Chain Mediating Role of Illness Perception and Fear of Hypoglycemia in Impaired Hypoglycemic Awareness and Mild Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

Mengyao      Han; Xiangning      Li; Yuying      He; Yinshi      Kan; Xiaojuan      Wan; Lin      Liu; Yue      Su; Jing      Chen; Li      Fang; Jinping      Wang; Yu      Zhang

doi:10.2174/0115733998418191251127053922

Abstract

Introduction: Impaired hypoglycemic awareness (IAH) in type 2 diabetes mellitus (T2DM) is linked to mild cognitive impairment (MCI), but the underlying mechanisms are unclear. This study aimed to explore the chain mediating role of two psychological factors, illness perception (IP) and fear of hypoglycemia (FOH), in the relationship between IAH and MCI.

Methods: A cross-sectional survey of 251 T2DM patients was conducted using convenience sampling at two tertiary hospitals. Data on IAH, IP, FOH, and MCI were collected using standardized questionnaires. Data were analyzed and compared using SPSS 27.0 and AMOS 27.0.

Results: There were significant correlations among IAH, IP, FOH, and MCI. Higher IAH was associated with increased FOH and more negative IP, which were both linked to worse cognitive function. Mediation analysis showed that IAH indirectly affects MCI through three pathways: independently via FOH, independently via IP, and via a chained effect of FOH and IP.

Discussion: The findings underscored that the link between IAH and cognitive decline is not solely physiological, but is substantially mediated by psychological responses. Negative illness perceptions and heightened fear, triggered by the unpredictability of IAH, drive maladaptive behaviors and emotional distress that contribute to worse cognitive outcomes.

Conclusion: The findings highlighted the role of psychological factors in cognitive decline among T2DM patients with IAH. We recommend that future interventions consider the associations between these variables. Diverse interventions aimed at improving IP and FOH levels could help slow cognitive decline in patients with IAH.

Keywords: Type 2 diabetes mellitus, impaired awareness of hypoglycemia, fear of hypoglycemia, illness perception, mild cognitive impairment, cross-sectional study, mediation analysis.

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DOI https://dx.doi.org/10.2174/0115733998418191251127053922	Print ISSN 1573-3998
Publisher Name Bentham Science Publishers	Online ISSN 1875-6417

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Chain Mediating Role of Illness Perception and Fear of Hypoglycemia in Impaired Hypoglycemic Awareness and Mild Cognitive Impairment in Patients with Type 2 Diabetes Mellitus

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