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

成人头条 volume听25, Article听number:听397 (2025) Cite this article

Abstract

Background

Self-care, a process of maintaining health through health-promoting practices and managing illness, is pivotal for the management of type 2 diabetes. This study aimed to explore the self-care level 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 the outpatient departments 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, and self-care management as three critical components of the dynamic self-care process. Self-care self-efficacy is a critical factor affecting the self-care process, which was measured by the SCODI. Multiple quantile regression models were employed to identify the determinants of each self-care component and self-care self-efficacy.

Results

Participants had a median age of 62 years, of whom 55.4% were male. The median scores for self-care maintenance, self-care monitoring, and self-care management were 66.67 (50.00-85.42), 47.06 (32.35鈥�58.82), and 53.13 (34.38鈥�68.75), respectively, whereas the median score for self-care self-efficacy was 70.45 (52.27鈥�84.09). Living in the southwest of Zhejiang province and having lower self-care self-efficacy were associated with lower self-care maintenance. Female gender, belonging to minorities, having complications, not attending diabetes self-management education in the last year, living in the southwest of Zhejiang province, and having lower self-care self-efficacy were associated with lower self-care monitoring. Having complications, using insulin, living in the southwest of Zhejiang province, and having lower self-care self-efficacy were associated with a lower level of self-care management. Living in the southwest of Zhejiang province was associated with lower self-care self-efficacy.

Conclusions/interpretation

The findings of this study provide invaluable insights into the factors affecting self-care among Chinese adults with type 2 diabetes. By enhancing self-care self-efficacy and participating in diabetes self-management education, healthcare providers can develop tailored self-care interventions to improve diabetes care, particularly for adults with type 2 diabetes who are female, belong to minority groups, have complications, use insulin, or reside in the southwest of Zhejiang province.

Peer Review reports

Background

Diabetes has become a significant global public health issue. According to the latest IDF Diabetes Atlas, almost 10.5% of the global population aged 20鈥�79 years was reported to have diabetes in 2021 [1]. Based on World Health Organization (WHO) reports, diabetes has become the ninth leading cause of death worldwide [2]. In 2021, approximately one adult died every 5听s due to diabetes or its complications [1]. Furthermore, diabetes incurs a health expenditure of at least 966听billion USD, reflecting a 316% increase over the past 15 years [1]. China has witnessed one of the most dramatic increases in the prevalence, incidence, and mortality of diabetes, with nearly 25% (140.9听million) of the global cases of diabetes reported in China in 2021 [1]. The estimated prevalence of diabetes in China rose from 10.9% in 2013 to 12.4% in 2018, contributing to higher mortality rates and increased health expenditure related to its management and complications [3].

Type 2 diabetes, the most prevalent type of diabetes, constitutes over 90% of cases of diabetes and is typically considered a chronic disease affecting individuals older than 40 years [4]. Adults with type 2 diabetes typically experience problems associated with the disease itself, its treatment, and complications. These issues comprise physical, psychological, social, and economic dimensions, such as experiencing common symptoms and signs [5], depression [6], and diabetes-related distress [7]. For instance, if left untreated, type 2 diabetes can damage small blood vessels, resulting in organ and tissue dysfunction [4]. This damage can cause both macrovascular and microvascular complications [4]. Macrovascular complications, such as coronary artery disease, cardiomyopathy, arrhythmias, and cerebrovascular diseases, are major contributors to morbidity and mortality in patients with diabetes, with cardiovascular disease being the leading cause of death among patients with type 2 diabetes [8]. On the other hand, microvascular complications, such as diabetic retinopathy, nephropathy, and neuropathy, can lead to vision loss, renal impairment, and numbness, finally lowering the quality of life of patients [9].

Patients with type 2 diabetes must receive complex therapeutic regimes to maintain their physical and psychosocial health, manage their signs and symptoms, reduce or prevent complications, and improve their quality of life [1]. All these behaviors require knowledge, skills, experience, and motivation, and have been referred to as the concept of self-care [10]. Previous studies have shown that adults with type 2 diabetes can have stable glycemic control, prevent complications, enhance their quality of life, and reduce hospitalization frequency, costs, and mortality rates by participating in self-care behaviors [11,12,13].

Self-care used to be defined as behaviors that maintain or promote health and manage illness [14, 15]. However, a new concept defines self-care as a process of enhancing health through health-promoting practices and managing illness [16]. This self-care process involves three components: self-care maintenance, self-care monitoring, and self-care management [16]. Self-care maintenance is defined as those behaviors improving well-being, preserving health, or maintaining physical and emotional stability [16]. Self-care monitoring is the process of routine vigilant body monitoring, surveillance, or 鈥渂ody listening鈥� [16]. Self-care management assesses changes in physical and emotional signs and symptoms to determine whether further actions are needed [16]. Moreover, self-care self-efficacy refers to the belief that one can perform specific self-care tasks or behaviors and persist in them despite difficulties [16]. It is not a component of the self-care process, but a significant predictor of the self-care process and positively affects self-care maintenance, self-care monitoring, and self-care management [16, 17].

There is a trend to accept self-care as a process due to its flexibility and systematic view [18]. This concept helps identify adequate self-care behaviors and inadequate self-care behaviors [16], and tailored interventions can be applied to improve outcomes [18]. Therefore, exploring self-care as a process and identifying the specific characteristics of individuals inactively engaged in self-care may help develop tailored self-care interventions to achieve the optimal outcome.

However, self-care is currently unsatisfactory among patients with type 2 diabetes. A systematic review of self-care in adults with type 2 diabetes included 34 studies [19] and showed that general self-care was unsatisfactory and physical exercise was the least frequent self-care activity while adherence to medication was the most frequent behavior. The situation was similar in China, and the overall level of self-care was low to moderate among adults with type 2 diabetes [20, 21]. A large cross-sectional study found that only 51.6% of Chinese people with type 2 diabetes performed foot care, and 25.9% adopted self-management of blood glucose (SMBG) [22]. In Zhejiang province, a cross-sectional study found that only 6.66% of adults with type 2 diabetes (aged 35 to 64 years) had adequate self-care [23]. Although the Chinese government released the Standards of Medical Care for Type 2 Diabetes in China to guide the prevention and management of type 2 diabetes [24], previous cross-sectional studies indicated unsatisfactory performance in various self-care behaviors among adults with type 2 diabetes [20,21,22,23]. Their findings suggested that the existing self-care interventions have not been adequately implemented or patients are less responsive to usual care [25]. Furthermore, the prevalence, morbidity, and mortality of type 2 diabetes in China continue to increase [3]. Therefore, there is an urgent need to develop effective strategies to address the treatment and self-care needs of Chinese adults with type 2 diabetes.

Identification of the determinants of self-care provides a deeper insight for designing future self-care intervention studies [26] to unravel the characteristics of less-engaged participants and identify modifiable factors. Such studies can guide the development of tailored self-care interventions for Chinese adults with type 2 diabetes. Many studies have explored the determinants of self-care in adults with type 2 diabetes [27]. However, most of these studies have approached self-care as a static behavior, focusing on individual aspects, such as physical activities [28], medication adherence [29], and foot care [30], or as a combination of several self-care behaviors [27, 31]. Few studies have investigated self-care as a dynamic, complex, and adaptable process of maintaining health and managing illness [18]. This perspective has been predominantly developed and disseminated in developed countries, including the United States, Italy, and Canada [18, 32, 33], and remains rarely explored in China [34]. Thus, a comprehensive understanding of the full spectrum of self-care behaviors and processes was not presented. Besides, theoretical frameworks are needed to explain behaviors, investigate relationships, and predict the outcomes of interventions [32]. However, the application of self-care theory in cross-sectional studies [35] and the availability of theoretically robust instruments to measure self-care [36] remain limited.

To address these gaps, this study utilized the Self-Care of Diabetes Inventory (SCODI), a theoretically and psychometrically sound instrument [33, 34], to assess self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy among Chinese adults with type 2 diabetes. The study also identified socio-demographic and clinical factors associated with the self-care process and self-care self-efficacy.

Methods

Study design and participants

This cross-sectional study included patients with type 2 diabetes from the outpatient departments of three tertiary hospitals in Zhejiang province, China. A convenient sampling method was applied. The three tertiary hospitals were in Lishui, Jinhua, and Wenzhou, the cities of Zhejiang province. These cities belong to different areas of Zhejiang province (southwest, midland, and southeast, respectively). They are in geographical proximity and have close communication and economic and cultural exchanges [37].

We enrolled consecutive adults with type 2 diabetes during their outpatient visits between June 2023 and July 2023. The inclusion criteria were as follows: (1) confirmed diagnosis of type 2 diabetes based on the criteria outlined in the Chinese guideline [38]; (2) being at least 18 years old; (3) having type 2 diabetes for more than 6 months; and (4) willing to participate in this study. The exclusion criteria were as follows: (1) inability to read or understand the questionnaire; (2) presence of cognitive impairment; and (3) a history of psychiatric conditions.

Data collection

A self-reported questionnaire was used to collect socio-demographic, clinical data and self-care. Based on previous studies [17, 39], the following factors were regarded as the potential socio-demographic and clinical determinants of self-care: age, gender, nationalities, areas, marital status, education level, household income, time from diagnosis, having complications, insulin use, participation in diabetes self-management education, and self-care self-efficacy.

The Self-Care of Diabetes Inventory (SCODI) was used to measure the level of self-care and its determinant (self-care self-efficacy). This self-reported questionnaire was developed by Ausili et al. [33]. and was translated into Chinese this year [34]. This tool originated from the middle-range theory of self-care of chronic illness. It comprises 40 items categorized into 4 dimensions: self-care maintenance (12 items), self-care monitoring (8 items), self-care management (9 items), and self-care self-efficacy (11 items) [34]. Self-care maintenance includes health-promoting exercise behaviors, disease prevention behaviors, health-promoting behaviors, and illness-related behaviors. Self-care monitoring includes body listening and symptom recognition. Self-care management includes autonomous self-care management behaviors and consultative self-care management behaviors. Self-care self-efficacy includes task-specific self-care self-efficacy and persistent self-care self-efficacy. It utilizes a 5-point Likert-type scale, and the developer recommends standardized scores for each scale and subscale to a 0-100 scale for easier comparisons. A high score means higher self-care and self-care self-efficacy. A cut-off of 70 points was utilized to classify self-care maintenance, self-care monitoring, and self-care self-efficacy, and 60 points were recommended for self-care management [40]. The content validity index (CVI) for each item and scale reached 100% [33]. The original SCODI demonstrated good internal consistency, supported by adequate internal coherence across the four scales, with high composite reliability coefficients and a global reliability index for multidimensional scales [33]. The Chinese version of SCODI also has good structural validity (based on exploratory factor analysis) and internal consistency (Cronbach鈥檚 伪 for the four dimensions were 0.709鈥�0.908) [34].

Statistical analysis

Descriptive statistics were used to summarize the socio-demographic and clinical characteristics of participants, including frequencies, percentages, median, and interquartile range. The distribution of the three components of self-care and self-care self-efficacy, measured based on the SCODI, was evaluated using the Kolmogorov鈥揝mirnov test and visual inspection of histograms. Due to the non-normal distribution of the scores for four dimensions of SCODI, boxplots were applied to visualize the distribution of scores based on the mean, median, and interquartile range (IQR). Correlation analysis was used to evaluate the relationship between variables using Spearman鈥檚 rho correlation. Nonparametric Tests (Mann-Whitey U Test or Kruskal-Wallis H Rank test) were also conducted for comparison. Finally, quantile regression models were used to analyze the median values of the three components of self-care and self-care self-efficacy in relation to socio-demographic and clinical variables. The parameters estimated by the model represent the changes in the median (rather than the mean) for each unit increase in independent variables. The regression parameters were estimated using the least-absolute-value models, and confidence intervals and p-values were estimated using the bootstrap (400). A p-value of less than 0.05 was deemed statistically significant. Analyses were conducted using STATA 15.

Results

Finally, 495 adults with type 2 diabetes were enrolled, with a median age of 62 (55.00, 70.00) years. More than half of the participants were male (55.4%, n鈥�=鈥�274), and 43.2% (n鈥�=鈥�214) were older people. The majority of participants were married (77.6%, n鈥�=鈥�384), had Han nationality (95.2%, n鈥�=鈥�471), were from the southeast of Zhejiang province (40.8%, n鈥�=鈥�202), and had a level of education corresponding to middle school or below (77.3%, n鈥�=鈥�383). A small proportion of participants were newly diagnosed with type 2 diabetes (6 months to less than 1 year, 12.1%, n鈥�=鈥�60), while a greater proportion had been living with type 2 diabetes for more than 10 years (37.4%, n鈥�=鈥�185). Approximately half of the participants had a low income (52.3%, n鈥�=鈥�259), experienced complications (47.9%, n鈥�=鈥�237), and had received diabetes self-management education in the last year (46.1%, n鈥�=鈥�228). The socio-demographic and clinical characteristics of participants, and the scores for self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy, are presented in Table听1.

Table 1 Self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy scores by socio-demographic and clinical characteristics of the study sample (n鈥�=鈥�495)
Full size table

The relationship between study variables is presented in Table听2. Marital status exhibited no significant relationship with four dimensions of the SCODI and was excluded from the regression analysis.

Table 2 Correlation analysis between socio-demographic and clinical determinants of self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy
Full size table

The median scores for all components of self-care were below their cutoff score (60 or 70 points). The median scores for self-care maintenance, self-care monitoring, and self-care management were 66.67 (50.00-85.42), 47.06 (32.35鈥�58.82), and 53.13 (34.38鈥�68.75), respectively, while self-care self-efficacy had an adequate median score: 70.45 (52.27鈥�84.09) (Fig.听1).

Fig. 1
figure 1

The level of self-care maintenance, self-care monitoring, self-management, and self-care self-efficacy. The box represents the first and third quartile, the central line the median, the white square the mean, the whisker are located at the maximum and minimum observation if these are in the range of 1.5 x interquartile range from the box, outside observation is indicated with dots (no outside observation of SCODI score in this study), and dashed line represents the cut-off level of 60 or 70 points.

Full size image

Living in the southwest of Zhejiang province (尾鈥�=鈥�26.271, 95%CI鈥�=鈥�21.488, 31.053) and having lower self-care self-efficacy (尾鈥�=鈥�0.486, 95%CI鈥�=鈥�0.404, 0.567) were associated with lower self-care maintenance. Female gender (尾鈥�=鈥�2.362, 95%CI鈥�=鈥�0.128, 4.595), belonging to minorities (尾=-6.549, 95%CI=-11.721, -1.376), having complications (尾鈥�=鈥�3.514, 95%CI鈥�=鈥�1.220, 5.807), not attending diabetes self-management education in the last year (尾= -3.078, 95%CI=-5.340, -0.818), living in the southwest of Zhejiang province (尾鈥�=鈥�10.026, 95%CI鈥�=鈥�6.472, 13.580) and having lower self-care self-efficacy (尾鈥�=鈥�0.507, 95%CI鈥�=鈥�0.446, 0.568) were associated with lower self-care monitoring. Having complications (尾鈥�=鈥�4.597, 95%CI鈥�=鈥�1.815, 7.755), using insulin (尾鈥�=鈥�3.611, 95%CI鈥�=鈥�0.853, 6.369), not living in midland (尾鈥�=鈥�10.681, 95%CI鈥�=鈥�6.370, 14.991) or southeast (尾鈥�=鈥�4.280, 95%CI鈥�=鈥�1.155, 7.405) of Zhejiang province, and having lower self-care self-efficacy (尾鈥�=鈥�0.612, 95%CI鈥�=鈥�0.538, 0.685) were associated with lower level of self-care management. Not living in midland (尾鈥�=鈥�28.360, 95%CI鈥�=鈥�23.056, 33.664) or southeast (尾鈥�=鈥�10.178, 95%CI鈥�=鈥�5.875, 14.481) of Zhejiang province were associated with lower self-care self-efficacy. The determinants of self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy are shown in Table听3.

Table 3 Socio-demographic and clinical determinants of self-care maintenance, self-care monitoring, self-care management, and self-care self-efficacy (n鈥�=鈥�495)
Full size table

Discussion

This study shed light on the complexity of self-care by investigating the levels of three components of self-care and their critical predictors in Chinese adults with type 2 diabetes. Generally, poor self-care was detected in Chinese adults with type 2 diabetes. However, their self-care self-efficacy was relatively adequate, which served as a critical predictor of self-care. Additionally, gender, nationality, complications, insulin use, participation in diabetes self-care education in the last year, areas, and self-care self-efficacy were significantly associated with self-care.

The finding of poor self-care levels among Chinese adults with type 2 diabetes is consistent with those reported by previous studies in Zhejiang province [20, 41]. Compared to developed countries, like Italy [42] and Poland [43], a lower self-care level was found in China. The lower level of self-care among Chinese adults with type 2 diabetes can be attributed to several cultural, systemic, and socioeconomic factors. Compared to developed countries, such as Italy and Poland, China faces unique challenges that may affect self-care. These challenges include the huge number of patients with diabetes [1], limited access to healthcare resources [44], passive and low participation in health education programs [25], and economic disparities [45]. Thus, effective interventions are needed to enhance self-care among Chinese adults with type 2 diabetes.

Specific self-care, like self-care monitoring and self-care management, was relatively suboptimal among Chinese adults with type 2 diabetes, which was consistent with previous Chinese self-care studies [46, 47]. Inadequate self-care monitoring can make it hard to immediately detect bodily changes or symptoms; thus, proper self-care management behaviors cannot be conducted in a timely manner [48]. Additionally, the low levels of self-care monitoring and management indicate that more attention should be paid to training self-care monitoring and management, which can help patients master correct knowledge and techniques and adopt timely responses to bodily changes [49].

In terms of the determinants of self-care among Chinese adults with type 2 diabetes, an interesting finding was the area based-differences in self-care monitoring, self-care management, and self-care self-efficacy. Most Chinese cross-sectional studies on self-care had a single-center design [41, 50, 51] and area-based differences in self-care among patients with type 2 diabetes remained less studied [52]. The area-based differences in self-care can be attributed to the socio-economic level, access to healthcare resources and services, healthcare policy support, and lifestyle and health literacy of patients with type 2 diabetes in the area [52]. In the future, we aim to expand the sample size and study the reasons behind the self-care differences among these three areas. Finally, our findings uncovered area-based differences in Zhejiang province, which can guide policymakers to distribute healthcare resources more equitably and provide more support to areas with poor self-care levels, such as Lishui City, which resonated with China鈥檚 pursuit of common prosperity [53].

Gender differences were most notable in self-care monitoring, with female patients paying less attention to self-care monitoring, which was inconsistent with both international studies [17, 54] and Chinese studies [41, 51]. Cultural and social determinants may be involved in such discrepancy. In traditional Chinese society, women鈥檚 disproportionate household and caregiving responsibilities, coupled with societal expectations to prioritize family health over their own, may limit their time and energy for self-care activities, like glucose monitoring [55]. The clinical inertia among females may be another cause. Previous studies found the level of glycemic variability was higher in Chinese female patients than in male patients [56]. Persistence unstable glucose levels may discourage monitoring behaviors in women. The inconsistency between our findings and those reported by international studies and other Chinese studies warrants further studies, and factors, such as regional socioeconomic differences, variations in healthcare delivery systems, and cultural norms, may explain these discrepancies.

Compared to the Han majority, Chinese minorities, such as the She people who primarily reside in less developed and remote mountainous areas, like certain regions of Zhejiang province [57], often face significant challenges in terms of self-care. These communities typically have simple lifestyles, rely on farming for income, have low education levels, and are less likely to use public health services. They also report lower satisfaction with chronic disease management services [58]. Therefore, financial constraints, limited access to diabetes education, and a reluctance to engage with healthcare services contribute to poor self-care monitoring behaviors in these populations [58]. These findings highlight the urgent need for culturally tailored diabetes education and support programs to address the unique barriers faced by minority groups.

Participants with complications and those using insulin had lower self-care monitoring and/or self-care management. Having complications and using insulin may cause physical and psychological challenges in implementing self-care among patients with type 2 diabetes [59, 60]. For instance, vision problems may impair physical activity [60], and fear of hypoglycemia or discomfort with injections can lead to avoidance behaviors [61]. Thus, this finding suggests that the presence of complications and insulin use make self-care more complex and personalized self-care plans should be provided based on recent guidelines for the management of diabetes [62].

Attending diabetes self-management education in the last year positively affected self-care monitoring, which was the poorest behavior performed by Chinese participants. Diabetes self-management education provides the knowledge and skills necessary for effective self-care, emphasizing its critical role in diabetes self-care [63]. Efforts should be prioritized to expand access to diabetes self-management education, particularly in underserved cities.

Nearly half of Chinese adults with type 2 diabetes from Zhejiang province had relatively adequate self-care self-efficacy. However, this level of self-care self-efficacy was still lower than that observed in other countries [42], suggesting that there is still space for improving self-care self-efficacy among Chinese adults with type 2 diabetes. The study also indicated that lower levels of self-care self-efficacy were associated with poor self-care maintenance, self-care monitoring, and self-care management among Chinese adults with type 2 diabetes. This finding suggests that self-efficacy is critical in all stages of the self-care process as proposed in the Middle-Range Theory of Self-Care of Chronic Illness [16] and confirmed by others [42, 64]. Additionally, previous interventional studies have provided strong evidence regarding the effect of self-care self-efficacy on self-care behaviors through the four sources proposed by Bandura in his Social Learning Theory [65]: mastery experiences, vicarious experience, verbal persuasion, and physiological and emotional feedback [66]. Thus, the above strategies can be applied in future Chinese self-care self-efficacy enhancement interventions to directly improve self-care levels in diabetes care.

To the best of our knowledge, this is the first survey that investigated the entire self-care process in Chinese adults with type 2 diabetes. Previous Chinese studies typically considered self-care as static behaviors or activities, overlooking the dynamic changes in self-care. Additionally, a new and theoretically sound instrument was applied to identify both sufficient and poor self-care behaviors and their socio-demographic and clinical determinants [34]. This study provides evidence for improving the outcomes of target groups and facilitates tailored self-care interventions.

However, there are several limitations to this study. Firstly, although our study found area-based differences in self-care, and the mean age and distribution of our participants were similar to a previous study in Zhejiang province [41], our participants were from one province in China. The convenient sampling method might affect the representativeness of our sample and our findings should be generalized with caution. Secondly, although the determinants of self-care were selected based on our viewpoint and literature review, this study did not include comorbid conditions as influencing factors and only explored having or not having complications. Future studies should explore comorbid conditions and detailed complications to confirm the role of comorbidities and complications. Thirdly, a self-reported questionnaire was applied to collect clinical data, such as complications, and the medical records were not confirmed. This might lead to overreporting or underreporting. Future studies can combine self-reported data with clinical data to find stronger evidence for self-care. Finally, this was a cross-sectional study, and causal relationships between self-care and its determinants cannot be inferred.

Conclusions

Self-care remains insufficient among Chinese adults with type 2 diabetes. Healthcare providers and policymakers in China should prioritize addressing the self-care needs of adults with type 2 diabetes who are female, belong to minority groups, have complications, use insulin, or reside in the southwest of Zhejiang province. Increasing participation in diabetes self-management education and enhancing self-care self-efficacy are two potential strategies that can improve self-care in this population.

Data availability

The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request. Data are located in controlled access data storage at Lishui University.

Abbreviations

CI:

Confidence interval

DSME:

Diabetes Self-Management Education

IDF:

International diabetes federation

IQR:

Interquartile range

SCODI:

Self-Care of diabetes inventory

SMBG:

Self-monitoring of blood glucose

WHO:

World health organization

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Acknowledgements

The authors would like to thank all participants for participating in this study. Additionally, the authors express gratitude to EditSprings (https://www.editsprings.cn) for their expert linguistic services.

Funding

This study was supported by the Health Science and Technology Program of Zhejiang Province, China (No.2022KY1453 & No. 2022ZH022), and Science and Technology Plan Project of Lishui City, Zhejiang Province, China (No. 2022RKX27).

Author information

Author notes

  1. Shunfei Lu and Bin Ye contributed equally to this work.

Authors and Affiliations

  1. Nursing Department, Medicine College, Lishui University, Lishui, Zhejiang, China

    Xuefen Lan

  2. Department of Endocrinology, Lishui People鈥檚 Hospital, Lishui, Zhejiang, China

    Xiaozhen Ji,听Xiaojia Zheng听&听Bin Ye

  3. Emergency Medicine Center, Internal Medicine General Ward, Jinhua Municipal Center Hospital, Jinhua, Zhejiang, China

    Xiaoyu Ding

  4. Hepato-Biliary-Pancreatic Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China

    Hongyi Mou

  5. Medicine College, Lishui University, Lishui, Zhejiang, China

    Shunfei Lu

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  1. Xuefen Lan

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Contributions

XL and XJ were responsible for conceptualization, design, and data acquisition. XZ, XD, BY, and HM conducted data acquisition and analysis. XL, XJ, and SL was responsible for drafting the manuscript. SL and BY were responsible for the literature review. XL, SL, and BY made critical revisions to the paper. All authors approved the final version of the manuscript. XL and XJ are the guarantors of this work.

Corresponding authors

Correspondence to Shunfei Lu or Bin Ye.

Ethics declarations

Ethics approval and consent to participate

Ethical approval of this study was obtained from the Ethics Committee of Lishui University (No. 2023YR0029). All participants provided signed informed consent. The study was conducted in accordance with the ethical standards of human studies and followed the revised version of the Declaration of Helsinki.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

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Lan, X., Ji, X., Zheng, X. et al. Socio-demographic and clinical determinants of self-care in adults with type 2 diabetes: a multicenter cross-sectional study in Zhejiang province, China. 成人头条 25, 397 (2025). https://doi.org/10.1186/s12889-025-21622-w

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  • DOI: https://doi.org/10.1186/s12889-025-21622-w

Keywords

成人头条

ISSN: 1471-2458

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