Clinical and socio-demographic determinants of self-care in type 2 diabetes patients: a multi-centre cross-sectional study

Background. Knowledge of clinical and socio-demographic determinants of self-care in type 2 diabetes mellitus (T2DM) population is needed to identify patients at risk of poor self-care and to tailor effective interventions. Determinants of self-care, as defined by the middle-range theory of self-care of chronic illness, have not previously been investigated in T2DM. Aims. To describe self-care maintenance, monitoring, management and confidence and to identify their clinical and socio-demographic determinants in a T2DM population. Methods. A multicentre cross-sectional study was conducted involving 540 patients with a confirmed diagnosis of T2DM from 6 outpatient diabetes services in Italy. Socio-demographic and clinical data were collected from medical records. The Self-Care of Diabetes Inventory (SCODI) was used to measure self-care maintenance, monitoring, management and confidence dimensions. Scores were standardized 0-100 with higher SCODI scores indicating better self-care; a score ≥70 is adequate. Multiple quantile regression models were performed to identify determinants of each self-care dimension. Results. Self-care maintenance (median = 81.2, Q1-Q3: 72.9-89.5) and self-care confidence (median = 79.5, Q1-Q3: 65.9-93.1) were adequate in most of the subjects. Self-care monitoring was adequate only in half of the sample (median = 70.5, Q1-Q3: 55.8-85.2). Self-care management was poor (median = 59.3, Q1-Q3: 39.7-75.0). Lower self-care maintenance was associated with lower self-care confidence (beta= 0.13; p<0.001). Lower self-care monitoring was associated with being male (beta= -9.95; p<0.001), having lower self-care confidence (beta= 0.48; p<001), and having diabetes for < 10 years (beta= -9.68; p<0.001). Lower self-care management was associated with being male (beta= -6.35; p=0.002), being older (beta= -9.24; p=0.005), having a low income (beta= -4.44; p=0.030), being employed (beta= -8.33; p=0.008), having missed diabetes education in the last year (beta=-12.73; p=0.002), and lower self-care confidence (beta=0.7; p<0.0001). Lower self-care confidence was associated with having diabetes for less of 10 years (beta= -6.06; p=0.008), lacking family support (beta= -5.30; p=0.054) and having at least one comorbid condition (beta=-9.09; p=0.006). Conclusions. Determinants of self-care maintenance, monitoring, management and confidence include both clinical and socio-demographic variables. Modifiable determinants such as self-care confidence, diabetes education, and family support could be used to tailor interventions to improve diabetes self-care