胰岛素治疗糖尿病患者低血糖感知受损现状及心理因素分析

The prevalence and contributing factors of impaired awareness of hypoglycemia in people treated with insulin for diabetes mellitus

目的调查并分析胰岛素治疗糖尿病患者低血糖感知受损的发生现状及其心理影响因素。方法于2022年6月—9月,采用便利抽样法选取安徽省某两所综合性医院内分泌病房和糖尿病体检中心的251例接受胰岛素治疗的糖尿病患者作为调查对象。采用一般资料调查表、Gold评分和Clarke问卷、爱丁堡低血糖症状量表、低血糖感知信念问卷、低血糖应对信心问卷及简易应对问卷进行评估。基于单因素分析和相关性分析结果,采用多元线性回归分析相关心理变量对低血糖感知水平的独立贡献。结果低血糖感知受损的发生率为28.7%~31.5%,多元线性回归分析结果显示,在控制年龄和糖化血红蛋白因素后,低血糖症状体验、低血糖应对信心和低血糖感知信念是低血糖感知受损的独立影响因素(P<0.001),共解释低血糖感知水平44.3%的变异。结论胰岛素治疗糖尿病患者低血糖感知水平受多因素综合影响。临床医护人员应重视胰岛素治疗糖尿病患者的低血糖感知状态以及低血糖发生情况的评估,包括个体的症状体验和强度;引导或修正个体形成正确的低血糖感知信念;提高低血糖应对信心,预防或改善低血糖感知受损结局。

Objective To investigate the hypoglycemic awareness status of insulin-treated people with diabetes and to analyze its influencing factors.Methods A total of 251 individuals with insulin-treated diabetes in the endocrine wards and diabetic physical examination centres of 2 comprehensive hospitals in Anhui Province were recruited as respondents from June to September 2022.General information questionnaire,Gold score and Clarke questionnaire,Edinburgh symptom scale,attitudes to awareness of hypoglycemia questionnaire,hypoglycemia confidence questionnaire and ways of coping questionnaire were used for assessment.Multivariate regression analysis was used to investigate the independent influences on hypoglycemia awareness,based on the results of univariate and correlation analyses.Results The prevalence of impaired awareness of hypoglycemia(IAH)ranged from 28.7%to 31.5%.Regression analysis showed that hypoglycemic symptom experience,hypoglycemic confidence and attitudes to awareness of hypoglycemia contributed independently to IAH(P<0.001),in total accounting for 44.3%of the variation in hypoglycemia awareness.Conclusion The hypoglycemic awareness state in diabetes is influenced by a combination of factors and deserves further attention and research.Healthcare providers should focus on identifying and quantifying hypoglycemic awareness states and assessing hypoglycemic symptoms,guiding or modifying individuals to form correct hypoglycemic cognitive beliefs,and helping patients improve their hypoglycemic coping skills and ultimately to reverse IAH outcomes.