自我管理干预中情绪变化在老年2型糖尿病患者管理行为与生存质量间的中介效应  

Mediating effects of emotional changes on management behavior and quality of life in elderly patients with type 2 diabetes mellitus in self-management intervention

作　　者：付文[1] 徐珏[1] 姜彩霞[1] 刘庆敏[1] 刘仕俊[1] 裘欣[1] Fu Wen;Xu Jue;Jiang Caixia;Liu Qingmin;Liu Shijun;Qiu Xin(Hangzhou Center for Disease Control and Prevention,Hangzhou 310017)

机构地区：[1]杭州市疾病预防控制中心,杭州310017

出　　处：《中华老年医学杂志》2023年第9期1123-1128,共6页Chinese Journal of Geriatrics

基　　金：杭州市科技局农业与社会发展一般项目(20201203B207)。

摘　　要：目的 分析自我管理干预中情绪变化在老年2型糖尿病患者管理行为与生存质量之间的中介效应,为改善老年糖尿病患者情绪状态及以后的社区自我管理干预提供参考.方法 2016-2020年杭州市共组建69个自我管理小组,每组招募10~15例2型糖尿病患者.依托医联体建设及家庭医生签约服务资源,组建干预团队,以小组为单位开展系列团体自我管理活动.在干预前、后及干预后6个月,通过问卷调查方式收集患者基本人口学信息、疾病状况、情绪、生存质量及自我管理行为情况,评估干预效果,并分析情绪、自我管理行为、生活质量变化的相关性,采用Bootstrap进行中介效应检验.结果 最终707例老年糖尿病患者纳入研究.干预前、后及干预后6个月焦虑自评量表(SAS)得分、抑郁自评量表得分(SDS),健康调查简表(SF-36)的生理机能、生理职能、躯体疼痛、一般健康状况、精力、社会功能、情感职能、精神健康、生理健康、心理健康维度得分,2型糖尿病自我管理行为量表(2-DSCS)的饮食控制、规律锻炼、遵医嘱服药、血糖监测、足部护理、预防与处理高低血糖维度得分及2-DSCS总分差异均有统计学意义(均P<0.05).除干预后血糖监测维度变化值与情绪变化值无明显相关外,干预后、干预后6个月较干预前SAS、SDS变化值及生理健康、心理健康变化值与2-DSCS各维度变化值均呈相关(r=-0.336~0.333,P<0.05).老年2型糖尿病患者自我管理行为对生存质量的直接效应为0.159,自我管理行为通过情绪对生存质量产生的间接效应为0.229,中介效应占总效应的59.02%.结论 社区团体自我管理活动可有效改善老年糖尿病患者情绪、管理行为,并提升生存质量,且情绪变化在自我管理行为与生存质量改善之间存在一定中介作用.Objective To analyze the mediating effects of emotional changes in self-management interventions on the relationship between behavioral management and quality of life in elderly patients with type 2 diabetes and therefore to provide a reference for improving the emotional status of elderly diabetes patients and future community-based self-management interventions.Methods From 2016 to 2020,a total of 69 self-management groups were formed in Hangzhou,each consisting of 10-15 patients with type 2 diabetes.Based on the construction of a medical consortium and family doctors signing up to provide services,intervention teams were established to conduct a series of group self-management activities for each group.Surveys via questionnaires were conducted before and after the intervention,as well as 6 months after the intervention,to collect patient data on demographics,disease status,emotions,quality of life,and self-management behaviors.The intervention effects were evaluated,and the correlations between emotional changes,self-management behaviors,and changes in quality of life were analyzed.Bootstrap analysis was used to test the mediating effects.Results A total of 707 elderly diabetes patients were included.There were statistically significant differences in the scores of the Self-Rating Anxiety Scale(SAS),the Self-Rating Depression Scale(SDS),physical functioning,role-physical,bodily pain,general health,vitality,social functioning,role-emotional,mental health,physical component summary,mental component summary,the dietary control dimension of the type 2 diabetes self-care scale(2-DSCS),regular exercise,medication adherence,blood glucose monitoring,foot care,the dimension of prevention and management of hyperglycemia and hypoglycemia,and the total score of 2-DSCS(P<0.05 for all).Compared with pre-intervention,changes in SAS,SDS,physical component summary and mental component summary scores were all correlated with each dimension of 2-DSCS right after intervention and 6 months after intervention(r=-0.336-0.333,P<0.05)

关 键 词：2型糖尿病 情绪 生存质量 自我管理行为 中介效应 

分 类 号：R473.5[医药卫生—护理学]