The mediating effect of diabetic distress on the fear of disease progression and quality of life in elderly patients with type 2 diabetes

LI Zhongyan; LI Renguo; LU Jing; DANG Lingjing; YANG Jiangrong; ZHANG Jianqiong

doi:10.3969/j.issn.2096-9058.2025.05.011

Abstract：Objective To investigate the mediating role of diabetic distress in the relationship between the fear of disease progression and quality of life among elderly patients with type 2 diabetes mellitus(T2DM).Methods A conve-nience sampling approach was employed.A total of 226 elderly inpatients with T2DM from the First Affiliated Hospital of Yunnan University of Traditional Chinese Medicine between January and October 2024 were recruited as the study sub-jects.General information questionnaires,the Diabetes-Specific Quality of Life Scale,the Simplified Fear of Progression Questionnaire,and the Diabetes Distress Scale were utilized to collect data and assess the quality of life,fear of disease progression,and the level of diabetic distress.Pearson correlation analysis was carried out to explore the correlations among the scores of diabetic distress,the fear of disease progression,and quality of life in elderly T2DM patients.The me-diating effect of diabetic distress was examined using the Amos23.0 software in combination with the Bootstrap method(with 5 000 resamples).Results The total score of quality of life among elderly T2DM patients was 84.93±12.15,the score of the fear of disease progression was 36.10±12.16,and the score of diabetic distress was 56.59±12.41.Correla-tion analysis revealed that the quality of life score was positively correlated with both the fear of disease progression score(r=0.63,P<0.001)and the diabetic distress score(r=0.60,P<0.001).Mediation analysis demonstrated that the fear of disease progression had a significant direct effect on quality of life,with an effect size of 0.41(95%CI:0.27-0.55,P<0.05),accounting for 65.08%of the total effect.Additionally,diabetic distress played a partial mediating role between the two,with an indirect effect size of 0.22(95%CI:0.09-0.34,P<0.05),accounting for 34.92%of the total effect.Conclusions The fear of disease progression has a direct negative influence on the quality of life of elderly T2DM pa-tients,and diabetic distress plays a partial mediating role.Clinically,it is necessary to simultaneously focus on cognitive interventions for the fear of disease progression and emotional management of diabetic distress to interrupt the vicious cycle of"the fear of disease progression→diabetic distress→decline in quality of life"and enhance the quality of life of patients.