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Article(id=1311350243027936059, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202512005, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1764518400000, receivedDateStr=2025-12-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1790579861647, onlineDateStr=2026-09-28, pubDate=1782316800000, pubDateStr=2026-06-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1790579861647, onlineIssueDateStr=2026-09-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1790579861647, creator=13701087609, updateTime=1790579861647, updator=13701087609, issue=Issue{id=1311349919793905738, tenantId=1146029695717560320, journalId=1227665162245664772, year='2026', volume='53', issue='12', pageStart='2113', pageEnd='2304', issueExtLink='null', onlineDate='null', pubDate='1782316800000', pubDateStr='2026-06-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1790579784582, creator='13701087609', updateTime=1790588408144, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1311386089701597565, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1311386089701597566, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1311349919793905738, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2238, endPage=2242, ext={EN=ArticleExt(id=1311350246844752701, articleId=1311350243027936059, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Analysis of the mediating effect of social support between hypoglycemic fear and quality of life in elderly patients with type 2 diabetes, columnId=1228016572451718132, journalTitle=Modern Preventive Medicine, columnName=Health and Social Behavior, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the relationship between social support, hypoglycemic fear (FoH) and quality of life in elderly patients with type 2 diabetes mellitus (T2DM), and to test its mediating effect.

Methods

By using the method of convenience sampling, elderly patients with type 2 diabetes mellitus (T2DM) who visited Nanjing Hospital Affiliated to Nanjing Medical University were selected as the research subjects. The Social Support Rating Scale (SSRS), the Chinese version of the Hypoglycemia Fear Questionnaire-Worry Scale (CHFSⅡ-WS), the Diabetes Specific Quality of Life Scale (DSQL), and a general questionnaire were used to investigate elderly patients with type 2 diabetes mellitus (T2DM). A structural equation model was established for the SSRS, CHFSⅡ-WS, and DSQL scores of elderly T2DM patients, and the mediating effect was tested through Bootstrap post hoc tests.

Results

The effective sample size of this study was 115 cases. The total score of SSRS for elderly patients with T2DM was (38.71±6.25) points, and the score of CHFSⅡ-WS was (26.44±4.28) points; the total score of DSQL was (52.33±13.56) points (Higher DSQL scores mean worse quality of life). The results of the mediating effect test showed that FoH had a direct negative predictive effect on social support in elderly patients with T2DM (β=-0.696, P<0.001), social support had a direct negative predictive effect on quality of life (β=-0.532, P<0.001), indicating that higher levels of social support were associated with better quality of life and lower DSQL scores, and FoH had a direct positive predictive effect on quality of life (β=0.381, P<0.001); The mediating effect value was β=0.370, and the total effect value was β=0.751. The proportion of the mediating effect of social support was 49.27%, and the mediating effect was established.

Conclusion

There is a close correlation among social support, FoH and quality of life in elderly patients with type 2 diabetes mellitus (T2DM). Social support has a partial mediating effect between FoH and quality of life, and the proportion of the mediating effect is 49.27%.

, authors=Dan NIU1, Su-ping QIN2, Xiao-mei LI1, Chen-sheng LI3, authorsList=Dan NIU, Su-ping QIN, Xiao-mei LI, Chen-sheng LI, authorCompany=null, correspAuthors=Xiao-mei LI, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1311350256558760771, articleId=1311350243027936059, tenantId=1146029695717560320, journalId=1227665162245664772, language=CN, title=社会支持在老年2型糖尿病患者低血糖恐惧与生存质量间的中介效应分析, columnId=1228016572640461823, journalTitle=现代预防医学, columnName=健康与社会行为, runingTitle=null, highlight=null, articleAbstract=
目的

探讨老年2型糖尿病（T2DM）患者社会支持、低血糖恐惧与生存质量之间的关系，并检验其中介效应。

方法

采用便利抽样的方法，选取南京医科大学附属南京医院就诊的老年T2DM患者作为研究对象。采用社会支持量表（SSRS）、中文版低血糖恐惧调查-忧虑量表（CHFSⅡ-WS）、糖尿病特异性生存质量量表（DSQL）及一般调查表对老年T2DM患者进行调查，建立老年T2DM患者SSRS、CHFSⅡ-WS、DSQL得分的结构方程模型，并通过Bootstrap事后检验其中介效应。

结果

本研究有效样本量115例。老年T2DM患者SSRS总得分（38.71±6.25）分，CHFSⅡ-WS得分（26.44±4.28）分；DSQL总分为（52..33±13.56）分（DSQL得分越高，生存质量越差）。中介效应检验结果显示，老年T2DM患者低血糖恐惧对社会支持有直接负向预测作用（β=-0.696，P<0.001），社会支持对生存质量有直接负向预测作用（β=-0.532，P<0.001，即社会支持水平越高，生存质量越好，DSQL得分越低）；低血糖恐惧对生存质量有直接正向预测作用（β=0.381，P<0.001）；中介效应值为β=0.370，总效应值为β=0.751，社会支持的中介效应占比为49.27%，中介效应成立。

结论

老年T2DM患者的社会支持、低血糖恐惧及生存质量之间存在密切关联，社会支持在FoH与生存质量间存在部分中介效应，中介效应占比为49.27%。

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牛丹（1990—），女，硕士，护师，研究方向：内分泌护理

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李晓梅, E-mail:
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Acta Diabetologica,2022, 59(5): 641-650., articleTitle=Impact of fear of hypoglycaemia on self-management in patients with type 2 diabetes mellitus: structural equation modelling, refAbstract=null), Reference(id=1311350302293451680, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, doi=null, pmid=null, pmcid=null, year=2025, volume=52, issue=13, pageStart=2444, pageEnd=2449, 2458, url=null, language=null, rfNumber=[20], rfOrder=30, authorNames=苏思慧, 唐琦, 夏颖, journalName=现代预防医学, refType=null, unstructuredReference=苏思慧，唐琦，夏颖，等．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［J］．现代预防医学，2025，52（13）：2444-2449, 2458．, articleTitle=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, refAbstract=null), Reference(id=1311350302364754849, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, doi=null, pmid=null, pmcid=null, year=2025, volume=52, issue=13, pageStart=2444, pageEnd=2449, 2458, url=null, language=null, rfNumber=[20], rfOrder=31, authorNames=Su SH, Tang Q, Xia Y, journalName=Modern Preventive Medicine, refType=null, unstructuredReference=Su SH, Tang Q, Xia Y, et al. 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, 2458. (In Chinese), articleTitle=Current status and influencing factors of fear of hypoglycemia in elderly patients with type 2 diabetes based on random forest model, refAbstract=null)], funds=[Fund(id=1311350287995069311, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, awardId=M2020091, language=CN, fundingSource=江苏省卫生健康委科研项目(M2020091), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1311350260228776775, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, xref=1., ext=[AuthorCompanyExt(id=1311350260342022984, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, companyId=1311350260228776775, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=Endocrinology and Metabolism Department of Nanjing Medical University Affiliated Nanjing Hospital （Nanjing First Hospital）, Nanjing, Jiangsu 210006, China), AuthorCompanyExt(id=1311350260639818569, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, companyId=1311350260228776775, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1.南京医科大学附属南京医院（南京市第一医院）内分泌代谢科，江苏 南京 210006)]), AuthorCompany(id=1311350261130552138, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, xref=2., ext=[AuthorCompanyExt(id=1311350261491262283, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, companyId=1311350261130552138, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=2.南京医科大学附属南京医院（南京市第一医院）南院综合办公室)]), AuthorCompany(id=1311350261969412940, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, xref=3., ext=[AuthorCompanyExt(id=1311350262766330701, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, companyId=1311350261969412940, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=3.徐州矿务集团总医院内分泌科)])], figs=[ArticleFig(id=1311350282127238004, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=EN, label=Fig.1, caption=Bootstrap mediation effect analysis of social support in T2DM patients on hypoglycemia fear and quality of life, figureFileSmall=6GD2feghQPWJcYyGIKi5Eg==, figureFileBig=zIqxaIqg9PlSOwNPeDVe+Q==, tableContent=null), ArticleFig(id=1311350283314226038, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=CN, label=图1, caption=T2DM患者社会支持在低血糖恐惧与生存质量的Bootstrap中介效应分析

注：e1为低血糖恐惧感；e2为客观支持；e3为主观支持；e4为支持利用度；e5为生理能力；e6为心理精神；e7为社会关系；e8为治疗维度。

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General information of 115 elderly patients with type 2 diabetes mellitus（n=115）

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项目例数构成比（%）
性别
男7060.87
女4539.13
年龄（岁）
60~747968.70
75~853631.30
文化程度
小学及以下3126.96
初中5144.35
高中/中专/职高2320.00
大专及本科以上108.70
居住状态
独居2925.22
与配偶居住3429.57
与子女居住4337.39
其他97.83
家庭人均月收入（元）
≤3 000119.57
3 000~5 0003732.17
>5 0006758.26
医疗费用支出方式
自费108.70
医保10591.30
糖尿病病程（年）
≤106354.78
>105245.22
治疗方式
非药物2723.48
口服药6960.00
胰岛素/胰岛素+口服药1916.52
并发症
有3328.70
无8271.30
半年内发生低血糖频次（次）
1~37867.83
>33732.17
低血糖的严重程度
轻度8977.39
中度2320.00
重度32.61
糖尿病及并发症认知
中高认知水平3126.96
低认知水平8473.04
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115例老年T2DM患者一般资料（n=115）

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项目例数构成比（%）
性别
男7060.87
女4539.13
年龄（岁）
60~747968.70
75~853631.30
文化程度
小学及以下3126.96
初中5144.35
高中/中专/职高2320.00
大专及本科以上108.70
居住状态
独居2925.22
与配偶居住3429.57
与子女居住4337.39
其他97.83
家庭人均月收入（元）
≤3 000119.57
3 000~5 0003732.17
>5 0006758.26
医疗费用支出方式
自费108.70
医保10591.30
糖尿病病程（年）
≤106354.78
>105245.22
治疗方式
非药物2723.48
口服药6960.00
胰岛素/胰岛素+口服药1916.52
并发症
有3328.70
无8271.30
半年内发生低血糖频次（次）
1~37867.83
>33732.17
低血糖的严重程度
轻度8977.39
中度2320.00
重度32.61
糖尿病及并发症认知
中高认知水平3126.96
低认知水平8473.04
), ArticleFig(id=1311350284983559033, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=EN, label=Table 2, caption=

Social support, family history, quality of life scores and correlation analysis of elderly patients with type 2 diabetes mellitus（n=115）

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项目CHFSⅡ-WS得分DSQL得分
生理功能心理精神社会关系治疗维度
SSRS得分
客观支持-0.687a-0.520a-0.532a-0.486a-0.537a
主观支持-0.581a-0.479a-0.504a-0.523a-0.488a
支持利用度-0.614a-0.437a-0.502a-0.463a-0.500a
), ArticleFig(id=1311350285059056506, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=CN, label=表2, caption=

老年T2DM患者社会支持、低血糖恐惧、生存质量得分及相关性分析（n=115）

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项目CHFSⅡ-WS得分DSQL得分
生理功能心理精神社会关系治疗维度
SSRS得分
客观支持-0.687a-0.520a-0.532a-0.486a-0.537a
主观支持-0.581a-0.479a-0.504a-0.523a-0.488a
支持利用度-0.614a-0.437a-0.502a-0.463a-0.500a
), ArticleFig(id=1311350285151331195, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=EN, label=Table 3, caption=

Fit indices of structural equation model

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拟合指数χ2/dfPFIGFICFINFITLIRMSEA
实际值2.0570.9600.9130.9370.9600.9110.055
判定标准<3.000>0.900>0.900>0.900>0.900>0.900<0.079
), ArticleFig(id=1311350285486875516, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=CN, label=表3, caption=

结构方程模型拟合指数

, figureFileSmall=null, figureFileBig=null, tableContent=
拟合指数χ2/dfPFIGFICFINFITLIRMSEA
实际值2.0570.9600.9130.9370.9600.9110.055
判定标准<3.000>0.900>0.900>0.900>0.900>0.900<0.079
), ArticleFig(id=1311350285843391357, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1311350243027936059, language=EN, label=Table 4, caption=

Path analysis of self-management ability of T2DM patients in relation to hypoglycemia fear and quality of life

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效应类型路径效应值（95%CI）效应占比（%）P值
总效应低血糖恐惧→生存质量0.751（0.464~1.557）<0.001
直接效应低血糖恐惧→生存质量0.381（0.162~0.739）50.73<0.001
中介效应低血糖恐惧→社会支持→生活质量0.370（0.210~0.534）49.27<0.001
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T2DM患者自我管理能力在低血糖恐惧感与生活质量的路径分析

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型路径效应值（95%CI）效应占比（%）P值
总效应低血糖恐惧→生存质量0.751（0.464~1.557）<0.001
直接效应低血糖恐惧→生存质量0.381（0.162~0.739）50.73<0.001
中介效应低血糖恐惧→社会支持→生活质量0.370（0.210~0.534）49.27<0.001
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社会支持在老年2型糖尿病患者低血糖恐惧与生存质量间的中介效应分析
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牛丹 1 , 秦素萍 2 , 李晓梅 1 , 李晨盛 3
现代预防医学 | 健康与社会行为 2026,53(12): 2238-2242
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现代预防医学 |健康与社会行为 2026 , 53 (12) : 2238 -2242
社会支持在老年2型糖尿病患者低血糖恐惧与生存质量间的中介效应分析
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牛丹1, 秦素萍2, 李晓梅1 , 李晨盛3
作者信息
  • 1.南京医科大学附属南京医院（南京市第一医院）内分泌代谢科，江苏 南京 210006
  • 2.南京医科大学附属南京医院（南京市第一医院）南院综合办公室
  • 3.徐州矿务集团总医院内分泌科
通讯作者:
李晓梅, E-mail:
作者简介:

牛丹（1990—），女，硕士，护师，研究方向：内分泌护理

Analysis of the mediating effect of social support between hypoglycemic fear and quality of life in elderly patients with type 2 diabetes
Dan NIU1, Su-ping QIN2, Xiao-mei LI1 , Chen-sheng LI3
Affiliations
  • Endocrinology and Metabolism Department of Nanjing Medical University Affiliated Nanjing Hospital （Nanjing First Hospital）, Nanjing, Jiangsu 210006, China
出版时间: 2026-06-25 doi: 10.20043/j.cnki.MPM.202512005
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摘要
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目的

探讨老年2型糖尿病（T2DM）患者社会支持、低血糖恐惧与生存质量之间的关系，并检验其中介效应。

方法

采用便利抽样的方法，选取南京医科大学附属南京医院就诊的老年T2DM患者作为研究对象。采用社会支持量表（SSRS）、中文版低血糖恐惧调查-忧虑量表（CHFSⅡ-WS）、糖尿病特异性生存质量量表（DSQL）及一般调查表对老年T2DM患者进行调查，建立老年T2DM患者SSRS、CHFSⅡ-WS、DSQL得分的结构方程模型，并通过Bootstrap事后检验其中介效应。

结果

本研究有效样本量115例。老年T2DM患者SSRS总得分（38.71±6.25）分，CHFSⅡ-WS得分（26.44±4.28）分；DSQL总分为（52..33±13.56）分（DSQL得分越高，生存质量越差）。中介效应检验结果显示，老年T2DM患者低血糖恐惧对社会支持有直接负向预测作用（β=-0.696，P<0.001），社会支持对生存质量有直接负向预测作用（β=-0.532，P<0.001，即社会支持水平越高，生存质量越好，DSQL得分越低）；低血糖恐惧对生存质量有直接正向预测作用（β=0.381，P<0.001）；中介效应值为β=0.370，总效应值为β=0.751，社会支持的中介效应占比为49.27%，中介效应成立。

结论

老年T2DM患者的社会支持、低血糖恐惧及生存质量之间存在密切关联，社会支持在FoH与生存质量间存在部分中介效应，中介效应占比为49.27%。

2型糖尿病  /  社会支持  /  低血糖恐惧感  /  生存质量  /  中介效应
Objective

To explore the relationship between social support, hypoglycemic fear (FoH) and quality of life in elderly patients with type 2 diabetes mellitus (T2DM), and to test its mediating effect.

Methods

By using the method of convenience sampling, elderly patients with type 2 diabetes mellitus (T2DM) who visited Nanjing Hospital Affiliated to Nanjing Medical University were selected as the research subjects. The Social Support Rating Scale (SSRS), the Chinese version of the Hypoglycemia Fear Questionnaire-Worry Scale (CHFSⅡ-WS), the Diabetes Specific Quality of Life Scale (DSQL), and a general questionnaire were used to investigate elderly patients with type 2 diabetes mellitus (T2DM). A structural equation model was established for the SSRS, CHFSⅡ-WS, and DSQL scores of elderly T2DM patients, and the mediating effect was tested through Bootstrap post hoc tests.

Results

The effective sample size of this study was 115 cases. The total score of SSRS for elderly patients with T2DM was (38.71±6.25) points, and the score of CHFSⅡ-WS was (26.44±4.28) points; the total score of DSQL was (52.33±13.56) points (Higher DSQL scores mean worse quality of life). The results of the mediating effect test showed that FoH had a direct negative predictive effect on social support in elderly patients with T2DM (β=-0.696, P<0.001), social support had a direct negative predictive effect on quality of life (β=-0.532, P<0.001), indicating that higher levels of social support were associated with better quality of life and lower DSQL scores, and FoH had a direct positive predictive effect on quality of life (β=0.381, P<0.001); The mediating effect value was β=0.370, and the total effect value was β=0.751. The proportion of the mediating effect of social support was 49.27%, and the mediating effect was established.

Conclusion

There is a close correlation among social support, FoH and quality of life in elderly patients with type 2 diabetes mellitus (T2DM). Social support has a partial mediating effect between FoH and quality of life, and the proportion of the mediating effect is 49.27%.

Type 2 diabetes  /  Social support  /  Fear of hypoglycemia  /  Quality of life  /  Mediating effect
牛丹, 秦素萍, 李晓梅, 李晨盛. 社会支持在老年2型糖尿病患者低血糖恐惧与生存质量间的中介效应分析. 现代预防医学, 2026 , 53 (12) : 2238 -2242 . DOI: 10.20043/j.cnki.MPM.202512005
Dan NIU, Su-ping QIN, Xiao-mei LI, Chen-sheng LI. Analysis of the mediating effect of social support between hypoglycemic fear and quality of life in elderly patients with type 2 diabetes[J]. Modern Preventive Medicine, 2026 , 53 (12) : 2238 -2242 . DOI: 10.20043/j.cnki.MPM.202512005
正文
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1　引言
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部分老年2型糖尿病（T2DM）可能因过度控糖发生低血糖，并存在低血糖恐惧感（FoH）。FoH严重影响患者治疗依从性与生活质量，其生活质量下降的独立危险因素［1］。黄静等［2］表明，亲友忽视和护理指导不足易致低血糖，故家庭与医院支持至关重要。社会支持已被证明有助于T2DM患者更有效地进行疾病管理［3］。已有证据显示，社会支持与糖尿病患者生存质量之间存在正相关，社会支持可能通过心理、行为、生理等多途径支持患者良好的控制疾病，进而提升生存质量［4-5］。然而，传统研究较少将社会支持作为中介变量。本研究创新性地提出：低血糖恐惧作为心理应激源，可通过引发患者回避行为，削弱其主动寻求社会支持的能力，进而降低生存质量。即社会支持在低血糖恐惧与生存质量之间起中介作用。因此，本研究应用中介效应验证社会支持在老年T2DM患者低血糖恐惧与生存质量之间的关系，明确变量间的影响过程及机制，从而更好地指导临床干预。
2　方法
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2.1　研究对象
依据EPI原则估算样本量，按自变量数（9个）的5~10倍计算，并预留20%流失量，至少需112例。本研究共纳入120例，符合要求。采用便利抽样，选取2024年6月至2025年5月南京医科大学附属南京医院收治的老年T2DM患者120例。纳入标准：年龄≥60岁；确诊T2DM≥1年［6］；近半年发生过低血糖；具备基本读写能力。排除标准：合并恶性肿瘤、严重心脑血管疾病等重大疾患；近2年经历重大心理或社会应激事件；合并其他类型糖尿病；存在精神障碍或认知异常。本研究共发放问卷120份，有效回收115份，有效回收率为95.83%。研究获伦理委员会批准（20231012）。
2.2　研究工具
2.2.1　社会支持量表（SSRS）
本研究采用肖水源［7］编制的SSRS量表，涵盖客观支持（1~22分）、主观支持（8~32分）、和对支持的利用度（3~12分）3个维度，共10个条目。采用Likert 4级计分，总分12~66分。≤22分支持不足（低水平），23~44分一般支持（中等水平），≥45分支持充足（高水平）。Cronbach α系数为0.771~0.842。
2.2.2　中文版低血糖恐惧调查-忧虑量表（CHFSⅡ-WS）
该量表来源于2011年修订的低血糖恐惧调查表Ⅱ（HFSⅡ）的忧虑量表（HFSⅡ-WS），后经穆纯［8］汉化，用于评估T2DM病人对低血糖的恐惧心理。本研究采用中文版量表评估近6个月低血糖恐惧，共13项条目，得分为0~4分，总分0~52分，分越高恐惧越重。内容效度指数0.93，Cronbach α为0.88。
2.2.3　糖尿病特异性生存质量量表（DSQL）
该量表由廖志红等［9］于1997年研发，主要用于反映糖尿病患者的生理功能（12个条目）、心理精神（8个条目）、社会关系（4个条目）及治疗方面（3个条目），共含4个维度，27个条目。每个条目分为5个等级，从“根本没有”到“总是”分别计1~5分，总分72~135分，分越高生存质量越好。Cronbach α为0.845~0.902。
2.2.4　一般资料调查表
自拟调查问卷，主要内容包括性别、年龄、居住状态、文化程度等人口学资料，糖尿病病程、治疗方式、糖尿病相关并发症、半年内发生低血糖频次、低血糖的严重程度（参照《中国糖尿病防治指南（2024）》［10］中低血糖严重程度危险分层，轻度血糖3.0~3.9 mmol/L，中度<3.0 mmol/L，重度无固定阈值发生意识障碍、抽搐、昏迷，以半年内最高危险级别为准）、糖尿病及并发症的认知程度［密歇根糖尿病知识测验（MDKT）中文简化版［11］评定，其中<15分为认知水平较低］等糖尿病相关特征。
2.3　质量控制
对2名调查员实施同质化培训，采用统一指导语，以一对一方式协助患者完成问卷。问卷内容包括一般资料调查表、SSRS、CHFSⅡ-WS及DSQL量表。调查员经统一培训，一对一指导填写。问卷由两人独立录入并核对。无效问卷剔除标准包括未完成、答案模糊、逻辑矛盾或关键信息缺失过多。
2.4　统计学分析
所有数据采用SPSS 26.0软件进行分析。计数资料以例数和百分比表示，计量资料均数±标准差（）表示，相关性采用Pearson分析。SSRS以量表的3个维度分作为潜变量的观测指标，低血糖恐惧以量表总分为观测指标，DSQL以量表的4个维度分作为观测指标，使用AMOS 7.0构建社会支持→低血糖恐惧→生存质量的中介效应结构方程模型，模型识别通过t规则（t-rule）验证，通过理论驱动的残差相关修正优化拟合效果，并结合Bootstrap法检验中介效应。检验水准α=0.05。
3　研究结果
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3.1　115例老年T2DM患者一般资料
115例老年T2DM患者中男性70例（60.87%）女性45例（39.13%）；年龄范围为60~85岁；以初中文化程度（44.35%）、与子女居住（37.39%）、家庭月收入>5 000元（58.26%）、医保（91.30%）、糖尿病病程≤10年（54.78%）、口服药（60.00%）、无并发症（71.30%）、半年内发生低血糖1~3次（67.83%）、轻度低血糖程度（77.39%）、糖尿病及并发症低认知水平（73.04%）的患者为主。见表1。
3.2　老年T2DM患者社会支持、低血糖恐惧、生存质量得分及相关性分析
本研究115例老年T2DM患者SSRS总得分（38.71±6.25）分，其中客观支持得分（13.28±2.49）分、主观支持得分（18.09±3.35）分、支持利用度得分（7.54±1.82）分；CHFSⅡ-WS得分（26.44±4.28）分；DSQL总分为（52.33±13.56）分，85.22%（98/115）的患者DSQL总分≥40分；其中生理功能（19.00±4.63）分、心理精神（16.19±3.95）分、社会关系（8.42±2.74）分、治疗维度（9.51±2.42）分。Pearson相关分析结果显示，老年T2DM患者SSRS量表各维度与CHFSⅡ-WS得分均呈负相关（r=-0.687、-0.581、-0.614，P<0.001），与DSQL量表生理功能、心理精神、社会关系和治疗维度四维度评分均负相关（P<0.001）；CHFSⅡ-WS得分与DSQL四维度评分之间均呈正相关（P<0.001）。见表2。
3.3　老年T2DM患者社会支持在低血糖恐惧与生活质量间的中介效应分析
以CHFSⅡ-WS得分为预测变量预测T2DM患者生存质量（DSQL得分为结果变量），SSRS得分为中介变量，建立结构方程模型进行中介效应的检验。各项拟合指标均超过判定标准，见图1和表3。
中介效应检验结果显示，老年T2DM患者低血糖恐惧对社会支持有直接负向预测作用（β=-0.696，P<0.001），社会支持对生存质量有直接负向预测作用（β=-0.532，P<0.001），低血糖恐惧对生存质量有直接正向预测作用（β=0.381，P<0.001）；中介效应值为β=-0.696×（-0.532）=0.370，总效应值为β=0.381+0.370=0.751，社会支持的中介效应占比为49.27%，其中介效应的95%置信区间不包括0，说明中介效应成立。见表4。
4　讨论
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4.1　老年T2DM患者社会支持、低血糖恐惧及生存质量分析
本研究发现老年T2DM患者SSRS总得分（38.71±6.25）分，处于中等水平，主观支持维度得分最高、客观支持次之，与陆丽君等［12］的研究一致。样本中45.22%患者的病程≥10年、28.70%的人伴并发症，病程久及并发症易致消极态度、自我管理效能下降、回避寻求支持，且加重家庭照护负担、消耗支持资源、降低感知情感支持［13-14］。主观支持得分高或因66.96%患者与家人共同生活，同住获更多家庭情感支持。本研究老年T2DM患者CHFSⅡ-WS得分（26.44±4.28）分，高于国内T2DM患者低血糖恐惧平均水平，提示样本群体存在一定低血糖恐惧。低血糖恐惧是对低血糖及后果的过度担忧引发的焦虑恐惧，可导致患者刻意维持高血糖、增加并发症风险。独居老人恐惧最强，担心无人救助［15］。降糖方案复杂（如胰岛素/胰岛素+口服药，占37.39%）增加低血糖风险，老年记忆减退易误执行，胰岛素治疗者恐惧更强。此外，73.04%患者糖尿病及并发症认知水平低，缺乏了解致过度担忧、强化恐惧［16］。本研究还显示，患者DSQL总分为（52.33±13.56）分，其中85.22%（98/115）的患者DSQL总分≥40分，表明样本人群生存质量整体处于中低等水平。分析原因：首先，高达72.60%的老年T2DM患者在半年内发生低血糖频次超过3次，频发低血糖损害生存质量，国内研究证实其为社区老年T2DM严重低血糖恐惧关键因素，显著降低生活质量［17］。其次，22.61%为中重度低血糖患者，其头晕、无力等症状增跌倒风险，严重低血糖伤认知、增痴呆风险［18］。最后，糖尿病终身服药属长期消耗病，老年收入偏低，药物等费用负担重，家庭收入低可能迫选价廉药影响生存质量。
4.2　老年T2DM患者社会支持、低血糖恐惧感及生存质量存在相关性
本研究老年T2DM患者SSRS量表各维度（社会支持）与CHFSⅡ-WS得分（低血糖恐惧）均呈负相关，提示社会支持越强的患者低血糖恐惧越低。首先，社会支持通过三个维度共同发挥缓解低血糖恐惧的作用：①客观支持：家人提供控糖物品、科学餐食等物质援助，直接降低恐惧；②主观支持：患者主动求助、参与社区活动，打破孤立获情感慰藉；三维动态系统共同减轻恐惧［19-20］。值得注意的是：传统观点多强调社会支持对心理状态的缓冲效应，但社会支持与低血糖恐惧之间并非单向关系，低血糖恐惧对社会支持可能存在预测作用。高强度的低血糖恐惧往往伴随着显著的焦虑行为和频繁的求助信号，可能直接触发家庭成员及照护者提供更密集的监护与情感慰藉，即患者的心理痛苦程度促使外部支持系统的响应强度；患者高恐惧状态对外界的善意和帮助会更为敏感，从而在主观评价上获得更高的支持得分；因此，社会支持与低血糖恐惧感之间可能存在双向动态平衡。同时，SSRS得分还与DSQL得分（生存质量）成负相关，而CHFSⅡ-WS得分与DSQL得分成正相关，值得特别注意：DSQL量表为糖尿病特异性生存质量量表，其得分越高，反映患者的生存质量越差。因此，上述相关关系实际表明：社会支持水平越高，患者的生存质量越好；而低血糖恐惧越强，生存质量越差；这符合常规预期，并非真正的“悖论”。因此，提供有效的情感与实际帮助等高质量的社会支持才能有效化解低血糖恐惧，从而获得较高生存质量。
4.3　老年T2DM患者社会支持在低血糖恐惧感与生活质量中存在中介效应
本研究中介效应分析显示，老年T2DM患者低血糖恐惧（CHFSⅡ-WS）对生存质量的总效应β=0.751，其中49.27%通过社会支持（SSRS）的中介路径实现，中介效应置信区间（95%CI不包含0）的统计学显著性明显，即使控制其他潜在变量，社会支持仍是低血糖恐惧影响生存质量的关键中介路径。分析其原因，本研究发现，低血糖恐惧并未导致老年患者自我封闭，反而作为作为一种强烈的应激信号，促使患者更频繁的倾诉与求助，进而获得家属和医护人员提供更密集的照护、物质帮助及情感安慰，形成良性互动。由恐惧驱动所获得的支持，一方面通过规范控糖行为降低低血糖的实际发生风险，另一方面通过提供安全感缓解心理焦虑，身体状态和心理状态的双重改善，共同提升患者的生存质量。此外，社会支持量表反映的是患者主观感受到的支持程度。处于高恐惧状态的患者对安全相关信息更为敏感，往往能更深刻地感知并珍视外界提供的细微帮助，并可能强化的被支持感，能有效抵消恐惧带来的负面影响，进而改善生存质量。虽然理论上极度恐惧可能导致部分患者回避社交从而削弱支持，但本研究数据显示，在老年T2DM群体中，恐惧激发有效支持的正面路径占据主导，说明当前的家庭与社会支持系统对患者心理痛苦的反应是积极且有效的。因此，临床工作者不应简单将低血糖恐惧视为纯粹的负面因素，而应将其视为调动和优化社会支持资源的契机，通过引导患者将恐惧转化为建设性的求助行为，最大化社会支持的保护作用，最终实现生存质量的全面提升。
5　结论
收起
综上所述，T2DM患者的社会支持、低血糖恐惧、生存质量存在紧密关系，社会支持在低血糖恐惧与生存质量间起部分中介作用，中介效应占比为49.27%，这表明社会支持作为积极的关键因素，在缓解低血糖恐惧和提升生存质量具有重要作用。因此在临床实践中，家人、社区和医护人员应协同工作为患者提供有效、高质量的社会支持，以降低低血糖恐惧，从而改善其整体生存质量。本研究局限性：样本量偏小且为单中心便利抽样，外推性受限；仅纳入近半年有低血糖发作史的患者，无法代表无发作史人群；仅分析自我管理能力一个中介变量。未来需通过多中心大样本、多中介及纵向设计进一步验证。
基金
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  • 江苏省卫生健康委科研项目(M2020091)
文献
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2026年第53卷第12期
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doi: 10.20043/j.cnki.MPM.202512005
  • 接收时间：2025-12-01
  • 首发时间：2026-09-28
  • 出版时间：2026-06-25
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  • 收稿日期：2025-12-01
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江苏省卫生健康委科研项目(M2020091)
作者信息
    1.南京医科大学附属南京医院（南京市第一医院）内分泌代谢科，江苏 南京 210006
    2.南京医科大学附属南京医院（南京市第一医院）南院综合办公室
    3.徐州矿务集团总医院内分泌科

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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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