| ObjectiveThe objective of this research is to explore the diabetes stigma current situation among young and middle-aged patients with type 2 diabetes in China and analyze the influence of diabetes stigma on emotion,behaviour and glycemic control,and further explore the effect of psychosocial moderators(hope,self-esteem,social support),and provide a reference for the optimization of self-control of blood sugar level among among young and middle-aged patients with type 2 diabetes and the improvement of the knowledge system of diabetes management,and provide scientific guidance for promoting the physical and mental health.Methods1.The first stage is cross sectional research.I choose the young and middle-aged patients with type 2 diabetes hospitalized in the Department of Endocrinology,the First Affiliated Hospital of Soochow University from November 2021 to December 2022 as the research objective by using convenient sampling method.The Type 2 Diabetes Stigma Assessment Scale(DSS-2)was used to evaluate the level of diabetes stigma in patients with type 2 diabetes.The hospital anxiety and depression scale(HADS)investigated the emotional status(anxiety and depression)of patients with type 2 diabetes.the Appraisal of Diabetes Scale(ADS)is used to evaluate the psychological stress of type 2 diabetes patients.The Summary of Diabetes Self-Care Activities Measure(SDSCA)was used to investigate the self-management status of diabetes of the subjects.HbAlc values were collected from venous blood drawn by the medical staff of the undergraduate department during the study subjects’ hospitalization as a basis for assessing blood glucose control.With diabetes stigma score as independent variable and anxiety,depression,diabetes stress,self-care behavior and HbA1c as dependent variables,univariate and multiple linear regression models were constructed based on the control of confounding factors of each dependent variable to analyze the effects of diabetes stigma on emotion,behavior and blood glucose control.Herth Hope Index(HHI),Rosenberg Self-Esteem Scale and Social Support Rating were used Scale(SSRS)respectively investigated the hope,self-esteem and social support level of the subjects.Based on the previous research on the influence of diabetes stigma on emotion,behavior and blood sugar control,linear regression models were constructed with anxiety,depression and diabetes stress as dependent variables,diabetes stigma score as independent variables,and hope,self-esteem and social support as moderating variables,respectively,to analyze the moderating effects of social psychological factors on stigma,anxiety,depression and stress.At the same time,a simple slope analysis diagram is drawn with the adjustment effect model constructed by PROCESS3.3 software.2.The second stage is prospective observational research.The 300 young and middleaged patients with type 2 diabetes were followed up 3 months after discharge from hospital.The HbAlc values of the patients were collected using venous blood collected during hospitalization as baseline data,and the date of HbAlc retest was informed to the subjects who had been discharged three months in advance in order to collect their HbA1c values again.A total of 132 young and middle-aged patients with type 2 diabetes who provided a retest of HbA1c within a specified period of time were selected as the objects of a prospective observational study,with stigma as the independent variable and HbA1c at 3 months after discharge as the dependent variable,to explore the effect of diabetes stigma on blood glucose control.Results1.The stigma score of young and middle-aged patients with type 2 diabetes in China was 38.99±11.56.The scores of anxiety and depression were 5.44±3.56 and 3.91±3.28,respectively.There were 76 cases(25.3%)of anxiety and 45 cases(15.0%)of depression.The stress score of diabetes mellitus was 18.98±4.03,195 cases(65.0%)with low stress level(<21 points)and 105 cases(35.0%)with high stress level(≥21 points).The score of self-care behavior was 34.25±14.03,and the proportion of good self-care level was the largest(77.0%(231/300).The HbAlc range was 4.90%to 18.90%,with an average of 11.05±2.29%,in which 57.7%(173/300)had HAb1c≥10.51%.2.On the basis of controling confounding variables,the results of linear regression showed that diabetes stigma was positively correlated with anxiety(P<0.01),depression(P<0.01)and diabetes stress(P<0.01)in young and middle-aged patients with type 2 diabetes.The higher the level of stigma,the higher the level of anxiety,depression and diabetes.There was no significant correlation between diabetes stigma and self-care behavior(P>0.05)and HbAlc(P>0.05)in young and middle-aged patients with type 2 diabetes.3.The score of hope level,self-esteem level and social support level were 39.55± 4.73,30.39±3.49 and 44.57±6.68 respectively among young and middle-aged patients with type 2 diabetes in China.By building a linear regression model,it was expected to play a negative moderating role in the relationship between stigma and anxiety of diabetes mellitus(B=0.117,t=-2.222,P<0.05).The moderating effects of self-esteem(P>0.05)and social support(P>0.05)on stigma and anxiety were not significant.Hope(B=-0.126,t=-2.334,P<0.05),self-esteem(B=-0.144,t=-2.742,P<0.01)and social support(B=-0.122,t=-2.285,P<0.05)could negatively mediate the relationship between diabetic stigma and depression.Hope(P>0.05),self-esteem(P>0.05)and social support(P>0.05)had no significant mediating effects on diabetic stigma and diabetic stress.4.In a prospective study of 132 young and middle-aged patients with type 2 diabetes,the stigma score of this group was 39.03 ± 11.37,and the provided mean HbAlc value at 3 months after discharge was 6.92±1.46%.The results of linear regression analysis showed that stigma level of young and middle-aged patients with type 2 diabetes had no significant effect on HbA1c 3 months after discharge(P>0.05).Conclusions1.Stigma of young and middle-aged patients with type 2 diabetes in China is at a lower than medium level.2.Diabetes stigma was positively correlated with anxiety,depression and diabetes stress,and the levels of anxiety,depression and diabetes stress increased with the increase of stigma level.3.Hope can play a negative moderating role in the relationship between diabetes stigma and anxiety,and weaken the effect of stigma on anxiety.Hope,self-esteem and social support can negatively mediate the relationship between diabetes stigma and depression,and weaken the influence of stigma on depression.4.Clinical medical workers should pay more attention to psychological care for patients with diabetes,enhance psychological construction and promote their physical and mental health. |
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