Socio-demographic and clinical determinants of self-care in Chinese adults with type 2 diabetes: a multicenter cross-sectional study

Abstract

Abstract Background Self-care is essential for the management of type 2 diabetes. This study aims to explore self-care level as a dynamic process and investigate its socio-demographic and clinical determinants among Chinese adults with type 2 diabetes. Methods In this multicenter cross-sectional study, we enrolled 495 Chinese adults with type 2 diabetes from outpatient settings of three tertiary hospitals in Zhejiang province, China. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, self-care monitoring, self-care management, and self-care confidence as four critical components of the dynamic self-care process. Multiple quantile regression models were used to identify the determinants of each self-care dimension. Results The median scores for self-care maintenance, self-care monitoring, and self-care management were 66.67, 47.06, and 53.13, respectively. Over half of the participants exhibited inadequate self-care maintenance, self-care monitoring, and self-care management (score less than 70), whereas their self-care confidence was adequate (median = 70.45). Lower level of self-care maintenance was associated with being male (p = 0.002), younger (p = 0.006), having at least one complication (p = 0.014), not living in city A (p < 0.001), and lower self-care confidence (p < 0.001). Lower level of self-care monitoring was associated with being female (p = 0.035), belonging to ethnic minorities (p = 0.002), not attending diabetes self-management education in the last year (p = 0.003), not living in city B (p < 0.001), and having lower self-care confidence (p < 0.001). Lower level of self-care management was associated with not having any complications (p = 0.003), not living in city B (p < 0.001), and having lower self-care confidence (p < 0.001). Lower level of self-care confidence was associated with not having any complications (p = 0.009), not attending diabetes self-management education (p = 0.004), and not living in city B (p < 0.001) or C (p = 0.001). Conclusions/interpretation: Among Chinese adults with type 2 diabetes, the degree of self-care maintenance, self-care monitoring, and self-care management was poor, whereas self-care confidence was relatively sufficient. More attention should be paid to the self-care of younger male patients belonging to ethnic minorities who live in less-developed cities. Modifiable determinants, such as self-care confidence and participation in diabetes self-management education, can be targeted to develop tailored self-care interventions.