Overall diabetes self-care among adults with type 2 diabetes in Northwestern China was suboptimal (mean 36.11 ± 7.84), with physical exercise and foot care showing the poorest adherence, and age and education level identified as independent correlates of overall self-care behaviors.
Key Findings
Results
Overall diabetes self-care among T2DM patients in Northwestern China was suboptimal.
Mean overall self-care score was 36.11 ± 7.84 on the Chinese version of the Summary of Diabetes Self-Care Activities (SDSCA) scale.
A total of 410 adult inpatients with T2DM were enrolled in this hospital-based cross-sectional study.
Data were collected at Xi'an People's Hospital (Xi'an Fourth Hospital) from February to August 2025 using convenience sampling.
Eligible inpatients diagnosed with T2DM during the study period were consecutively invited to participate.
Results
Physical exercise and foot care showed the poorest adherence among the four self-care domains, while dietary management and glucose monitoring were relatively better maintained.
Four self-care domains were assessed: dietary management, physical exercise, glucose monitoring, and foot care.
Physical exercise and foot care were identified as the domains with the lowest adherence.
Dietary management and glucose monitoring were comparatively better maintained than the other two domains.
Results
Older age was independently associated with better overall diabetes self-care behaviors.
Age was significantly associated with overall self-care (B = 0.096, 95% CI: 0.004–0.189, P = 0.041).
Older age was also specifically correlated with better dietary self-care (B = 0.073, 95% CI: 0.027–0.119, P = 0.002).
Association was identified through multiple linear regression analysis.
Results
Higher education level was independently associated with better overall self-care behaviors and with specific domains including dietary self-care and foot care.
Education level was significantly associated with overall self-care (B = 2.094, 95% CI: 0.481–3.708, P = 0.011).
Higher education was associated with better dietary self-care (B = 1.263, 95% CI: 0.457–2.070, P = 0.002).
Higher education was independently associated with better foot care behaviors (B = 0.647, 95% CI: 0.148–0.145, P = 0.011).
Results
Fewer chronic comorbidities were associated with better dietary self-care.
Number of chronic comorbidities was negatively associated with dietary self-care (B = -0.651, 95% CI: -1.167 to -0.135, P = 0.014).
This association was identified in multiple linear regression analysis adjusting for other factors.
Results
Occupational status was associated with exercise self-care, with retired patients showing better exercise adherence than employed or unemployed patients.
Retired patients showed significantly better exercise self-care compared to employed or unemployed patients (B = 1.067, 95% CI: 0.184–1.951, P = 0.018).
This finding was specific to the physical exercise domain of self-care.
What This Means
This research examined how well adults with type 2 diabetes in Northwestern China manage their condition through self-care behaviors such as diet, exercise, blood sugar monitoring, and foot care. The study surveyed 410 hospitalized patients at a hospital in Xi'an using a validated questionnaire. Overall, the patients' self-care was rated as suboptimal, meaning most were not adequately following recommended self-management practices. Foot care and physical exercise were the areas where patients struggled the most, while diet and blood sugar monitoring were somewhat better maintained.
The study found that older patients and those with more education tended to do better at self-care overall. Specifically, older age and higher education were linked to better diet management, and higher education was also linked to better foot care. Retired patients were more likely to exercise regularly compared to those who were employed or unemployed. Patients with more chronic health conditions (beyond diabetes) had worse dietary self-care, possibly because managing multiple conditions is more complex.
This research suggests that people with type 2 diabetes in this region — particularly younger adults and those with lower levels of education — may benefit from targeted health education programs and interventions to improve their self-care practices. Foot care and physical activity appear to be especially important areas for intervention in this population. The findings highlight how demographic and social factors like age, education, and employment can shape a person's ability to manage a chronic disease like diabetes.
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Pan J, Xue X, Hu B, Wu L. (2026). Self-care behaviors and correlates among adults with type 2 diabetes in Northwest China.. Frontiers in endocrinology. https://doi.org/10.3389/fendo.2026.1874726