关键词: 糖尿病, 2型；低血糖意识受损；胰岛素；疾病感知；应对方式；常识模型；混合方法研究

Abstract: Background　Illness perception has great significant implications for patient disease management and health outcomes.Currently，quite few reports focus on the level and specific experience of illness perceptions of impaired awareness of hypoglycemia （IAH） following insulin therapy in type 2 diabetics.Objective　To explore the level and specific experience of illness perception of IAH as defined by the common-sense model following insulin therapy in type 2 diabetics，to provide a basis for delivering targeted interventions for such patients.Methods　This study adopted a two-phase，mixed-methods sequential explanatory design.The first phase was a quantitative analysis.Eligible type 2 diabetes inpatients with IAH following insulin therapy were recruited from Department of Endocrinology，Affiliated Hospital of Jiangsu University from February to December 2019 and received a self-administered or researcher-administered questionnaire survey using Demographic Questionnaire developed by our research group，the Brief Illness Perception Questionnaire（BIPQ） and Simplified Coping Style Questionnaire（SCSQ）.The scale score of BIPQ，and scores of consequences，timeline，personal and treatment control，identity，concern，overall comprehension of illness，and emotional response were compared by coping strategies.The second phase was a qualitative analysis.Qualitative data were derived from semi-structured face-to-face in-depth interviews with 14 cases selected from the participants of the first phase of study and were analyzed comparatively，including real experience of IAH，and illness perceptions of IAH（consequences，personal control，identify，concern，overall comprehension of illness，and emotional response） related to coping strategies.Results　The questionnaire survey obtained a response rate of 100.0%（113/113）.The prevalence of using negative and positive coping strategies was 36.8%（49/133） and 63.2%（84/133），respectively.Participants who used positive coping strategies had higher mean scale score of BIPQ，and higher mean scores of consequences，personal control，identity，concern，overall comprehension of illness，and emotional response（P<0.05）.5 themes were summarized from the interview results of participants using positive coping strategies：difficulties to take appropriate prevention and treatment measures for IAH，sensitivity to recognize the symptoms of IAH，restricted social communication，emotional responses，typical behaviors and eager for illness knowledge.5 themes were also summarized from the interview results of those using negative coping strategies：identifying hypoglycemia based on personal experience，rationalizing the prevalence of IAH，denying suffering from the negative impact of IAH，lack of psychological fluctuation experience caused by illness and emphasizing the dangers of hyperglycemia.Conclusion　Most of type 2 diabetics with IAH following insulin therapy had negative responses to their illness，and their illness perceptions differed by coping strategies.In view of this，medical workers should provide professional and personalized health education and emotional support based on the patient's illness perceptions and coping strategies.

Key words: Diabetes mellitus, type 2；Impaired awareness of hypoglycemia；Insulin；Illness perception；Coping style；Common sense model；Mixed methods research