Effect of fear of hypoglycaemia on sleep quality of patients with type 2 mellitus diabetes: The mediating role of alexithymia

Liuhong Tian; Ke Liu; Li Li; Wenwen Wu; Ningrui Zhang

doi:10.1016/j.heliyon.2024.e26137

Effect of fear of hypoglycaemia on sleep quality of patients with type 2 mellitus diabetes: The mediating role of alexithymia

Heliyon. 2024 Feb 9;10(4):e26137. doi: 10.1016/j.heliyon.2024.e26137. eCollection 2024 Feb 29.

Authors

Liuhong Tian¹, Ke Liu², Li Li³, Wenwen Wu^{4

5

6}, Ningrui Zhang⁶

Affiliations

¹ School of Public Health and Management, Wenzhou Medical University, Wenzhou, 325035, Zhejiang Province, China.
² School of Public Health, Guangzhou Medical University, Guangzhou, 511436, Guangdong Province, China.
³ Institute for Evidence-Based Nursing, Renmin Hospital, Hubei University of Medicine, Shiyan, 442000, Hubei Province, China.
⁴ Sinopharm Dongfeng General Hospital (Hubei Clinical Research Center of Hypertension) , Hubei University of Medicine, Shiyan, 442000, China.
⁵ Center of Health Administration and Deve1opment Studies, Hubei University of Medicine, Shiyan, 442000, China.
⁶ School of Public Health, Hubei University of Medicine, Shiyan, 442000, Hubei Province, China.

Abstract

Background: Patients with type 2 diabetes mellitus (T2DM) commonly experience poor sleep quality. This study aimed to investigate whether alexithymia mediates the association between fear of hypoglycaemia (FoH) and sleep quality in patients with T2DM.

Methods: From September 2021 to November 2021, a cross-sectional survey was conducted on 407 patients with T2DM in China. Data collection was made possible through the administration of the Chinese Version of the Worry Scale, Toronto Alexithymia Scale and Chinese version of the Pittsburgh Sleep Quality Index (CPSQI). Multiple linear regression analyses were also performed.

Results: A total of 65.6% of the participants were male, and 75.7% were aged 18-40 years. FoH showed a moderate and positive correlation with CPSQI scores (r = 0.308, p < 0.001). Alexithymia was weakly and positively correlated with CPSQI scores (r = 0.185, p < 0.001). Meanwhile, FoH exhibited a moderate and positive correlation with alexithymia (r = 0.422, p < 0.001), and difficulty in identifying (r = 0.414, p < 0.001) and describing feelings (r = 0.416, p < 0.001) and a weak and positive correlation with externally oriented thinking (r = 0.221, p < 0.001). The total effect (β = 0.408, p < 0.001) of FoH on CPSQI comprised not only the direct (β = 0.293, 95% confidence interval: 0.174-0.411, p < 0.001) but also the indirect effect (β = 0.115, p < 0.001) of alexithymia.

Conclusions: Alexithymia can mediate the association between FoH and sleep quality. Clinicians should recognize the potential effect of alexithymia and incorporate it in intervention planning and care. Addressing the affective disturbances arising from FoH can enhance emotional expression and sleep quality among T2DM patients.

Keywords: Alexithymia; Diabetes; Fear of hypoglycaemia; Sleep quality.