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Article(id=1241329582696092039, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202502060, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1738771200000, receivedDateStr=2025-02-06, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773885635302, onlineDateStr=2026-03-19, pubDate=1752076800000, pubDateStr=2025-07-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773885635302, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773885635302, creator=13701087609, updateTime=1773885635302, updator=13701087609, issue=Issue{id=1241329570129956900, tenantId=1146029695717560320, journalId=1227665162245664772, year='2025', volume='52', issue='13', pageStart='2305', pageEnd='2496', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773885632307, creator=13701087609, updateTime=1773885763730, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241330121425080472, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241330121425080473, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241329570129956900, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=2444, endPage=2449, ext={EN=ArticleExt(id=1241329583199408547, articleId=1241329582696092039, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Current status and influencing factors of fear of hypoglycemia in elderly patients with type 2 diabetes based on random forest model, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the status and influencing factors of fear of hypoglycemia (FoH) in elderly patients with type 2 diabetes mellitus (T2DM), providing evidence for improving glycemic management and psychological health.

Methods

From March 2022 to January 2023, 302 elderly T2DM patients from three tertiary hospitals in Chengdu were assessed using general information questionnaires, Hypoglycemia Fear Survey-Worry Scale, Social Support Rating Scale, and Connor-Davidson Resilience Scale.

Results

The mean FoH score was 33.009±11.243, indicating high overall fear levels. Random forest model screening (optimal λ=0.77925) identified seven key factors in descending importance: psychological resilience, social support, subjective support, objective support, support utilization, hypoglycemia type, and education level. Multiple linear regression showed psychological resilience (β=-0.315, 95%CI: -0.455 to -0.246), subjective support (β=-0.260, 95%CI: -0.845 to -0.374), objective support (β=-0.176, 95%CI:-0.895 to -0.256), and support utilization (β=-0.145, 95%CI:-1.327 to -0.226) negatively influenced FoH, while hypoglycemia type (β=0.314, 95%CI: 2.227 to 3.873) and frequency (β=0.296,95%CI: 2.632 to 4.719) were positive contributors.

Conclusion

Elderly T2DM patients exhibit high FoH levels influenced by multiple factors. Healthcare providers should enhance psychological resilience and social support, with particular attention to patients experiencing severe or frequent hypoglycemic episodes.

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目的

探究老年2型糖尿病（type 2 diabetes mellitus，T2DM）患者低血糖恐惧现状并分析其影响因素，为促进老年T2DM患者血糖管理和心理健康提供依据。

方法

2022年3月—2023年1月，选取成都市某3所三级甲等医院302例老年T2DM患者为研究对象，采用一般资料问卷、低血糖恐惧感调查-忧虑量表、社会支持量表以及心理弹性量表开展调查研究。

结果

受访者对低血糖恐惧的现状得分为（33.009±11.243）分，提示整体恐惧水平较高。基于随机森林模型的变量筛选结果显示，当正则化参数λ为0.779 25时，模型预测精度最优，共提取出7项核心影响因素，按重要性降序依次为心理弹性水平、社会支持度、主观支持、客观支持、对支持的利用度、低血糖类型及受教育程度。多元线性回归分析显示，有效阻碍老年T2DM患者对低血糖恐惧程度的因子有心理弹性水平（β=-0.315，95%CI：-0.455～-0.246）、主观支持度（β=-0.260，95%CI：-0.845～-0.374）、客观支持度（β=-0.176，95%CI：-0.895～-0.256）、对支持的利用度（β=-0.145，95%CI：-1.327～-0.226），而低血糖类型（β=0.314，95%CI：2.227～3.873）及发生频率（β=0.296，95%CI：2.632～4.719）均对老年T2DM患者产生低血糖恐惧起促进作用。

结论

本研究中，老年T2DM患者对低血糖恐惧程度的水平较高，现状受多因子影响。医护人员可通过提高老年T2DM患者的心理弹性水平，提高社会支持力度以改善对低血糖的恐惧程度，重点关注低血糖发生程度重、频率高的患者。

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王佳琳，E-mail:
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苏思慧与唐琦为共同第一作者

苏思慧（1996—），女，硕士，护师，研究方向：临床专科护理；

唐琦（1998—），女，硕士在读，研究方向：临床专科护理；

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苏思慧（1996—），女，硕士，护师，研究方向：临床专科护理；

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BMC Psychiatry, 2023, 23(1):204., articleTitle=The relationship between components of hypoglycemia worries and avoiding hypoglycemia behavior in type 2 diabetes mellitus with hypoglycemia: a network analysis, refAbstract=null), Reference(id=1241329777085304941, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, doi=null, pmid=null, pmcid=null, year=2025, volume=63, issue=null, pageStart=1, pageEnd=7, url=null, language=null, rfNumber=[33], rfOrder=45, authorNames=Tang Q, Wang JL, Su SH, journalName=Geriatric Nursing, refType=null, unstructuredReference=Tang Q, Wang JL, Su SH, et al. Prevalence and factors of fear of hypoglycemia among Chinese older adults with type 2 diabetes mellitus: A cross-sectional study[J] . Geriatric Nursing, 2025, 63: 1-7., articleTitle=Prevalence and factors of fear of hypoglycemia among Chinese older adults with type 2 diabetes mellitus: A cross-sectional study, refAbstract=null), Reference(id=1241329777206939761, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, doi=null, pmid=null, pmcid=null, year=2023, volume=22, issue=3, pageStart=453, pageEnd=456, url=null, language=null, rfNumber=[34], rfOrder=46, authorNames=Mangas N, Mateu-Salat M, Mart í nez MJ, journalName=Hormones, refType=null, unstructuredReference=Mangas N, Mateu-Salat M, Mart í nez MJ, et al. Hybrid closed-loop systems can help patients with extreme fear of hypoglycemia or hyperglycemia[J] . 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Physiol Int, 2024,111(2): 143-164., articleTitle=Treatment of type 2 diabetes mellitus in the elderly-Special considerations, refAbstract=null)], funds=[Fund(id=1241329767216108418, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, awardId=JKRWZ23-02, language=CN, fundingSource=健康人文研究中心重点项目(JKRWZ23-02), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241329762103251440, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, xref=1., ext=[AuthorCompanyExt(id=1241329762115834353, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, companyId=1241329762103251440, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Critical Care Medicine Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,Sichuan 610072, China), AuthorCompanyExt(id=1241329762124222964, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, companyId=1241329762103251440, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.四川省医学科学院·四川省人民医院 重症医学中心，四川 成都 610072)]), AuthorCompany(id=1241329762220691963, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, xref=2., ext=[AuthorCompanyExt(id=1241329762237469182, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, companyId=1241329762220691963, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.成都中医药大学 护理学院，四川 成都 611137)])], figs=[ArticleFig(id=1241329765609689872, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Figure 1, caption=Measurement results of the importance of influencing factors, figureFileSmall=bME4ohztKy+PHSFkg3meHw==, figureFileBig=kpPG4QL3HEe1rzFVIJeS2A==, tableContent=null), ArticleFig(id=1241329765760684829, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=图1, caption=影响因素重要性度量结果, figureFileSmall=bME4ohztKy+PHSFkg3meHw==, figureFileBig=kpPG4QL3HEe1rzFVIJeS2A==, tableContent=null), ArticleFig(id=1241329765915874092, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Figure 2, caption=Characteristic variable screening based on LASSO analysis, figureFileSmall=uL2V/f29QSjfsqygYS8E4Q==, figureFileBig=VgFlaTm8MDC5ch+G4s017g==, tableContent=null), ArticleFig(id=1241329766037508912, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=图2, caption=基于LASSO分析的特征性变量筛选, figureFileSmall=uL2V/f29QSjfsqygYS8E4Q==, figureFileBig=VgFlaTm8MDC5ch+G4s017g==, tableContent=null), ArticleFig(id=1241329766142366524, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Table 1, caption=

Univariate analysis of FOH in elderly with T2DM ［n=302，n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类总数FOH得分统计值P值
性别男161（53.30）32.702±11.979t=-0.5080.611
女141（46.70）33.362±10.369
年龄（岁）60～69110（36.40）31.064±11.532F=3.3060.026*
70～79112（37.10）32.670±11.511
80～8973 (24.20)36.140±9.918
≥907 (2.30)36.429±9.449
教育程度文盲60 (19.90)36.767±10.577F=4.0400.008**
小学100 (33.10)31.970±10.907
中学112 (37.10)33.054±11.480
大专及以上30 (9.90)28.800±11.068
婚姻状况单身54 (17.90)33.833±11.663F=0.0260.974
已婚167 (55.30）33.143±10.862
离异或分居81 (26.80)32.852±11.854
工作状况全职30 (9.90)33.400±12.661F=1.2630.285
兼职71 (23.50)33.803±10.778
务农86 (28.50)34.570±10.427
退休106(35.10)31.123±11.617
其他9 (3.00)32.778±12.327
糖尿病病程（年）≤565 (21.50)34.154±11.55F=1.0540.369
6～1086 (28.50)32.035±10.384
11～1592 (30.50)34.065±10.967
≥1659 (19.50)31.525±12.345
糖尿病家族史有145 (48.00)33.503±11.374t=0.7320.464
无163 (52.00)32.554±11.137
低血糖发生频率（半年内，次）143(14.20)27.651±10.661F=4.9500.002**
2106 (35.10)32.698±11.845
3110 (36.40)34.209±10.995
4及以上43 (14.20)36.070±9.200
对低血糖的了解程度非常了解78 (25.80)32.833±11.570F=0.4220.656
比较了解150 (49.70)32.593±11.518
很少了解74(24.50)34.040±10.380
低血糖类型假性低血糖26 (8.60)26.231±11.570F=3.6420.007**
无症状低血糖55 (18.20)33.163±10.614
可疑症状性低血糖95 (31.50)33.189±10.856
症状性低血糖82 (27.20)32.902±11.226
严重低血糖44 (14.60)36.636±11.885
), ArticleFig(id=1241329766234641218, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=表1, caption=

老年T2DM患者FOH的单因素分析［n=302，n（%），（）］

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类总数FOH得分统计值P值
性别男161（53.30）32.702±11.979t=-0.5080.611
女141（46.70）33.362±10.369
年龄（岁）60～69110（36.40）31.064±11.532F=3.3060.026*
70～79112（37.10）32.670±11.511
80～8973 (24.20)36.140±9.918
≥907 (2.30)36.429±9.449
教育程度文盲60 (19.90)36.767±10.577F=4.0400.008**
小学100 (33.10)31.970±10.907
中学112 (37.10)33.054±11.480
大专及以上30 (9.90)28.800±11.068
婚姻状况单身54 (17.90)33.833±11.663F=0.0260.974
已婚167 (55.30）33.143±10.862
离异或分居81 (26.80)32.852±11.854
工作状况全职30 (9.90)33.400±12.661F=1.2630.285
兼职71 (23.50)33.803±10.778
务农86 (28.50)34.570±10.427
退休106(35.10)31.123±11.617
其他9 (3.00)32.778±12.327
糖尿病病程（年）≤565 (21.50)34.154±11.55F=1.0540.369
6～1086 (28.50)32.035±10.384
11～1592 (30.50)34.065±10.967
≥1659 (19.50)31.525±12.345
糖尿病家族史有145 (48.00)33.503±11.374t=0.7320.464
无163 (52.00)32.554±11.137
低血糖发生频率（半年内，次）143(14.20)27.651±10.661F=4.9500.002**
2106 (35.10)32.698±11.845
3110 (36.40)34.209±10.995
4及以上43 (14.20)36.070±9.200
对低血糖的了解程度非常了解78 (25.80)32.833±11.570F=0.4220.656
比较了解150 (49.70)32.593±11.518
很少了解74(24.50)34.040±10.380
低血糖类型假性低血糖26 (8.60)26.231±11.570F=3.6420.007**
无症状低血糖55 (18.20)33.163±10.614
可疑症状性低血糖95 (31.50)33.189±10.856
症状性低血糖82 (27.20)32.902±11.226
严重低血糖44 (14.60)36.636±11.885
), ArticleFig(id=1241329766318527303, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Table 2, caption=

The correlation between FOH and psychological resilience and social support in elderly with T2DM (r value, n = 302)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量123456
均值33.00922.36839.57024.3648.0367.169
标准差11.24310.1098.3104.7843.4312.098
1.FOH得分1
2.心理弹性水平-0.435**1
3.社会支持水平-0.501**0.455**1
4.主观支持-0.409**0.371**0.868**1
5.客观支持-0.380**0.336**0.769**0.413**1
6.对支持的利用度-0.429**0.407**0.724**0.482**0.471**1
), ArticleFig(id=1241329766419190605, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=表2, caption=

老年T2DM患者FOH得分与心理弹性、社会支持的相关性（r值，n=302）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量123456
均值33.00922.36839.57024.3648.0367.169
标准差11.24310.1098.3104.7843.4312.098
1.FOH得分1
2.心理弹性水平-0.435**1
3.社会支持水平-0.501**0.455**1
4.主观支持-0.409**0.371**0.868**1
5.客观支持-0.380**0.336**0.769**0.413**1
6.对支持的利用度-0.429**0.407**0.724**0.482**0.471**1
), ArticleFig(id=1241329766511465299, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Table 3, caption=

The importance ranking of influencing factors of FOH in elderly with T2DM based on random forest

, figureFileSmall=null, figureFileBig=null, tableContent=
重要性排序变量名称平均基尼系数
1心理弹性水平51.676
2社会支持水平46.166
3主观支持42.945
4客观支持40.135
5对支持的利用度34.866
6低血糖类型30.443
7低血糖发生频率25.239
8受教育程度24.957
9年龄分组22.689
), ArticleFig(id=1241329766607934298, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=表3, caption=

基于随机森林的老年T2DM患者FOH影响因素的重要性排序

, figureFileSmall=null, figureFileBig=null, tableContent=
重要性排序变量名称平均基尼系数
1心理弹性水平51.676
2社会支持水平46.166
3主观支持42.945
4客观支持40.135
5对支持的利用度34.866
6低血糖类型30.443
7低血糖发生频率25.239
8受教育程度24.957
9年龄分组22.689
), ArticleFig(id=1241329766704403296, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Table 4, caption=

Variable assignment table

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名赋值
低血糖发生频率（半年内，次）1=0，2=1，3=2，4及以上=3
假性低血糖=0，无症状低血糖=1，
低血糖类型可疑症状性低血糖=2，症状性
低血糖=3，严重低血糖=4
), ArticleFig(id=1241329766800872295, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=表4, caption=

变量赋值表

, figureFileSmall=null, figureFileBig=null, tableContent=
变量名赋值
低血糖发生频率（半年内，次）1=0，2=1，3=2，4及以上=3
假性低血糖=0，无症状低血糖=1，
低血糖类型可疑症状性低血糖=2，症状性
低血糖=3，严重低血糖=4
), ArticleFig(id=1241329766926701424, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=EN, label=Table 5, caption=

Multiple linear regression analysis of FOH in elderly with T2DM (n=302)

, figureFileSmall=null, figureFileBig=null, tableContent=
参数B β95%CIt值P值
(常量)46.8982.79941.389～52.40716.754<0.001
心理弹性水平-0.3500.053-0.315-0.455～-0.246-6.589<0.001
主观支持-0.6100.120-0.260-0.845～-0.374-5.096<0.001
客观支持-0.5760.162-0.176-0.895～-0.256-3.547<0.001
对支持的利用度-0.7770.280-0.145-1.327～-0.226-2.7770.006
低血糖类型3.0500.4180.3142.227～3.8737.291<0.001
低血糖发生频率（半年内）3.6750.5300.2962.632～4.7196.932<0.001
), ArticleFig(id=1241329767014781816, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241329582696092039, language=CN, label=表5, caption=

老年T2DM患者FOH的多元线性回归分析（n=302）

, figureFileSmall=null, figureFileBig=null, tableContent=
参数B β95%CIt值P值
(常量)46.8982.79941.389～52.40716.754<0.001
心理弹性水平-0.3500.053-0.315-0.455～-0.246-6.589<0.001
主观支持-0.6100.120-0.260-0.845～-0.374-5.096<0.001
客观支持-0.5760.162-0.176-0.895～-0.256-3.547<0.001
对支持的利用度-0.7770.280-0.145-1.327～-0.226-2.7770.006
低血糖类型3.0500.4180.3142.227～3.8737.291<0.001
低血糖发生频率（半年内）3.6750.5300.2962.632～4.7196.932<0.001
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基于随机森林模型的老年2型糖尿病患者低血糖恐惧的现状和影响因素分析
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苏思慧 1 , 唐琦 2 , 夏颖 2 , 蔚萌 2 , 王佳琳 2
现代预防医学 | 健康与社会行为 2025,52(13): 2444-2449
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现代预防医学 | 健康与社会行为 2025, 52(13): 2444-2449
基于随机森林模型的老年2型糖尿病患者低血糖恐惧的现状和影响因素分析
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苏思慧1, 唐琦2, 夏颖2, 蔚萌2, 王佳琳2
作者信息
  • 1.四川省医学科学院·四川省人民医院 重症医学中心，四川 成都 610072
  • 2.成都中医药大学 护理学院，四川 成都 611137

    • 苏思慧（1996—），女，硕士，护师，研究方向：临床专科护理；

    唐琦（1998—），女，硕士在读，研究方向：临床专科护理；

通讯作者:

王佳琳，E-mail:
Current status and influencing factors of fear of hypoglycemia in elderly patients with type 2 diabetes based on random forest model
Si-hui SU1, Qi TANG2, Ying XIA2, Meng WEI2, Jia-lin WANG2
Affiliations
  • Critical Care Medicine Center, Sichuan Academy of Medical Sciences & Sichuan Provincial People’s Hospital, Chengdu,Sichuan 610072, China
出版时间: 2025-07-10 doi: 10.20043/j.cnki.MPM.202502060
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摘要
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目的

探究老年2型糖尿病（type 2 diabetes mellitus，T2DM）患者低血糖恐惧现状并分析其影响因素，为促进老年T2DM患者血糖管理和心理健康提供依据。

方法

2022年3月—2023年1月，选取成都市某3所三级甲等医院302例老年T2DM患者为研究对象，采用一般资料问卷、低血糖恐惧感调查-忧虑量表、社会支持量表以及心理弹性量表开展调查研究。

结果

受访者对低血糖恐惧的现状得分为（33.009±11.243）分，提示整体恐惧水平较高。基于随机森林模型的变量筛选结果显示，当正则化参数λ为0.779 25时，模型预测精度最优，共提取出7项核心影响因素，按重要性降序依次为心理弹性水平、社会支持度、主观支持、客观支持、对支持的利用度、低血糖类型及受教育程度。多元线性回归分析显示，有效阻碍老年T2DM患者对低血糖恐惧程度的因子有心理弹性水平（β=-0.315，95%CI：-0.455～-0.246）、主观支持度（β=-0.260，95%CI：-0.845～-0.374）、客观支持度（β=-0.176，95%CI：-0.895～-0.256）、对支持的利用度（β=-0.145，95%CI：-1.327～-0.226），而低血糖类型（β=0.314，95%CI：2.227～3.873）及发生频率（β=0.296，95%CI：2.632～4.719）均对老年T2DM患者产生低血糖恐惧起促进作用。

结论

本研究中，老年T2DM患者对低血糖恐惧程度的水平较高，现状受多因子影响。医护人员可通过提高老年T2DM患者的心理弹性水平，提高社会支持力度以改善对低血糖的恐惧程度，重点关注低血糖发生程度重、频率高的患者。

老年人  /  低血糖恐惧  /  2型糖尿病  /  随机森林  /  影响因素
Objective

To investigate the status and influencing factors of fear of hypoglycemia (FoH) in elderly patients with type 2 diabetes mellitus (T2DM), providing evidence for improving glycemic management and psychological health.

Methods

From March 2022 to January 2023, 302 elderly T2DM patients from three tertiary hospitals in Chengdu were assessed using general information questionnaires, Hypoglycemia Fear Survey-Worry Scale, Social Support Rating Scale, and Connor-Davidson Resilience Scale.

Results

The mean FoH score was 33.009±11.243, indicating high overall fear levels. Random forest model screening (optimal λ=0.77925) identified seven key factors in descending importance: psychological resilience, social support, subjective support, objective support, support utilization, hypoglycemia type, and education level. Multiple linear regression showed psychological resilience (β=-0.315, 95%CI: -0.455 to -0.246), subjective support (β=-0.260, 95%CI: -0.845 to -0.374), objective support (β=-0.176, 95%CI:-0.895 to -0.256), and support utilization (β=-0.145, 95%CI:-1.327 to -0.226) negatively influenced FoH, while hypoglycemia type (β=0.314, 95%CI: 2.227 to 3.873) and frequency (β=0.296,95%CI: 2.632 to 4.719) were positive contributors.

Conclusion

Elderly T2DM patients exhibit high FoH levels influenced by multiple factors. Healthcare providers should enhance psychological resilience and social support, with particular attention to patients experiencing severe or frequent hypoglycemic episodes.

Aged  /  Fear of hypoglycemia  /  Type 2 diabetes mellitus  /  Random forest  /  Influencing factors
苏思慧, 唐琦, 夏颖, 蔚萌, 王佳琳. 基于随机森林模型的老年2型糖尿病患者低血糖恐惧的现状和影响因素分析. 现代预防医学, 2025 , 52 (13) : 2444 -2449 . DOI: 10.20043/j.cnki.MPM.202502060
Si-hui SU, Qi TANG, Ying XIA, Meng WEI, Jia-lin WANG. Current status and influencing factors of fear of hypoglycemia in elderly patients with type 2 diabetes based on random forest model[J]. Modern Preventive Medicine, 2025 , 52 (13) : 2444 -2449 . DOI: 10.20043/j.cnki.MPM.202502060
正文
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2型糖尿病（type 2 diabetes mellitus，T2DM）在全球糖尿病病例中占比高达90%[1]，其治疗过程中频发的急性并发症低血糖已成为临床管理的关键挑战[2]。现有数据显示，T2DM患者低血糖发生率为21.7%～95.3%[3-4]，相关症状及潜在危害易引发患者对低血糖的过度担忧，即低血糖恐惧（fear of hypoglycemia,FOH）[5]。FOH被定义为患者因低血糖经历或风险而产生的持续性心理应激反应[5]，其患病率在糖尿病患者中达17.4%～50%[6-7]。此类心理状态不仅与睡眠障碍[8-10]、焦虑情绪[11]及抑郁加重[5]显著关联，还会降低患者对饮食与运动的依从性[12]，并干扰胰岛素治疗方案的制定与执行[13]，从而加剧血糖控制难度。因此，早期识别并干预FOH对改善患者预后具有重要临床价值。
尽管目前国外对糖尿病患者FOH的研究越来越多，但先前研究多集中于依赖胰岛素治疗的I型糖尿病患者，近期证据表明，低血糖造成的严重后果可能对T2DM患者更显著，特别是对心血管系统的影响[14]。此外，我国糖尿病发病率高，且多为老年T2DM患者，因此，关注我国T2DM老年人的低血糖恐惧感，有助于促进他们的身心健康，提高其幸福感，推动我国健康老龄化的发展。
1　对象与方法
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1.1　研究对象
选择符合纳入排除标准的老年T2DM患者，对成都市三家三级甲等医院采用方便抽样的方式，于2022年3月—2023年1月进行调查。纳入标准：（1）年龄≥60岁且经WHO临床诊断指南确诊为T2DM老年患者；（2）最近6个月出现低血糖史；（3）无沟通障碍，对答切题，且自愿参加本研究。排除标准：有严重合并症（如癌症）或有精神病史（或正在服用精神药物）或参加过其他研究的受试者。研究员剔除无效问卷，最终纳入老年T2DM患者302例。成都中医药大学伦理委员会已批准本研究的进行（审批号：2022KL- 033-01）。
1.2　研究工具
1.2.1　一般资料问卷
该问卷包含性别（男/女）、年龄（≥60岁）、教育程度、婚姻状况等人口学因素和糖尿病病程及家族史等疾病现况，共计10项指标。
1.2.2　低血糖恐惧感调查-忧虑量表(CHFSII-WS)
目前评估FOH的标准化工具[15]，共计13项题目综合评估受试者近6个月对低血糖的担忧畏惧和尴尬情绪二维度的主观体验。采用5级Likert评分（0～4分），总分范围为0～52分，得分与恐惧程度呈正相关。该量表的内部一致性信度是0.904。
1.2.3　社会支持评定量表（SSRS）
1994年沿用，从客观支持（3项）、主观支持（4项）、支持利用度（3项）三方面全面评估受试者的社会支持状况[16]，使用Likert 4级评分法，累积10个条目（12～66分）。社会支持程度越高则得分越高，其中总分≤22分、22～44分以及>44分分别对应低、中、高支持水平[17]。SSRS具有较高的信度（Cronbach α=0.8936），现已成为社会支持研究领域的广泛应用工具。
1.2.4　心理弹性量表简化版（CD-RISC-10）
由原始25条目Connor-Davidson心理弹性量表精简为10条目版本，用于评估个体在压力事件中的综合适应能力。量表总分范围为0～40分，得分与心理弹性水平呈正相关[18]，其内部一致性信度是0.910。
1.3　过程性质量控制
本研究形式以现场填答纸质问卷+线上问卷的方式进行，但以纸质问卷填写为主要方式。正式开展研究前召开组会并对三名研究生进行统一培训，开展过程中由研究对象自行完成问卷，若有困难则由研究员如实填写受访者回答，结束后复查问卷，确保内容的完整性和逻辑性。
1.4　统计学方法
数据分析通过SPSS 25.0与R Studio完成。分别采用（均数±标准差）、频数和百分比表示连续型变量和分类变量。一般资料组间差异比较采用t检验或方差分析（ANOVA）检验进行。关联性分析采用Pearson相关系数进行评估。基于R Studio的Random Forest包构建随机森林模型，通过计算平均基尼系数下降值确定老年T2DM患者FOH影响因素的优先级[19]，其中基尼系数降幅越大提示变量重要性越高[20]。此外，通过LASSO回归筛选关键变量后，进一步采用多元线性回归模型进行多因素分析。检验水准α=0.05。
2　结果
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2.1　研究对象基本状况
参与者的社会人口学特征和疾病相关信息见表1。302例老年T2DM患者中，以男性（53.3%）、60～79岁（73.5%）、已婚（55.3%）、小学及以下文化程度（53.0%）为主。在疾病相关特征方面，有糖尿病家族史的有145人（48.0%），仅有78例（25.8%）患者对低血糖“非常了解”。
2.2　相关性分析
如表2所示，老年T2DM患者的FOH感、心理弹性和社会支持得分分别为（33.009±11.243）、（22.368±10.109）和（39.570±8.310）分，社会支持各维度得分由高到低依次为主观支持（24.364±4.784）分、客观支持（8.036±3.431）分、支持利用（7.169±2.098）分。相关性结果表明，在心理弹性与FOH间为负相关关系（r=-0.435，P<0.01）。同样，FOH与社会支持间也呈现显著的负相关（r=-0.501，P<0.01）。但r=0.455表明正相关关系存在于社会支持和心理弹性之间（P<0.01）。
2.3　老年T2DM患者低血糖恐惧感影响因素的筛选
2.3.1　基于随机森林的老年T2DM患者FOH影响因素的重要性排序
单因素及相关性分析显示，病人年龄、教育、低血糖发生频率、低血糖类型、社会支持水平、主观支持、客观支持、支持利用度、心理弹性水平对老年T2DM患者FOH有重要影响。模型测试显示，当mtry=3，ntree=500时模型趋于稳定。据表3和图1的随机森林分析结果，本次研究纳入的9个影响因素重要性排序依次为患者的心理弹性、社会支持及各维度、低血糖类型、低血糖发生频率、受教育程度、年龄分组。
2.3.2　变量筛选
根据随机森林影响因素重要性度量结果，采用glmnet程序包对单因素分析中筛选出的9个显著性变量构建LASSO回归模型。通过交叉验证确定最优正则化参数λ（0.779 25），该值对应模型预测误差最小，见图2，最终筛选出7项核心影响因素，分别为心理弹性、社会支持度、主观支持、客观支持、对支持的利用度、低血糖类型及发生频率，并将其纳入多元线性回归模型以量化效应强度[18]。
2.4　老年T2DM患者FOH影响因素的多元线性回归分析
变量赋值情况如表4所示。多元线性回归分析显示，心理弹性水平、主观支持、客观支持、对支持的利用度等因子均能阻碍老年T2DM患者产生FOH（P<0.05），而低血糖类型及发生频率等因子均能促进老年T2DM患者对低血糖产生恐惧（P<0.05）。见表5。
3　讨论
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本研究结果显示，老年T2DM患者FOH平均得分为（33.009±11.243）分，提示老年T2DM患者对低血糖具有较高恐惧程度。但本研究数据分析结果源自单一地区的医院样本，对比重庆地区医院样本的（38.15±10.57）[21]、江苏省医院人群的（35.0 [27.8, 47.0]）[22-23]及南充市医养结合机构老年群体的（48.91±10.44）[24]，发现本研究结论与前人一致，均提示老年T2DM患者具有较高程度的FOH。低血糖本身给患者带来的一系列不适症状和不良临床结局，使得患者对低血糖的发生感到恐惧是产生此现状的原因。因此，医护人员在工作中不仅需关注低血糖发作时给患者带来的影响，还需关注患者低血糖发作间歇期时的情绪状态，行入院即时评估，并告知有关低血糖的相应诊疗方法及注意事项，以达到减轻低血糖的恐惧心理。
本研究表明，影响老年T2DM患者对FOH程度的主要因素为心理弹性水平、主观支持、客观支持、对支持的利用度、低血糖类型及发生频率。其中，心理弹性水平对缓解老年T2DM患者FOH的影响最为重要。前人的研究也强调了心理弹性对改善糖尿病患者不良心理状况和预后的重要性[25]，且心理弹性已被发现与焦虑、疲劳、糖尿病困扰和认知功能障碍呈负相关[26-28]。可能的原因是，心理弹性较高的老年人，为了维持身体内部的稳定，更善于感受积极的情绪，并能积极地面对因低血糖事件而产生的消极影响所遇到的困难和挫折。因此，可通过提高T2DM老人的心理弹性以助其理解和感知低血糖经历引起的心理恐惧，并提高低血糖事件的应对能力。
另外，在我们的研究中，社会支持的各维度在影响因素中仅次于心理弹性，且患者的社会支持水平与FOH呈负相关，这与李思悦等人[29]认为良好的社会支持可以改善患者的幸福感和身心健康的观点一致。不仅如此，我们的研究发现，老年T2DM患者的社会支持得分为（39.57±8.10）分，较以往研究更低[30]，提示该群体的社会支持程度仍需改善。并且在社会支持的各维度中，主观支持得分最高，对患者FOH程度的影响排序也更重要。患者在社会中体验尊重、支持和理解并获得满足，这些都关联于个体的主观感受[16]。随年龄增长，老年人的健康储备不断下降，而糖尿病具有病程长、并发症多的特点，长期的患病状态可加重老年人的社会衰弱[31]，使老年人抵御疾病的信心减弱。因此，医护人员应重视老年人的社会支持水平，尊重和理解老年人并主动给予关怀，加强心理慰藉，为其提供糖尿病管理的信息和低血糖控制的知识，增强老年人战胜疾病的信心。
前人的研究已经探索了对低血糖产生恐惧心理与发生低血糖间的相关关系。首先，研究显示T2DM患者发生严重低血糖与产生对低血糖的恐惧心理间具有显著相关（Wu等人）[32]。其次，Vexiau[33]通过研究证实低血糖症状发作越严重，由此产生的恐惧心理程度也越高。本研究发现6个月内低血糖≥3次和低血糖发生程度更重的老年T2DM患者FOH水平更高，这可能是由于低血糖的频繁发生使得个人的自我调节和应对能力受限，从而加重FOH[34]，而此现象尤其容易发生在老年群体中。
本研究具有一定的局限性：首先，本研究存在未测量混杂因素（如经济状况、用药依从性等），结论中的影响因素可能并不全面；其次，采用方便抽样的方法，样本范围限于成都市，使得研究结论推广性有限，后续可行大范围多中心调查进一步验证本研究结论。基于此，建议后续可通过纵向研究了解患者FOH水平的变化轨迹以明确其中的因果关系，质性研究深入了解病人对于FOH的切实体验，为提升其心理健康状况提供更多依据。未来30年内，老年人将成为T2DM患者的主要群体[35]。FOH可造成或加重老年T2DM患者的负面情绪，甚至成为血糖控制水平和治疗方案选择的阻碍因素。本研究通过整合随机森林模型的变量筛选与多元线性回归的效应量分析，兼顾变量重要性排序与具体效应值解析，在定性评估与实证量化实现了互补融合。研究结果表明T2DM老人的FOH受多种因素的影响，加强对患者FOH水平的评估，为后续的心理护理提供依据。此外，可采取针对性的干预措施提高其心理弹性，并鼓励患者充分利用社会支持，从而帮助其保持心理健康，减轻FOH。
基金
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  • 健康人文研究中心重点项目(JKRWZ23-02)
文献
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doi: 10.20043/j.cnki.MPM.202502060
  • 接收时间：2025-02-06
  • 首发时间：2026-03-19
  • 出版时间：2025-07-10
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  • 收稿日期：2025-02-06
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健康人文研究中心重点项目(JKRWZ23-02)
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    1.四川省医学科学院·四川省人民医院 重症医学中心，四川 成都 610072
    2.成都中医药大学 护理学院，四川 成都 611137

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Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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