Associations among fear of hypoglycemia, cognitive fusion and diabetes self- care activities in elderly patients with type 2 diabetes: a cross-sectional study

Background Fear of hypoglycemia (FOH), considered an underestimated issue in clinical care, is not only related to patients' negative psychological states but also adversely affects the metabolic control of diabetes patients. This study aims to investigate the current status and influencing factors of FOH in elderly patients with type 2 diabetes, and to examine its relationships with cognitive fusion and self-care activities using structural equation modeling. Methods This study adopts a cross-sectional design. From November 2023 to October 2024, elderly patients with type 2 diabetes admitted to the endocrinology department of two tertiary hospitals in Zhengzhou were selected as subjects. The research tools are general data questionnaires, cognitive fusion questionnaire (CFQ-F), the Chinese Version Hypoglycemia Fear Survey II-Worry Scale (CHFSII-WS), and the Summary of Diabetes Self-Care Activities (SDSCA). Data entry was performed using Epidata 3.1, statistical analysis was performed on SPSS 20.0, and structural model analysis was performed on AMOS 24.0. Results A total of 200 elderly patients with type 2 diabetes were included in this study. The total score of FOH in elderly patients with type 2 diabetes was (25.81 ± 10.81). Age, the number of hypoglycemia, medical payment methods (free medical service/own expense), cognitive fusion and self-care activities were the influencing factors of FOH ( P  < 0.05). The path factor model showed that age, the number of hypoglycemia, self-pay, self-management, and cognitive fusion had an indirect effect on the FOH. At the same time, age, the number of hypoglycemia, free medical service, self-management, and cognitive fusion had a direct effect on the FOH. Conclusion Elderly patients with type 2 diabetes often experience FOH, which is influenced by multiple factors such as the disease, cognitive fusion, and self-care. Healthcare professionals should balance glycemic targets with patients' psychological burden, avoiding excessive prevention of hypoglycemia that may heighten anxiety.