Self-care behaviors and correlates among adults with type 2 diabetes in Northwestern China

Background: Poor self-care behaviors remain prevalent among individuals with diabetes worldwide. Although previous Chinese studies examined diabetes self-care, evidence focusing on Northwestern China remains limited. This region’s distinct geographic and lifestyle traits influence patient self-care. This study aimed to assess self-care behaviors among patients with type 2 diabetes mellitus (T2DM) in Northwestern China and identify factors affected with different domains of self-care.

Methods: A hospital-based cross-sectional study with convenience sampling was conducted at Xi’an People’s Hospital (Xi’an Fourth Hospital) from February to August 2025. Eligible inpatients diagnosed with T2DM during the study period were consecutively invited to participate. A total of 410 adult patients were enrolled. The Chinese version of the summary of diabetes self-care activities (SDSCA) scale was used to evaluate patients’ self-care status. Multiple linear regression analysis was employed to identify the factors associated with self-care behaviors.

Results: Overall diabetes self-care among participants was suboptimal (mean 36.11 ± 7.84). Among four self-care domains, physical exercise and foot care showed the poorest adherence, whereas dietary management and glucose monitoring were relatively better maintained. Age (B = 0.096, 95% CI: 0.004-0.189, P = 0.041) and education level (B = 2.094, 95% CI: 0.481-3.708, P = 0.011) were independently associated with overall self-care behaviors. For specific domains, better dietary self-care was correlated with older age (B = 0.073, 95% CI: 0.027-0.119, P = 0.002), higher education level (B = 1.263, 95% CI: 0.457-2.070, P = 0.002), and fewer chronic comorbidities (B = -0.651, 95% CI: -1.167 -0.135, P = 0.014). Occupational status was associated with exercise self-care; retired patients showed better exercise adherence than employed or unemployed patients (B = 1.067, 95% CI: 0.184-1.951, P = 0.018). Higher education was independently associated with better foot care behaviors (B = 0.647, 95% CI: 0.148-0.145, P = 0.011).

Conclusion: T2DM patients in Northwestern China exhibit unsatisfactory overall self-care, especially for foot care and physical exercise. Advanced age and higher education correlated with better self-care outcomes. These results support targeted health education and interventions focused on younger patients and less educated patients.