2型糖尿病患者医院 -家庭过渡期症状群及核心症状的变化特征 [中文引用][英文引用]

目的  探讨 2 型糖尿病患者医院 - 家庭过渡期症状群及核心症状的变化特征，为临床症状管理措施提供依据。方法  采用便利抽样法，选取 2024 年 11 月— 2025 年 4 月在上海市浦东新区公利医院内分泌科就诊的 620 例 2 型糖尿病患者为研究对象，采用一般资料调查表和中文版 2 型糖尿病患者症状负担评估量表在患者出院时或出院前 1d（T1）和出院后 1 个月（T2）进行调查，采用探索性因子分析提取症状群，运用 R4.3.1 软件构建症状网络。结果  550 例 2 型糖尿病患者完成研究。探索性因子分析结果显示，在 T1~T2 期分别存在 6 个症状群，累积方差贡献率分别为 56.126% 与 58.882%；在 T1~T2 期均存在代谢紊乱症状群、疲乏相关症状群、眼科症状群、胃肠道 - 睡眠障碍症状群、神经病变症状群；认知 - 皮肤感觉异常症状群存在于T1 期，心理症状群存在于 T2 期。网络分析显示，T1 期与 T2 期强度中心性最高的症状分别是视力恶化（rs=1.79）与整体感觉疲乏（rs=1.68）。结论  在医院 - 家庭过渡期 2 型糖尿病患者的症状群大部分持续稳定存在，但群内症状呈现动态变化，视力恶化和整体感觉疲乏分别为出院前和出院后 1 个月的核心症状，医护人员应该根据此分别制定针对性干预措施，以提高症状管理效率。

Objective To explore the changes in symptom clusters and core symptoms in patients with Type II diabetes（T2D） over the hospital-to-home transition period and to create targeted symptom-management strategies. Methods Between November 2024 and April 2025，620 T2D patients were recruited by convenience sampling from the Department of Endocrinology，Gongli Hospital in Shanghai. Data were collected with a general information questionnaire and the revised diabetes symptom checklist（DSC-R）at two time points，at discharge or one day before discharge［T1］and 1 month after discharge［T2］. Exploratory factor analysis（EFA）was performed with R4.3.1 to identify symptom clusters，and symptom networks were constructed to determine core symptoms. Results Complete data were acquired from 550 participants. EFA revealed 6 symptom clusters at both T1 and T2，explaining 56.126% and 58.882% of the total variance，respectively. Five distinct persistent symptom clusters across T1 and T2 were extracted：metabolic disorder，fatigue-related， ophthalmic，gastrointestinal-sleep disturbance and neuropathy symptom clusters. The cognitive-skin sensory abnormality symptom cluster emerged only at T1，whereas a psychological symptom cluster emerged at T2. Network analysis identified visual deterioration as the core symptom at T1（rs=1.79）and general fatigue at T2（rs=1.68）. Conclusion Most symptom clusters remain stable over the hospital-tohome transition period，however individual symptoms within clusters change dynamically. Visual deterioration and general fatigue are the core symptoms over the period before and at one month after discharge，respectively. Targeted interventions focused on these core symptoms may improve the efficiency of symptom management over the transition period.