2型糖尿病患者低血糖恐惧行为的质性研究

A qualitative research on the behaviors caused by fear of hypoglycemia in type 2 diabetic patients

目的：探索2型糖尿病患者因恐惧低血糖而做出的行为改变，并深入分析这些行为产生的原因，帮助医护人员充分了解低血糖患者的内心需求，实现血糖的有效管理，并为制定适合国内2型糖尿病患者的低血糖恐惧调查-行为量表（Hypoglycemia Fear Survey-behavior scale，HFS-BS）奠定基础。方法以知信行理论及社会认知理论为理论基础设计访谈提纲，采用解释现象学分析法，对5所不同级别医院的33例2型糖尿病低血糖患者进行半结构式访谈，分析访谈结果。结果提炼出4个主题，分别为敏感、谨慎、回避、妥协，其中敏感包含警惕性加餐、药物敏感、过度应对3种行为，谨慎包含力求血糖平稳、必备食物2种行为。结论研究结果显示，2型糖尿病患者对低血糖的恐惧心理严重，并为避免发生低血糖做出了行为改变，严重影响患者的生命质量及血糖管理。医护人员应重视低血糖患者的内心感受及行为，全面评估患者后作出适当的引导支持，与患者共同努力，实现血糖的有效管理。

Objective To explore the behaviors caused by fear of hypoglycemia in type 2 diabetic patients, and deeply analyze the causes of these behaviors, providing help for medical staff to fully understand the inner demands of diabetic patients with hypoglycemia, so as to manage the blood glucose effectively, laying the foundation of Hypoglycemia Fear Survey-behavior scale suitable for domestic type 2 diabetic patients. Methods The interpretative phenomenological analysis method was used guided by the knowledge-attitude-belief-practice and social cognitive theory, 33 patients with hypoglycemia from 5 hospitals with different levels were interviewed by semi-structured interview. Results Four themes were extracted, including excess sensitivity, caution, avoidance and compromise. The theme excess sensitivity contained three kinds of behaviors, that were meal with sensitive alertness, drug sensitivity and excessive response to the hypoglycemia, while the theme caution contained two kinds of behaviors, that were strive to blood sugar stable and must prepare food. Conclusions The results show that the fear of hypoglycemia is serious in type 2 diabetic patients, and they make many behavior change to avoid it, affecting their quality of life and glycemic management. Medical staff should attach importance to the inner feelings and behaviors of diabetic patients with hypoglycemia, and provide guidance and support after comprehensive assessment, working together with the patient to realize the effective management of blood glucose.