Relationship Between Perceived Stress And Frailty In Older Women With Type 2 Diabetes In Community:a Moderated Mediation Model

Purpose:The study was aimed to investigate the prevalence of frailty among elderly women with type 2 diabetes in community,and to explore the influencing factors of frailty and the psycho-behavioral mechanism of the impact of perceived stress on frailty.Methods:From March to August in 2021,a convenient sampling method was used to investigate 486 elderly women with type 2 diabetes in 3 community health service centers in Chengdu.Surveys were completed face-to-face using self-designed general demographic questionnaire,clinical disease-related questionnaire,Chinese Perceived Stress Scale,Diabetes Self-Care Scale,The Positive and Negative Affect Scale,and Tilburg Frailty Scale.Data entry and analysis were performed using Excel(Microsoft Office),SPSS 25.0(IBM Corp.,Armonk,NY,USA)software and PROCESS V3.3 plugin.Descriptive analysis was carried out on the basic characteristics of research subjects.Two independent samples t test and χ2 test was used to compare the characteristic differences of each variable in the diabetes with frailty group and the diabetes without frailty group.Pearson correlation analysis was used to explore the correlation between perceived stress,diabetes self-management behavior,positive and negative affect and frailty.Logistic regression analysis was used to explore the influencing factors of frailty.Process V3.3 was used to build a mediating moderation model to test the mediating effect of diabetes self-management behavior on the relationship between perceived stress and frailty,as well as the moderating effect of positive and negative affect on the relationship between perceived stress and frailty,and finally to clarify the influencing mechanism between various variables.Results:1.Among 486 elderly women with type 2 diabetes in the community,150 patients developed into frailty,accounting for 30.86%of the total.2.Univariate analysis showed that there were statistical differences between frail group and non-frail group in terms of years of education,monthly household income,sleep quality,chronic complications of diabetes and hospitalization history of diabetes(P<0.05).The total score of Diabetes Self-Care Scale,diet,exercise,medication,blood glucose monitoring,high/low blood sugar management score and positive affect score in frailty group were lower than those in non-frail diabetes group,and the differences were statistically significant(P<0.01).The scores of Chinese Perceived Stress Scale and negative affect score in frailty group were higher than those in non-frail group,and the difference were statistically significant(P<0.001).3.Multivariate analysis showed that monthly household income more than 5,000 yuan was a protective factor for frailty(OR=0.56,P=0.01).Poor sleep quality was a risk factor for frailty(OR=1.74,P=0.01).The absence of chronic complications of diabetes(OR=0.59,P=0.01)and the absence of diabetes hospitalization in past 1 year(OR=0.54,P=0.01)were protective factors for frailty.Perceived stress was a risk factor for frailty(OR=1.18,P<0.001),and negative affect was also a risk factor for frailty(OR=1.18,P<0.001).4.The results of mediation analysis suggested the direct effect of perceived stress on frailty is 0.603,the indirect effect of diabetes self-management behavior is 0.034,and the total effect is 0.637.Diabetes self-management behavior plays a partial mediating role between perceived stress and frailty,and the mediating effect accounting for 5.34%of the total effect.5.The moderating effect showed that positive affect moderated the second half pathway of the relationship between diabetes self-management behavior and perceived stress and frailty(95%CI=[0.01,0.15]).The results of simple slope analysis showed that compared with the high positive affect level group,the diabetes self-management behavior of the low positive affect level group had a stronger negative predictive effect on frailty,and the reduction of frailty in the elderly community-based women with type 2 diabetes was significantly larger.The critical value of positive emotion regulation effect is 0.6982(data were normalized),within this range,the association between diabetes selfmanagement behavior and frailty gradually increased with the increase of positive affect.The association between diabetes self-management behavior and frailty disappeared when positive affect exceeded 0.6982.However,the moderating effect of negative affect was not significant in the first half path,the second half path and the direct path of the mediation model.Conclusion:The incidence of frailty among elderly women with type 2 diabetes in the community was 30.86%,which is relatively high.There are many factors influencing frailty in these patients,including household monthly income,sleep quality,diabetes complications,diabetes hospitalization history in past year,perceived stress,negative affect and so on.Self-management behavior of diabetes mediated the relationship between perceived stress and frailty.Positive affect moderated the latter half of the mediation model.The moderated mediation model was constructed in this study revealed part of the psychobehavioral mechanism underlying the effect of perceived stress on frailty in older women with type 2 diabetes in community.