| Objectives1.To understand the current situation and influencing factors of fear of hypoglycemia in patients with type 2 diabetes mellitus.2.To explore the relationship between impaired awareness of hypoglycemia,medical support,diabetes self-management attitude and fear of hypoglycemia in patients with type 2 diabetes mellitus.3.Based on the BCW theory,construct an intervention plan to improve the fear of hypoglycemia in patients with type 2 diabetes mellitus,and preliminarily verify the intervention effect,providing a reference and basis for effectively reducing the level of fear of hypoglycemia in patients with type 2 diabetes mellitus.Methods1.212 patients with type 2 diabetes mellitus who were hospitalized in the endocrinology departments of 2 tertiary hospitals in Yangzhou,Jiangsu Province were selected as the subjects for a cross-sectional study from February 2021 to July 2021 according to the inclusion and exclusion criteria.In this study,the sociodemographic and disease-related information of patients with type 2 diabetes mellitus was assessed using self-designed general information questionnaire;the Hypoglycemia Fear Survey（HFS）,Gold scores,the Patients Assessment Chronic Illness Care（PACIC）,the self-management attitude scale for diabetes patients were used to assess patients’ levels of fear of hypoglycemia,impaired hypoglycemia awareness,medical support and diabetes self-management attitude.2.Totally 50 patients with type 2 diabetes mellitus were selected from the endocrinology departments of 2 tertiary hospitals in Yangzhou from August 2021 to January 2022 according to the inclusion and exclusion criteria,and were randomly divided into the intervention group（n=25）and the intervention group（n=25）by drawing lots.Control group patients were given routine diabetes health education for four weeks,while intervention group patients were given health education based on BCW theory and routine diabetes health education for four weeks.The levels of fear of hypoglycemia,impaired hypoglycemia awareness,medical support and diabetes self-management attitude were compared between the two groups before the intervention,four weeks after the intervention,and eight weeks after the intervention.3.The data were analyzed using SPSS 26.0 software and AMOS 24.0 software.Statistical methods included:descriptive analysis,independent sample t-test,paired sample t-test,oneway analysis of variance,nonparametric tests,chi-square test,multiple linear regression,Pearson correlation analysis,structural equation model and repeated measurement analysis of variance,P<0.05 was considered statistically significant.Results1.Study on the current situation and influencing factors of fear of hypoglycemia in patients with type 2 diabetes mellitusThis investigation was conducted on 212 patients with type 2 diabetes mellitus included in the study and found different levels of fear of hypoglycemia in patients with type 2 diabetes mellitus,with the scores of the Hypoglycemia Fear Survey,Behavior Subscale and Worry Subscale were（74.88±18.28）,（56.04±10.22）and（18.84±10.99）,respectively.Univariate analysis showed that fear of hypoglycemia was associated with BMI,number of complications,medication and treatment regimen,smoking,frequency of blood glucose monitoring,frequency of hypoglycemia in the past six months,severe hypoglycemia,nocturnal hypoglycemia,degree of understanding of hypoglycemia,impaired awareness of hypoglycemia,level of medical support and self-management attitude（P<0.05）.The results of multivariate linear analysis showed that the frequency of blood glucose monitoring,frequency of hypoglycemia in the past six months,degree of understanding of hypoglycemia,impaired awareness of hypoglycemia,medical support and diabetes self-management attitude were influential factors for fear of hypoglycemia in patients with type 2 diabetes mellitus（F=14.800,P<0.001）,which explained 57.9%of the total variance.2.Study on the relationship between impaired awareness of hypoglycemia,medical support and diabetes self-management attitude and fear of hypoglycemia in patients with type 2 diabetes mellitusAmong the 212 patients with type 2 diabetes mellitus surveyed,the average score of impaired awareness of hypoglycemia was（1.99±1.22）,of which 11.8%had impaired hypoglycemia awareness.The average score of PACIC was（3.78±0.50）,of which the dimensions with the lowest and highest score were goal setting/personal treatment and service system design/practice design,with scores of（3.33±0.59）and（4.17±0.49）respectively.The mean score of the Diabetes Self-Management Attitude Scale was（4.40±0.56）.There were significant correlations between fear of hypoglycemia and impaired awareness of hypoglycemia,medical support and self-management attitude.The structural equation model between fear of hypoglycemia and impaired awareness of hypoglycemia,medical support and self-management attitude based on the BCW-COMB model was well fitted,and the fitting indicators were as follows:x2=50.048,df=23,x2/df=2.176,GFI=0.959,AGFI=0.908,CFI=0.981,NFI=0.965,IFI=0.981,RMSEA=0.075.The relationship between impaired awareness of hypoglycemia,medical support,self-management attitude and fear of hypoglycemia in patients with type 2 diabetes mellitus included 3 direct pathways and 2 indirect pathways（P<0.05）,including:①impaired awareness of hypoglycemia→fear of hypoglycemia;②medical support→fear of hypoglycemia;③ self-management attitude→fear of hypoglycemia;④impaired awareness of hypoglycemia→self-management attitude→fear of hypoglycemia;⑤medical support→self-management attitude→fear of hypoglycemia.3.Construction and preliminary validation of intervention program for fear of hypoglycemia in type 2 diabetes patients based on BCW theory（1）There was no significant difference in the general demographic data,fear of hypoglycemia,impaired awareness of hypoglycemia,medical support and self-management attitude between the two groups（P>0.05）before the intervention,and the two groups were comparable.（2）There were statistically significant differences in the inter-group effect and primary time effect of fear of hypoglycemia after the intervention（P<0.001,P<0.001）,and there was an interaction between the intervention factor and the time factor（P<0.001）.The fear of hypoglycemia in the two groups showed a downward trend with the prolongation of the intervention time.The level of hypoglycemia fear in the intervention group was significantly lower than that in the control group at four weeks after the intervention and eight weeks after the intervention（P<0.001）.（3）There was no statistically significant difference in the inter-group effect of impaired awareness of hypoglycemia（P>0.05）after the intervention,while the primary time effect were statistically significant（P<0.001）,and there was an interaction between the intervention factor and the time factor（P<0.001）.The impaired awareness of hypoglycemia in the two groups showed a downward trend with the prolongation of the intervention time.The level of impaired awareness of hypoglycemia in the intervention group was significantly lower than that in the control group at four weeks after the intervention and eight weeks after the intervention（P<0.001）.（4）There were statistically significant differences in the inter-group effect and primary time effect of medical support after the intervention（P<0.001,P<0.001）,and there was an interaction between the intervention factor and the time factor（P<0.001）.The level of medical support in the two groups showed an upward trend with the prolongation of the intervention time.The level of medical support in the intervention group was significantly higher than that in the control group at four weeks after the intervention and eight weeks after the intervention（P<0.001）.（5）There were statistically significant differences in the inter-group effect and primary time effect of self-management attitude after the intervention（P<0.05,P<0.001）,and there was an interaction between the intervention factor and the time factor（P<0.05）.The level of self-management attitude in the two groups showed an upward trend with the prolongation of the intervention time.The level of self-management attitude in the intervention group was significantly higher than that in the control group at four weeks after the intervention and eight weeks after the intervention（P<0.001）.Conclusion1.The fear of hypoglycemia was more common in patients with type 2 diabetes mellitus.The frequency of blood glucose monitoring,frequency of hypoglycemia in the past six months,understanding of hypoglycemia,impaired awareness of hypoglycemia,medical support and diabetes self-management attitude were the influencing factors of hypoglycemia fear in patients with type 2 diabetes mellitus.Therefore,medical staff should strengthen the early screening of hypoglycemia fear in patients with type 2 diabetes mellitus,and can also formulate targeted interventions to reduce the fear of hypoglycemia in patients on the basis of summarizing the above influencing factors.2.Based on the BCW-COMB theoretical model,the influence pathways of impaired awareness of hypoglycemia,medical support,and self-management attitudes on fear of hypoglycemia in patients with type 2 diabetes mellitus include 3 direct pathways and 2 indirect pathways:impaired awareness of hypoglycemia,medical support and Self-management attitude can directly affect fear of hypoglycemia;and impaired awareness of hypoglycemia and medical support can indirectly affect hypoglycemia fear through the mediating effect of self-management attitude.The results clearly presented the internal mechanism of various variables affecting the fear of hypoglycemia in patients with type 2 diabetes mellitus,and provided a theoretical basis for the formulation of intervention measures for fear of hypoglycemia in the future.3.Health education based on BCW theory can effectively improve the level of fear of hypoglycemia,impaired awareness of hypoglycemia,medical support and self-management attitude in patients with type 2 diabetes mellitus,which provides theoretical basis for clinical medical staff to formulate effective intervention strategies for fear of hypoglycemia in patients with type 2 diabetes mellitus. |
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