Hepburn D A, Deary I J, MacLeod K M, Frier B M
Department of Diabetes, Royal Infirmary, Edinburgh, Scotland.
Diabetes Care. 1994 Nov;17(11):1273-80. doi: 10.2337/diacare.17.11.1273.
To assess the possible influence of personality on self-reported awareness, symptoms, and fear of hypoglycemia and also to identify the relationship among these self-reported measures using formal structural equation modeling.
A structured questionnaire, which included questions about sociodemographic details, awareness of the onset of hypoglycemia, and a list of symptoms of hypoglycemia, was completed by 305 consecutive insulin-treated diabetic patients attending the diabetic clinic at the Royal Infirmary of Edinburgh. They also completed the Hypoglycemia Fear Survey (HFS), and personality was assessed using the short form of the shortened Eysenck Personality Questionnaire-Revised (EPQ-R). Formal structural equation modeling was performed using the following variables: awareness, autonomic symptoms, neuroglycopenic symptoms, severe hypoglycemic episodes in the last year, worry and behavior (from the HFS), and extroversion and neuroticism (from the short EPQ-R). This allowed a model to be constructed that expressed the putative causal associations among the variables that could be tested statistically.
Of the 302 patients who had experienced hypoglycemia, 111 (37%) reported reduced awareness, and these patients scored higher on the worry subscale of the HFS (reduced awareness: 41 +/- 12 vs. normal awareness: 34 +/- 12, P < 0.001). The patients with reduced awareness scored higher for neuroticism than did the patients with normal awareness (reduced awareness: 6.1 +/- 3.4 vs. normal awareness: 4.9 +/- 3.3, P < 0.01) and scored lower for extroversion (reduced awareness: 5.8 +/- 3.7 vs. normal awareness: 7.1 +/- 3.7, P < 0.01). In the structural equation modeling exercise, neuroticism was a significant putative determinant of many of the other variables.
Personality was the major determinant of the variance that could be accounted for in this study and influenced self-reported symptoms, awareness, and fear of hypoglycemia. Personality factors may, therefore, influence self-reports from patients, particularly when soft measures, such as symptoms, are assessed and even when using validated clinical questionnaires. This finding stresses the importance of using additional evidence, such as reports from relatives, to substantiate reports from patients of loss of hypoglycemia awareness.
评估人格对自我报告的低血糖意识、症状及恐惧的可能影响，并使用正式的结构方程模型确定这些自我报告指标之间的关系。
305名连续就诊于爱丁堡皇家医院糖尿病门诊的接受胰岛素治疗的糖尿病患者完成了一份结构化问卷，问卷包括社会人口学细节问题、低血糖发作意识及一系列低血糖症状。他们还完成了低血糖恐惧调查（HFS），并使用简版的艾森克人格问卷修订版（EPQ-R）评估人格。使用以下变量进行正式的结构方程模型分析：意识、自主神经症状、神经低血糖症状、过去一年严重低血糖发作次数、担忧及行为（来自HFS），以及外向性和神经质（来自简版EPQ-R）。这使得能够构建一个模型，该模型表达了变量之间可能的因果关联，且可进行统计学检验。
在302名经历过低血糖的患者中，111名（37%）报告低血糖意识降低，这些患者在HFS的担忧子量表上得分更高（意识降低组：41±12 vs. 正常意识组：34±12，P<0.001）。意识降低的患者神经质得分高于意识正常的患者（意识降低组：6.1±3.4 vs. 正常意识组：4.9±3.3，P<0.01），外向性得分低于意识正常的患者（意识降低组：5.8±3.7 vs. 正常意识组：7.1±3.7，P<0.01）。在结构方程模型分析中，神经质是许多其他变量的一个重要假定决定因素。
人格是本研究中可解释变异的主要决定因素，影响自我报告的症状、意识及低血糖恐惧。因此，人格因素可能影响患者的自我报告，特别是在评估诸如症状等软性指标时，甚至在使用经过验证的临床问卷时也是如此。这一发现强调了使用额外证据（如亲属报告）来证实患者关于低血糖意识丧失报告的重要性。
