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Associations among fear of hypoglycemia, cognitive fusion and self-care activities in elderly patients with type 2 diabetes: a path analysis

Fangli Liu,Meng Wang,Luwen Zhang,Jianpei Niu

Published 2025 in BMC Nursing

ABSTRACT

Fear of hypoglycemia (FOH), considered an underestimated issue in clinical care, is not only related to negative psychological states but also adversely affects the metabolic control. Current research on FOH in patients with type 2 diabetes remains insufficient, particularly regarding the influencing mechanisms under the contexts of cognition and self-care activities. This study aims to investigate the current status and influencing factors of FOH in elderly patients with type 2 diabetes, and to examine its relationships with cognitive fusion, self-care activities and influencing factors using path analysis. This study adopts a cross-sectional design. From November 2023 to October 2024, elderly patients with type 2 diabetes admitted to the endocrinology department of two tertiary hospitals in Zhengzhou were selected as subjects. The research tools are general data questionnaires, cognitive fusion questionnaire (CFQ-F), the Chinese Version Hypoglycemia Fear Survey II-Worry Scale (CHFSII-WS), and the Summary of Diabetes Self-Care Activities (SDSCA). Data entry was performed using Epidata 3.1, statistical analysis was performed on SPSS 20.0, and path analysis was performed on AMOS 24.0. A total of 200 elderly patients with type 2 diabetes were included in this study. The total score of FOH in elderly patients with type 2 diabetes was (25.81 ± 10.81). Age, the number of hypoglycemia, medical payment methods (free medical service/self-pay), cognitive fusion and self-care activities were the influencing factors of FOH (P < 0.05). The path factor model showed that age, self-pay, free medical service, the number of hypoglycemia, cognitive fusion and self-care activities could directly affect FOH. Age, self-pay, the number of hypoglycemia, and cognitive fusion had significant indirect effects on FOH. Cognitive fusion ranks first among the total effects. Elderly patients with type 2 diabetes often experience FOH, which is influenced by multiple factors such as the disease, cognitive fusion, and self-care activities. Healthcare professionals should balance glycemic targets with patients’ psychological burden. Preventive interventions for hypoglycemia should be developed in a way that effectively reduces risk while minimizing potential anxiety in elderly patients. Not applicable.

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