The Relationship Between Hypoglycemia Fear And Self-management In Type 2 Diabetes Mellitus And Its Mediating Effect

ObjectiveThis study aims to investigate the current situation and influencing factors of hypoglycemic fear and self-management in patients with type 2 diabetes,explore the relationship among hypoglycemic fear,psychological pain,self-regulation fatigue and self-management,and then verify the chain mediating effect of psychological pain and self-regulation fatigue on hypoglycemic fear self-management.To provide theoretical support and research ideas for formulating targeted intervention measures in early clinical stage.MethodsIn this study,patients with type 2 diabetes were selected as subjects in the endocrinology outpatient Department of the Hospital,Jinzhou City,Liaoning Province from April 2021 to December 2021 according to the inclusion and exclusion criteria by convenience sampling method for cross-sectional investigation.A self-made general data Survey,Hypoglycemia Fear Survey(HFS),Diabetes Distress Scale(DDS),Self-Regulatory Fatigue Scale(SRF-S)and Summary of Diabrtrs Self-Care Activities(SDSCA)were used to evaluate the demographic characteristics,hypoglycemic fear,diabetes pain,self-regulation fatigue,and self-management level of patients with type 2 diabetes.SPSS 22.0,AMOS 24.0 and other statistical software were used for data analysis,and the bilateral test level α was 0.05.Descriptive statistics were used to analyze the basic situation of patients with type 2 diabetes;Person correlation analysis was used to explore the relationship among hypoglycemic fear,psychological distress,self-regulation fatigue and self-management;hierarchical regression and Bootstrap were used to verify the chain mediating effect between psychological distress and self-regulation fatigue in the self-management of hypoglycemic fear.Results1.A total of 340 subjects were included in this study,and the scores of hypoglycemia,fear-psychological distress,self-regulation fatigue and self-management of type 2 diabetes patients were(21.12±9.57),(55.84±16.59),(45.19±11.67)and(40.84±12.49),respectively.Independent sample T-test and univariate analysis showed age,sex,marital status,residence style,frequency,severity and fear of hypoglycemia.The level of self-management was significantly correlated(P<0.05).2.The hypoglycemic fear score of type 2 diabetes patients was positively correlated with the score of psychological distress(r=0.739,P<0.01)and self-regulation fatigue(r=0.739,P<0.01),and negatively correlated with the score of self-management level(r=-0.602,P<0.01);The score of psychological distress was positively correlated with the score of self-regulation fatigue(r=0.669,P<0.01),and negatively correlated with the score of self-management level(r=-0.609,P<0.01).The score of self-regulation fatigue was negatively correlated with the score of self-management(r=-0.596,P<0.01).3.Stratified regression showed that hypoglycemia phobia could explain6.8% of the variation in self-management activities;Self-regulation fatigue could explain 3.0% variation in self-management activities;Diabetic distress explained 1.0% of the variation in self-management activities.Path analysis showed that hypoglycemia phobia in type 2 diabetes patients could directly affect self-management behavior,could indirectly predict self-management level through self-regulated fatigue and psychological distress,and could negatively affect self-management behavior through the chain mediation of self-regulated fatigue and psychological distress(χ2/df = 3.079,PNFI=0.566,GFI=0.920,CFI=0.961,NFI=0.943,IFI=0.961,TLI=0.945,RMSEA=0.078).Conclusions1.Type 2 diabetes patients have higher hypoglycemic fear level and lower level of self-management behavior.Women who were elderly,divorced/widowed,lived alone,and self-reported hypoglycemia within six months had greater fear of hypoglycemia and lower self-management activities.2.Hypoglycemia phobia,self-regulation fatigue and diabetes pain negatively predicted the self-management level of diabetic patients.3.Hypoglycemia phobia in type 2 diabetes patients not only directly affects self-management behavior,but also has three indirect paths: partial mediating of self-regulated fatigue,partial mediating of psychological pain,and chain mediating of self-regulated fatigue and psychological pain.