Mediating effects of emotional changes on management behavior and quality of life in elderly patients with type 2 diabetes mellitus in self-management intervention / 中华老年医学杂志

ABSTRACT

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), with the exception of changes in the blood glucose monitoring dimension score and changes in the emotional status score.The direct effect of self-management behavior on the quality of life in elderly patients with type 2 diabetes was 0.159, and the indirect effect through emotions was 0.229, with the mediating effect accounting for 59.02% of the total effect. Conclusions:Community-based group self-management activities can effectively improve the emotions and management behaviors of elderly diabetes patients and enhance their quality of life, Emotional changes play a certain mediating role between self-management behaviors and improvement in quality of life.