研究背景与研究目的：我国Ⅱ型糖尿病患者数量逐年递增，Ⅱ型糖尿病已对我国公共卫生医疗体系造成巨大的负担。尤其是在农村地区，因医疗保障体系以及公共医疗卫生服务体系的不健全，造成农村地区Ⅱ型糖尿病患者血糖控制水平普遍不高，进而导致了患者认知功能的下降。为了改善农村地区Ⅱ型糖尿病患者晚年的生活质量，有必要保持其现有的认知功能或缓解其认知功能下降的程度，而家庭支持能对其认知功能起到很好的支撑和改善作用。因此，有必要研究农村地区Ⅱ型糖尿病患者家庭支持与其认知功能的关系。

研究方法：运用目的性抽样和整群抽样，对江苏省大丰市和常熟市农村地区8所卫生服务站的853名Ⅱ型糖尿病患者进行问卷调查。将糖尿病患者问卷A部分三道主观题作为家庭支持三个因素（聊天倾诉、重大决定、外出陪伴）的测量，使用简易精神状态量表测量认知功能。运用均值、标准差、百分比对患者的人口统计学变量、临床指标和混杂因素进行统计分析；运用卡方检验、方差齐性检验、t检验和方差分析，分析家庭支持、认知功能在人口统计学变量、临床指标和混杂因素上的差异；运用多元线性回归分析，探索家庭支持对认知功能的影响，以及不同性别下家庭支持对认知功能的影响。

研究结果：本研究有效问卷回收率为51.11%（436份有效问卷）。研究对象中女性患者269人（61.98%），男性患者165人（38.02%），平均年龄为63.86，主要户口类型为农业户口（93.29%）。农村地区Ⅱ型糖尿病患者受教育程度普遍偏低，学历为初中及以上的仅占34.64%，未上过学和小学学历的有283人。患者患病时长平均为20.40年，糖化血红蛋白值平均为7.78%，主要医疗保险类型为新型农村合作医疗及城镇居民基本医疗保险（402人）。

在控制人口统计学变量、临床指标和混杂因素后，家庭支持可以解释认知功能3.00%的变异。在聊天倾诉因素，与直系血亲相比，患者选择与配偶进行交流沟通能对患者的认知功能产生正向的预测（β =1.25，P＜0.05）；在重大决定因素，与直系血亲相比，患者选择与配偶进行商榷能对其认知功能起到正向预测的作用（β =1.24，P＜0.05）；在外出陪伴因素，与直系血亲相比，患者选择配偶及其他亲属是其认知功能的阻碍因素（β =-1.94，P＜0.01；β =-1.96，P＜0.05）。

在控制了人口统计学变量、临床指标和混杂因素的情况下，男性患者家庭支持可以解释认知功能总变异的7.00%。在重大决定因素，与直系血亲相比，患者选择与其他亲属进行商榷能对其认知功能起到正向预测的作用（β =3.71，P＜0.05）。

在控制了人口统计学变量、临床指标和混杂因素的情况下，女性家庭支持可以解释认知功能4.00%的变异。在聊天倾诉因素，与直系血亲相比，患者选择与配偶进行交流沟通能对患者的认知功能产生正向的预测（β =2.02，P＜0.05），在外出陪伴因素，与直系血亲相比，患者选择配偶陪同是其认知功能的阻碍因素（β =-2.73，P＜0.01）。

研究结论：性别、年龄、教育水平、是否患有肾脏疾病以及糖尿病知识水平与农村地区Ⅱ型糖尿病患者认知功能有显著相关，越年轻、受教育程度越高、糖尿病知识水平越高且没有肾脏疾病的男性患者，其认知功能越好。

对于农村地区Ⅱ型糖尿病患者来说，家庭支持与认知功能有显著相关，在聊天倾诉因素和重大决定因素上，与直系血亲相比，患者选择与配偶进行交流沟通和商榷，其认知功能越好；在外出陪伴因素上，与直系血亲相比，患者选择配偶或者其他亲属，其认知功能越差。

对于农村地区Ⅱ型糖尿病男性患者来说，家庭支持中重大决定因素与认知功能有显著相关，与直系血亲相比，患者选择与其他亲属进行商榷，其认知功能越好。教育水平对男性患者的认知功能无显著影响（P＞0.05）。

对于农村地区Ⅱ型糖尿病女性患者来说，家庭支持中聊天倾诉以及外出陪伴因素均与认知功能有显著相关，在聊天倾诉因素上，与直系血亲相比，患者选择与配偶进行交流沟通，其认知功能越好，在外出陪伴方面，与直系血亲相比，患者选择配偶陪同其认知功能越差。是否患有肾脏疾病对女性患者的认知功能无显著影响（P= 0.315）。

Background and purpose of the study: The number of type II diabetes patients in China is increasing year by year, and type II diabetes places a heavy burden on the public healthcare system in China. Particularly in rural areas, due to inadequate health care coverage and public health service systems, the level of glycaemic control among rural type II diabetics is generally low, resulting in cognitive decline. In order to improve the quality of life of rural type II diabetics in their later years, it is necessary to maintain their existing cognitive function or mitigate the degree of cognitive decline, and family support can play a good role in supporting and improving their cognitive function. Therefore, there is a need to study the relationship between family support and cognitive functioning in rural areas for people with type II diabetes.

Methods: Using purposive sampling and cluster sampling, questionnaires were administered to 853 patients with type Ⅱ diabetes in eight health service stations in rural areas of Dafeng and Changshu cities, Jiangsu Province. Three subjective questions in Part A of the questionnaire for diabetic patients were used as measures of three factors of family support (chatting and confiding, major decisions, and out-of-home companionship), and cognitive function was measured using the Mini-Mental State Examination. Statistical analysis of patient demographic variables, clinical indicators and confounding factors using means, standard deviations, and percentages; chi-square tests, chi-square tests, t-tests, and ANOVAs were used to analyze differences in family support and cognitive function on demographic variables and clinical indicator factors; multiple linear regression analyses were used to explore the effect of family support on cognitive function, and the effect of family support on cognitive function under different by gender.

Results: The valid questionnaire return rate of this study was 51.11% (436 valid questionnaires). And the study population consisted of 269 female patients (61.98%) and 165 male patients (38.02%) with a mean age of 63.86, and the main household type was agricultural (93.29%). The education level of type Ⅱ diabetes patients in rural areas was generally low, with only 34.64% with education of junior high school or above, and 283 with no schooling and elementary school education. The average length of illness of patients was 20.40 years, and the average glycosylated hemoglobin value was 7.78%. The main medical insurances are the new rural cooperative medical insurance and the basic medical insurance for urban residents (402 people).

After controlling for demographic variables, clinical indicators and confounding factors, family support explained 3.00% of the variance in cognitive function. In the chatting and confiding factor, patients' choice to communicate with their spouse was a positive predictor of their cognitive functioning compared to their immediate blood relatives (β=1.25, P<0.05); in the major decisions factor, patients' choice to confer with their spouse was a positive predictor of their cognitive functioning compared to their immediate blood relatives (β=1.24, P<0.05); and in the out-of-home companionship factor, patients' choice of spouse and other relatives was a positive predictor of their cognitive functioning compared to immediate blood relatives, patients' choice of spouse and other relatives was a hindrance to their cognitive functioning (β=-1.94, P<0.01; β=-1.96, P<0.05).

Controlling for demographic variables, clinical indicators and confounding factors, family support in male patients explained 7.00% of the total variance in cognitive function. In terms of significant determinants, patients' choice to confer with other relatives could positively predict their cognitive functioning compared to their immediate blood relatives (β=3.71, p<0.05).

Controlling for demographic variables, clinical indicators and confounding factors, female family support explained 4.00% of the variance in cognitive function. In the chatting and confiding factor, patients' choice to communicate with their spouse positively predicted their cognitive functioning compared to their immediate blood relatives (β=2.02, P<0.05), and in the out-of-home companionship factor, patients' choice to be accompanied by their spouse was a hindrance to their cognitive functioning compared to their immediate blood relatives (β=-2.73, P<0.01).

Conclusion: Gender, age, education level, presence of kidney disease and knowledge level about diabetes were significantly associated with cognitive function in rural areas with type Ⅱ diabetes, with younger, better educated and better informed men with diabetes and without kidney disease having better cognitive function.

For patients with type Ⅱ diabetes in rural areas, family support was significantly associated with cognitive function. For chatting and confiding factors and major decision factors, the better the cognitive function of patients who chose to communicate and negotiate with their spouses compared to their immediate blood relatives, and for out-of-home companionship factors, the worse the cognitive function of patients who chose their spouses or other relatives compared to their immediate blood relatives.

For men with type Ⅱ diabetes in rural areas, significant determinants of family support were significantly associated with cognitive function, and the more patients chose to confer with other relatives compared to their immediate blood relatives, the better their cognitive function. There was no significant effect of education level on cognitive function in male patients (p > 0.05).

For female patients with type Ⅱ diabetes in rural areas, both the chatting and out-of-home companionship factors of family support were significantly associated with cognitive function, and for the chatting factor, patients who chose to communicate with their spouses were better at cognitive function compared to their immediate blood relatives, and for out-of-home companionship, patients who chose to be accompanied by their spouses were worse at cognitive function compared to their immediate blood relatives. The presence or absence of kidney disease had no significant effect on the cognitive function of female patients (p= 0.315).