2型糖尿病患者恐惧疾病进展与血糖控制水平的关系：自我效能的中介作用

目的探讨2型糖尿病（type 2 diabetes mellitus, T2DM）患者恐惧疾病进展（fear of progression, FOP）与血糖控制水平的关系,分析自我效能在两者间的中介作用,为优化患者血糖控制水平提供参考依据。方法采用便利抽样法选取245例住院的T2DM患者为调查对象,检测患者糖化血红蛋白（glycated hemoglobin, HbA1c）水平,采用一般资料调查表、FOP简化量表、糖尿病自我效能量表（diabetes management self-efficacy scale, DMSES）对患者进行调查。结果 245例患者HbA1c水平为（9.22±1.92）%,72.7%（178/245）的患者血糖控制不理想;FOP总分为（28.02±8.66）分,31.4%（77/245）患者因过度FOP而导致心理功能失调;DMSES总分为（130.85±37.27）分,64.5%（158/245）的患者得分处于中等水平。FOP与血糖控制水平呈正相关（r=0.207,P<0.01）,自我效能与血糖控制水平呈负相关（r=-0.297,P<0.01）,自我效能在FOP及血糖控制水平间存在完全中介作用（P<0.01）。结论 FOP显著影响T2DM患者血糖控制水平,且主要通过自我效能的完全中介作用实现。避免患者产生过度的FOP心理、提高自我效能水平是血糖控制良好的有效措施。

Relationship between Fear of Disease Progression and Glycemic Control in Patients with Type 2 Diabetes Mellitus:the Mediating Role of Self-Efficacy

Objective To analyze the relationship between fear of progression(FOP)and glycemic control and the mediating effect of self-efficacy in patients with type 2 diabetes mellitus(T2DM),and to provide reference for optimizing blood glucose control.Methods Totally 245 T2DM patients were recruited by convenient sampling method.Levels of glycated hemoglobin(HbA1c)were detected in all patients.In addition,patients were surveyed using the general information questionnaire,FOP Questionnaire-Short Form,and Diabetes Management Self-Efficacy Scale(DMSES).Results The average level of HbA1c was(9.22±1.92)%,and 72.7%of the patients(178/245)had poor glycemic control.The total FOP score was(28.02±8.66),and 31.4%of the patients(77/245)suffered from psychological dysfunction due to excessive FOP.The total DMSES score was(130.85±37.27),and 64.5%(158/245)of the patients were scored in the moderate level.There was a positive correlation between FOP and glycemic control(r=0.207,P<0.01).In contrast,self-efficacy was negatively related to glycemic control(r=-0.297,P<0.01).Self-efficacy played a totally mediating role between FOP and glycemic control(P<0.01).Conclusion The FOP affects glycemic control through the intermediation of self-efficacy in patients with T2DM.Avoiding excessive FOP and improving self-efficacy are effective measures to ensure glycemic control.