社会参与在老年2型糖尿病患者自我管理与社会隔离间的中介效应

王静; 林可可; 孙超; 武全莹; 白小燕; 卫亦文; 刘宇

doi:10.16766/j.cnki.issn.1674-4152.003660

社会参与在老年2型糖尿病患者自我管理与社会隔离间的中介效应

doi: 10.16766/j.cnki.issn.1674-4152.003660

1.
北京中医药大学护理学院，北京 100029
2.
北京医院护理部国家老年医学中心中国医学科学院老年研究所，北京 100730

基金项目:

北京市社会科学基金资助项目 18SRB009

北京中医药大学2022年度基本科研业务费项目(揭榜挂帅项目) 2022-JYB-JBZR-026

详细信息

通讯作者:
刘宇，E-mail: liuyu222@hotmail.com

中图分类号: R587.1 R592
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出版历程
- 收稿日期: 2024-01-09

Mediating effect of social participation on self-management and social isolation in elderly patients with type 2 diabetes mellitus

1.
School of Nursing, Beijing University of Chinese Medicine, Beijing 100029, China

摘要

摘要: 目的探讨老年2型糖尿病(type 2 diabetes mellitus, T2DM)患者的自我管理对社会隔离的影响路径，并分析社会参与的中介作用。方法采用便利抽样，使用Lubben社会网络量表-6、糖尿病自我管理活动问卷及自主参与问卷，调查2023年5—11月在北京市三甲医院内分泌科或社区卫生服务中心就诊或住院的496例老年2型糖尿病患者的社会隔离现状，构建社会隔离与自我管理及社会参与的结构方程模型，分析社会参与的中介效应。结果 496例老年2型糖尿病患者中227例发生社会隔离，发生率为45.77%；发生家庭维度与朋友维度社会隔离人数分别为74例(14.92%)与239例(48.19%)。结构方程模型参数估计收敛良好，后验预测P值为0.371＞0.05，拟合较好。模型显示，自我管理中的运动管理与吸烟对社会隔离有负向直接效应(-0.136与-0.132)，还通过社会参与间接影响社会隔离(-0.201和-0.079)，中介效应比分别为59.47%和37.44%。结论老年2型糖尿病患者的自我管理(运动与吸烟)及社会参与可以预测社会隔离的发生，社会参与在糖尿病自我管理(运动与吸烟)与社会隔离的关系中起中介作用。
- 2型糖尿病 /
- 老年 /
- 社会隔离 /
- 社会参与 /
- 自我管理 /
- 中介效应
Abstract: Objective To analyze the influence pathway of self-management on social isolation in elderly patients with type 2 diabetes mellitus (T2DM) and the mediating role of social participation. Methods The social isolation status of er adults with T2DM treated in hospitals or community health service centers in Beijing from May to November 2023 was investigated with the Lubben social network scale-6, the summary of diabetes self-care activities and impact on participation and autonomy questionnaire. Structural equation model of social isolation and self-management and social participation were constructed to analyze the mediating effects of social participation. Results Among 496 er adults with T2DM, 227 experienced social isolation, and the incidence was 45.77%. The er adults experienced social isolation in family dimension and friend dimension were 74 (14.92%) and 239 (48.19%), respectively. The structural equation model parameter estimated converge well, while the posterior predicted P-value of the model was 0.371>0.05, which meant a good fit. The model showed that exercise management and smoking had a negative direct effect on social isolation (-0.136 and -0.132), and also indirect effected through social participation (-0.201 and -0.079), with a mediation effect ratio of 59.47% and 37.44%. Conclusion Self-management (exercise and smoking) and social participation in elderly patients with type 2 diabetes can predict the occurrence of social isolation. Social participation plays a mediating role in the relationship between diabetes self-management (exercise and smoking) and social isolation.
- Type 2 diabetes mellitus /
- Older adult /
- Social isolation /
- Social participation /
- Self-management /
- Mediating effect
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图 1 老年T2DM患者社会参与在自我管理与社会隔离间的中介效应

Figure 1. The mediating effect of social participation on self-management and social isolation in elderly patients with T2DM

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表 1 不同特征老年T2DM患者社会隔离发生情况比较

Table 1. Comparison of social isolation status among older adults with T2DM based on varying characteristics

项目	类别	例数	无社会隔离(n=269)	社会隔离(n=227)	统计量	P值
性别(例)	男性	273	162	111	6.380^a	0.012
	女性	223	107	116
年龄(例)	60~69岁	283	181	102	-5.218^b	＜0.001
	70~79岁	192	83	109
	≥80岁	21	5	16
文化程度(例)	初中及以下	145	71	74	-2.786^b	0.005
	高中/中专	179	88	91
	大专/本科及以上	172	110	62
婚姻状况(例)	有配偶	447	253	194	10.202^a	0.001
	无配偶	49	16	33
独居情况(例)	独居	23	8	15	3.676^a	0.055
	非独居	473	261	212
工作情况(例)	离退休	480	255	225	7.371^a	0.007
	在职	16	14	2
病程(例)	1~10年	162	89	73	-0.525^b	0.600
	10~19年	190	96	94
	≥20年	144	84	60
治疗方式(例)	口服药物	283	151	132	0.218^a	0.975
	胰岛素	54	30	24
	口服药物+胰岛素	146	81	65
	仅饮食运动控制	13	7	6
糖尿病并发症(例)	无	316	198	118	24.897^a	＜0.001
	有	180	71	109
空腹血糖[M(P₂₅, P₇₅)，mmol/L]			7.30(6.30, 9.30)	7.60(6.20, 10.87)	-1.190^b	0.234
注: ^a为χ²值，^b为Z值。

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表 2 老年T2DM患者社会隔离与自我管理及社会参与的相关性(r值)

Table 2. Correlation between social isolation, self-management, and social participation in elderly patients with T2DM(r value)

变量	社会隔离	饮食管理	运动管理	血糖监测	足部护理	药物使用	吸烟	IPA总分
社会隔离	1
饮食管理	0.074^a	1
运动管理	-0.275^a	0.112^b	1
血糖监测	0.082	0.315^a	-0.091^b	1
足部护理	0.094^b	0.212^a	0.102^b	0.190^a	1
药物使用	0.027	0.043	0.104^b	0.064	0.200^a	1
吸烟	-0.170^a	-0.155^a	-0.003	-0.061	-0.062	-0.001	1
IPA总分	0.651^a	0.060	-0.277^a	0.021	0.070	0.069	-0.123^a	1
注：^aP＜0.01，^bP＜0.05。

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表 3 变量标准化总效应、直接效应与间接效应结果

Table 3. Results of standardized total effect, direct effect, and indirect effect

路径关系	效应类型	Estimate	SE	95% CI	P值
社会隔离←运动管理	直接效应	-0.136	0.045	-0.222~-0.048	0.001
	间接效应	-0.201	0.029	-0.258~-0.144	＜0.001
	总效应	-0.338	0.049	-0.429~-0.239	＜0.001
社会隔离←吸烟	直接效应	-0.132	0.049	-0.228~-0.036	0.004
	间接效应	-0.079	0.029	-0.136~-0.023	0.004
	总效应	-0.211	0.056	-0.318~-0.101	＜0.001

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参考文献(27)

[1]	《中国老年型糖尿病防治临床指南》编写组. 中国老年2型糖尿病防治临床指南(2022年版)[J]. 中国糖尿病杂志, 2022, 30(1): 2-51. doi: 10.3969/j.issn.1006-6187.2022.01.002 Compilation team of Clinical Guidelines for the Prevention and Treatment of Elderly Diabetes mellitus in China. Clinical guidelines for prevention and treatment of type 2 diabetes mellitus in the elderly in China (2022 edition)[J]. Chinese Journal of Diabetes, 2022, 30(1): 2-51. doi: 10.3969/j.issn.1006-6187.2022.01.002
[2]	吴诗诗, 刘宇, 林可可, 等. 自我效能在社区2型糖尿病患者角色需求认知和自我管理间的中介效应[J]. 中华全科医学, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877 WU S S, LIU Y, LIN K K, et al. The mediating effect of diabetes self-efficacy between perceived role demands and diabetes self-management among community patients with type 2 diabetes[J]. Chinese Journal of General Practice, 2021, 19(4): 621-624, 666. doi: 10.16766/j.cnki.issn.1674-4152.001877
[3]	IDA S, KANEKO R, IMATAKA K, et al. Factors associated with social isolation and being homebound among older patients with diabetes: a cross-sectional study[J]. BMJ Open, 2020, 10(11): e037528. DOI: 10.1136/bmjopen-2020-037528.
[4]	王欣欣, 张呈蕊, 栾伟. 上海市社区老年人社会隔离及其影响因素研究[J]. 中国预防医学杂志, 2023, 24(11): 1159-1165. WANG X X, ZHANG C R, LUAN W. Social isolation and its influencing factors in the older adults in communities in Shanghai[J]. Chinese Preventive Medicine, 2023, 24(11): 1159-1165.
[5]	魏梓萱. 老年糖尿病患者社会隔离现状及其影响因素研究[D]. 合肥: 安徽医科大学, 2023. WEI Z X. Study on the status of social isolation and influencing factors in elderly patients with diabetes[D]. Hefei: Anhui Medical University, 2023.
[6]	BASMAZ S E, DOGAN F, SAHIN F. Relationship between mental symptoms, dietary compliance and glucose levels of diabetic patients in isolation during COVID-19 pandemic[J]. J Health Sci Med, 2022, 5(1): 189-194.
[7]	王佩, 王青, 赵翠芬, 等. 社区老年人社会隔离的潜在剖面分析及影响因素研究[J]. 护理学杂志, 2024, 39(2): 14-18. doi: 10.3870/j.issn.1001-4152.2024.02.014 WANG P, WANG Q, ZHAO C F, et al. Latent profile analysis and its influencing factors of social isolation among community older adults[J]. Journal of Nursing Science, 2024, 39(2): 14-18. doi: 10.3870/j.issn.1001-4152.2024.02.014
[8]	付蓓, 肖清丰, 胡慧. 老年糖尿病患者社会参与水平及影响因素分析[J]. 中国慢性病预防与控制, 2020, 28(1): 48-52. FU B, XIAO Q F, HU H. Analysis of the social participation level and influencing factors of elderly diabetes patients[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(1): 48-52.
[9]	中华医学会糖尿病学分会. 中国2型糖尿病防治指南(2020年版)[J]. 中华糖尿病杂志, 2021, 13(4): 315-409. Chinese Diabetes Society. Guideline for the prevention and treatment of type 2 diabetes mellitus in China (2020 edition)[J]. Chinese Journal of Diabetes, 2021, 13(4): 315-409.
[10]	CHANG Q S, SHA F, CHAN C H, et al. Validation of an abbreviated version of the Lubben Social Network Scale ("LSNS-6") and its associations with suicidality among older adults in China[J]. PLoS One, 2018, 13(8): e0201612. DOI: 10.1371/journal.pone.0201612.
[11]	孙胜男. 糖尿病患者自我管理现状及影响因素的研究[D]. 北京: 中国协和医科大学, 2010. SUN S N. Study on the current situation and influencing factors of self-management in diabetes patients[D]. Beijing: Peking Union Medical College, 2010.
[12]	贺亚楠. 首发脑卒中患者社会参与水平及影响因素的纵向研究[D]. 上海: 第二军医大学, 2013. HE Y N. A longitudinal study of the level of social participation and influencing factors in first-episode stroke patients[D]. Shanghai: Naval Medical University, 2013.
[13]	乔欣宇, 冯咏琳, 潘俊豪. 贝叶斯结构方程模型的原理及应用[J]. 心理技术与应用, 2023, 11(10): 599-619. QIAO X Y, FENG Y L, PAN J H. The Principle of Bayesian Structural Equation Model and Its Application in Psychology[J]. Psychology: Techniques and Applications, 2023, 11(10): 599-619.
[14]	YANG K L, LIU Y, YIN X, et al. A survey of social network status and its related factors for older adults with type 2 diabetes in Beijing, China[J]. Nurs Open, 2022, 9(2): 1005-1014. doi: 10.1002/nop2.1138
[15]	陈彤桦, 迟春花, 周国鹏. 新冠疫情防控下体检人群生活方式及体重变化的调查与分析[J]. 中华全科医学, 2022, 20(6): 1062-1065, 1070. doi: 10.16766/j.cnki.issn.1674-4152.002524 CHEN T H, CHI C H, ZHOU G P. Investigation and analysis on the changes of lifestyle and body weight in physical examination population during the novel coronavirus pneumonia epidemic prevention and control stage[J]. Chinese Journal of General Practice, 2022, 20(6): 1062-1065, 1070. doi: 10.16766/j.cnki.issn.1674-4152.002524
[16]	李雅娜, 韩影, 刘瑶, 等. 唐山市社区老年人社会隔离影响因素分析[J]. 中国公共卫生, 2021, 37(2): 319-322. LI Y N, HAN Y, LIU Y, et al. Prevalence and influencing factors of social isolation among community elderly in Tangshan city[J]. Chinese Journal of Public Health, 2021, 37(2): 319-322.
[17]	李茜, 张海茹, 易子涵, 等. 社区老年人社会隔离及自我感知老化现状调查[J]. 广西医学, 2021, 43(6): 763-767. LI Q, ZHANG H R, YI Z H, et al. Survey on status quo of social isolation and self-perception of aging amongthe elderly in community[J]. Guangxi Medical Journal, 2021, 43(6): 763-767.
[18]	唐丹, 张琨. 社会网络在老年人身体健康与心理健康关系中的作用机制[J]. 社会建设, 2023, 10(4): 60-71. TANG D, ZHANG K. Mechanisms of social networks in the relationship between physical health and mental health in the elderly[J]. Social Construction, 2023, 10(4): 60-71.
[19]	戴付敏, 刘思雨, 张希. 社区居家多病共存老年人的非正式照料研究进展[J]. 中华全科医学, 2020, 18(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001276 DAI F M, LIU S Y, ZHANG X. Research progress on informal care of the elderly living with multiple disease in a community home[J]. Chinese Journal of General Practice, 2020, 18(3): 471-475. doi: 10.16766/j.cnki.issn.1674-4152.001276
[20]	杨开连. 社会支持在老年2型糖尿病患者社会网络与自我管理间的中介作用[J]. 上海护理, 2023, 23(5): 40-44. doi: 10.3969/j.issn.1009-8399.2023.05.009 YANG K L. Mediating effect of social support on the relationship between social network and self-management among elderly patients with type 2 diabetes mellitus[J]. Shanghai Nursing, 2023, 23(5): 40-44. doi: 10.3969/j.issn.1009-8399.2023.05.009
[21]	杨予青, 陈荃, 何琪乐, 等. 北京市东城区老年糖尿病患者自我管理水平及其影响因素研究[J]. 医学信息学杂志, 2024, 45(1): 59-63, 88. doi: 10.3969/j.issn.1673-6036.2024.01.010 YANG Y Q, CHEN Q, HE Q L, et al. Study on self-management level of elderly diabetic mellitus patients in Dongcheng district of Beijing and its influencing factors[J]. Journal of Medical Informatics, 2024, 45(1): 59-63, 88. doi: 10.3969/j.issn.1673-6036.2024.01.010
[22]	刘成成, 陈利群, 谢博钦, 等. 社区高龄老年人社会隔离现状及影响因素研究[J]. 护理学杂志, 2022, 37(13): 98-102. doi: 10.3870/j.issn.1001-4152.2022.13.098 LIU C C, CHEN L Q, XIE B Q, et al. Prevalence and determinants of social isolation among community-living oldest-old adults[J]. Journal of Nursing Science, 2022, 37(13): 98-102. doi: 10.3870/j.issn.1001-4152.2022.13.098
[23]	杨开连. 老年2型糖尿病患者社会网络现状及其影响因素研究[D]. 北京: 北京中医药大学, 2020. YANG K L. Current status of social networks and their influencing factors in elderly patients with type 2 diabetes mellitus[D]. Beijing: Beijing University of Chinese Medicine, 2020.
[24]	左满芳, 于秋敏, 马欣, 等. 社区2型糖尿病患者体力活动状况分析[J]. 中国慢性病预防与控制, 2020, 28(11): 866-869. ZUO M F, YU Q M, MA X, et al. Analysis of the physical activity status of type 2 diabetes patients in the community[J]. Chinese Journal of Prevention and Control of Chronic Diseases, 2020, 28(11): 866-869.
[25]	陈海德, 赵博强, 疏雯, 等. 吸烟者感知吸烟社会规范与社交性吸烟行为的关系: 身份认同和关系观的作用[J]. 心理科学, 2021, 44(4): 933-939. CHEN H D, ZHAO B Q, SHU W, et al. The relationship between perceived smoking social norms and social smoking behavior among Chinese smokers: The mediating role of identity and moderating role of cultural value of Guanxi[J]. Journal of Psychological Science, 2021, 44(4): 933-939.
[26]	李月, 陆杰华, 成前, 等. 我国老年人社会参与与抑郁的关系探究[J]. 人口与发展, 2020, 26(3): 86-97. LI Y, LU J H, CHENG Q, et al. Association between social participation and depression among older adults in China[J]. Population and Development, 2020, 26(3): 86-97.
[27]	刘珊珊, 牛静雅, 王天歌, 等. 上海淞南社区2型糖尿病患者合并其他心血管代谢异常的现况流行病学调查[J]. 诊断学理论与实践, 2019, 18(3): 323-328. LIU S S, NIU J Y, WANG T G, et al. Epidemiological investigation on cardiometabolic abnormalities in Songnan Community residents with type 2 diabetes[J]. Journal of Diagnostics Concepts < Practice, 2019, 18(3): 323-328.