低血糖对2型糖尿病患者自我管理行为影响的路径分析

Impact of hypoglycemia on self-management in patients with type 2 diabetes mellitus:a path analysis

目的探讨低血糖对2型糖尿病(T2DM)患者自我管理行为的影响及路径分析。方法为横断面研究。采用便利抽样法,选择自2019年3至8月在天津医科大学朱宪彝纪念医院住院的1180例T2DM患者作为研究对象。使用自行设计的一般资料调查表、中文版低血糖恐惧-忧虑量表(CHFSII-WS)、低血糖感知受损评估表-Gold法、糖尿病自我管理行为量表(SDSCA)进行问卷调查。采用路径分析方法探索低血糖与自我管理行为的关系。组间比较采用t检验、单因素方差分析。采用多元线性回归分析法分析低血糖对T2DM患者自我管理行为的影响。运用AMOS 24.0软件进行路径分析,使用偏差校正的非参数百分位Bootstrap方法检验间接效应。结果患者SDSCA总分为(32.1±14.2)分。单因素分析结果显示,不同低血糖频次、低血糖类型、低血糖预防教育、低血糖恐惧感和低血糖感知状况的T2DM患者的SDSCA得分差异均有统计学意义(P<0.001)。多元线性回归分析结果显示,假性低血糖、症状性低血糖、参加低血糖预防教育、低血糖恐惧感得分≥10分、没有发生过低血糖是T2DM患者自我管理行为的影响因素(β=-0.216~0.218,均P<0.05)。路径分析结果显示,低血糖预防教育、低血糖类型对T2DM患者自我管理行为产生直接效应和间接效应,总效应值分别为0.257、0.177;低血糖恐惧感有直接效应,效应值为0.155;低血糖感知状态有间接效应,效应值为0.03。结论低血糖预防教育、低血糖类型、低血糖恐惧感和低血糖感知状态对T2DM患者自我管理行为有正向作用。

Objective To explore the effect of hypoglycemia on self-management behavior and its function route in patients with type 2 diabetes mellitus(T2DM).Methods This study was a cross-sectional study.A total of 1180 patients who were hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital from March to August 2019,were investigated by convenient sampling.The subjects were surveyed by the questionnaires including the self-designed General Demographic Information Questionnaire,the Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale(CHFSII-WS),hypoglycemia perception impairment-Gold method,and the Summary of Diabetes Self Care Activities(SDSCA).The path analysis model was conducted to explore the relationship between hypoglycemia and self-management behavior in T2DM patients.The t test and one-way analysis of variance(ANOVA)were used for comparison between groups.Multiple linear regression analysis was used to analyze the impact of hypoglycemia on self-management with T2DM.The path analysis was conducted using AMOS 22.0 software.Nonparametric percentile Bootstrap method of bias correction was adopted to test indirect effects.Results The total score of SDSCA was(32.1±14.2)points.Single factor analysis showed that the scores of self-management behavior in T2DM patients was significantly associated with the frequency of hypoglycemia,type of hypoglycemia,hypoglycemia prevention education,fear of hypoglycemia,hypoglycemia awareness state(all P<0.001).Multiple linear regression analysis showed that pseudo-hypoglycemia,documented symptomatic hypoglycemia,hypoglycemia prevention education and the scores of CHFSII-WS≥10 points,no experience of hypoglycemia were the influencing factors of self-management behavior(β=-0.216-0.218,all P<0.05)in T2DM patients.Hypoglycemia prevention education,hypoglycemia types had direct and indirect effects on the self-management behavior of T2DM patients,with the total effect values of 0.257 and 0.177,respectively.The effect value of fear of hypoglycemia had a direct effect of 0.155,and the effect value of hypoglycemia awareness state had an indirect effect of 0.032.Conclusions Hypoglycemia prevention education,hypoglycemia types,fear of hypoglycemia and hypoglycemia awareness state have a positive effect on the self-management behavior of T2DM patients.