2) and patients with and without exercise habits(P<0.05).(2)The DKT score of 259 GDM patients was(13.68±8.14)points,the GSES score was(2.05±0.34)points,and the HPLPⅡscore was(128.97±20.66)points.Pearson correlation analysis showed that DKT(r=–0.540,P<0.001),GSES(r=–0.380,P<0.001),HPLPⅡscore(r=–0.517,P<0.001)were all negatively correlated with FPG.DKT(r=–0.603,P<0.001),GSES(r=–0.415,P<0.001),HPLPⅡscore(r=–0.482,P<0.001)were negatively correlated with HbA1 c.(3)DKT score was positively correlated with GSES(r=0.645,P<0.001)and HPLPⅡscore(r=0.690,P<0.001),and GSES score was positively correlated with HPLPⅡscore(r=0.580,P<0.001).(4)The mediating effect test procedure and mediating model test show that cognitive level and self-efficacy are the mediating variables between healthy lifestyle and FPG,and cognitive level and self-efficacy play a chain mediating effect between healthy lifestyle and FPG and HbA1 c.Conclusion Healthy lifestyle can not only directly affect the blood glucose level of GDM patients,but also indirectly affect the blood glucose control level through the intermediary effect of cognitive level and self-efficacy,and the chain intermediary effect of cognitive level self-efficacy.