Impact of fear of hypoglycaemia on self-management in patients with type 2 diabetes mellitus: structural equation modelling

Abstract

Aims: This study aimed to explore the effect of fear of hypoglycaemia (FOH) on self-management and its specific action path in patients with type 2 diabetes mellitus (T2DM) to provide a basis for developing targeted nursing interventions.

Design: A cross-sectional study.

Methods: From June to October 2019, we recruited 258 patients with T2DM from the endocrinology department of three hospitals to complete questionnaires, including the Hypoglycaemia Fear Survey-II, Diabetes Distress Scale, Self-Stigma Scale, Social Support Rating Scale and Summary of Diabetes Self-Care Activities, in Jiangsu Province, China. Pearson's correlation analyses and structural equation modelling were conducted to explore the relationship and influence path among the above variables.

Results: The correlation analysis of FOH, distress, self-stigma, social support and self-management showed that, except for social support not being correlated with FOH and distress (P > 0.05), all variables were correlated in pairs (r = - 0.19-0.77, P < 0.01). The final model fit well, and the fitting indexes of the model were as follows: χ²/df = 2.191, GFI = 0.934, CFI = 0.954, TLI = 0.934, RMSEA = 0.068, and SRMR = 0.0649. The effects of FOH on self-management in patients with T2DM included one direct path and two indirect paths: (a) FOH had a direct impact on self-management (P < 0.05); (b) FOH had an indirect impact on self-management through distress (P < 0.05); and (c) FOH had an indirect impact on self-management through self-stigma and social support (P < 0.05).

Conclusions: FOH could directly influence self-management in patients with T2DM. Furthermore, distress, self-stigma and social support were important mediating variables of FOH influencing self-management. Researchers can develop personalized interventions to improve the self-management of patients with T2DM by regulating distress, self-stigma and social support levels.

Keywords: Distress; Fear of hypoglycaemia; Self-management; Self-stigma; Social support; Type 2 diabetes mellitus.