{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:30:41Z","timestamp":1786595441396,"version":"build-2736575974"},"reference-count":48,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T00:00:00Z","timestamp":1786579200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019s 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A hospital-based cross-sectional study with convenience sampling was conducted at Xi\u2019an People\u2019s Hospital (Xi\u2019an 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\u2019 self-care status. Multiple linear regression analysis was employed to identify the factors associated with self-care behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Overall diabetes self-care among participants was suboptimal (mean 36.11 \u00b1 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\u00a0=\u00a00.096, 95% CI: 0.004-0.189,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.041) and education level (B\u00a0=\u00a02.094, 95% CI: 0.481-3.708,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.011) were independently associated with overall self-care behaviors. For specific domains, better dietary self-care was correlated with older age (B\u00a0=\u00a00.073, 95% CI: 0.027-0.119,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.002), higher education level (B\u00a0=\u00a01.263, 95% CI: 0.457-2.070,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.002), and fewer chronic comorbidities (B = -0.651, 95% CI: -1.167 -0.135,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.014). Occupational status was associated with exercise self-care; retired patients showed better exercise adherence than employed or unemployed patients (B\u00a0=\u00a01.067, 95% CI: 0.184-1.951,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.018). Higher education was independently associated with better foot care behaviors (B\u00a0=\u00a00.647, 95% CI: 0.148-0.145,\n                      <jats:italic>P<\/jats:italic>\n                      =\u00a00.011).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1874726","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:24:08Z","timestamp":1786595048000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Self-care behaviors and correlates among adults with type 2 diabetes in Northwest China"],"prefix":"10.3389","volume":"17","author":[{"given":"Jingjing","family":"Pan","sequence":"first","affiliation":[{"name":"Department of Pharmacy, Xi\u2019an People\u2019s Hospital (Xi\u2019an Fourth Hospital)","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xiaorong","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xi\u2019an People\u2019s Hospital (Xi\u2019an Fourth Hospital)","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bin","family":"Hu","sequence":"additional","affiliation":[{"name":"Department of Pharmacy, Xi\u2019an People\u2019s Hospital (Xi\u2019an Fourth Hospital)","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lian","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology, Xi\u2019an People\u2019s Hospital (Xi\u2019an Fourth Hospital)","place":["Xi\u2019an, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/s11096-025-01941-z","article-title":"Self-care and self-management in diabetes: concepts, theories and practices","volume":"47","author":"Puzhakkal","year":"2025","journal-title":"Int J Clin Pharm"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.1016\/s2468-2667(24)00251-2","article-title":"Diabetes in China part 2: prevention, challenges, and progress","volume":"9","author":"Xu","year":"2024","journal-title":"Lancet Public Health"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-025-03185-9","article-title":"Diabetes mellitus and associated vascular disease: pathogenesis, complications, and evolving treatments","volume":"42","author":"Islam","year":"2025","journal-title":"Adv Ther"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.2174\/1570161117666190405165151","article-title":"Macrovascular complications of type 2 diabetes mellitus","volume":"18","author":"Viigimaa","year":"2020","journal-title":"Curr Vasc Pharmacol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1161\/jaha.123.032626","article-title":"Diabetes-related macrovascular complications are associated with an increased risk of diabetic microvascular complications: a prospective study of 1518 patients with type 1 diabetes and 20\u2009802 patients with type 2 diabetes in the UK Biobank","volume":"13","author":"Zhang","year":"2024","journal-title":"J Am Heart Assoc"},{"key":"B6","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1016\/j.jcot.2021.01.017","article-title":"The current burden of diabetic foot disease","volume":"17","author":"Edmonds","year":"2021","journal-title":"J Clin Orthop Trauma"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1111\/dom.16183","article-title":"Trends and analysis of risk factor differences in the global burden of chronic kidney disease due to type 2 diabetes from 1990 to 2021: a population-based study","volume":"27","author":"Wang","year":"2025","journal-title":"Diabetes Obes Metab"},{"key":"B8","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1177\/26350106211065378","article-title":"Diabetes self-management education and association with diabetes self-care and clinical preventive care practices","volume":"48","author":"Mendez","year":"2022","journal-title":"Sci Diabetes Self Manag Care"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.1016\/j.ijnsa.2023.100136","article-title":"Self-management practices for preventing complications of type II diabetes mellitus in low and middle-income countries: a scoping review","volume":"5","author":"Maina","year":"2023","journal-title":"Int J Nurs Stud Adv"},{"key":"B10","doi-asserted-by":"publisher","first-page":"102","DOI":"10.1186\/s13104-021-05511-0","article-title":"Self-care practice and its predictors among adults with diabetes mellitus on follow up at public hospitals of Arsi zone, southeast Ethiopia","volume":"14","author":"Kassa","year":"2021","journal-title":"BMC Res Notes"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.20945\/2359-3997000000648","article-title":"Knowledge about diabetes and its association with adherence to self-care and glycemic control in patients with type 1 diabetes in Southern Brazil","volume":"67","author":"Foppa","year":"2023","journal-title":"Arch Endocrinol Metab"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.15537\/smj.2020.9.25339","article-title":"Frequency and factors associated with inadequate self-care behaviors in patients with type 2 diabetes mellitus in Najran, Saudi Arabia. Based on diabetes self-management questionnaire","volume":"41","author":"Al-Qahtani","year":"2020","journal-title":"Saudi Med J"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0250462","article-title":"Diabetes self-care practice and associated factors among type 2 diabetic patients in public hospitals of Tigray regional state, Ethiopia: a multicenter study","volume":"16","author":"Molalign Takele","year":"2021","journal-title":"PloS One"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0248992","article-title":"Patterns and associated factors of diabetes self-management: results of a latent class analysis in a German population-based study","volume":"16","author":"Heise","year":"2021","journal-title":"PloS One"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.1111\/ijn.12987","article-title":"Self-care activities among patients with type 2 diabetes mellitus: a cross-sectional study","volume":"27","author":"Tang","year":"2021","journal-title":"Int J Nurs Pract"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.11124\/jbies-20-00020","article-title":"Factors influencing diabetes self-management in adults: an umbrella review of systematic reviews","volume":"19","author":"Alexandre","year":"2021","journal-title":"JBI Evid Synth"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0297132","article-title":"Understanding the diabetes self-care behaviour in rural areas: perspective of patients with type 2 diabetes mellitus and healthcare professionals","volume":"19","author":"Gupta","year":"2024","journal-title":"PloS One"},{"key":"B18","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1016\/j.diabres.2016.07.006","article-title":"Cultural issues and other factors that affect self-management of type 2 diabetes mellitus (T2D) by Chinese immigrants in Australia","volume":"119","author":"Eh","year":"2016","journal-title":"Diabetes Res Clin Pract"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1136\/bmjnph-2024-001153","article-title":"Dietary habits and complex food relations in Northwest China: a population-based network analysis","volume":"8","author":"Hui","year":"2025","journal-title":"BMJ Nutr Prev Health"},{"key":"B20","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1007\/s40119-016-0079-x","article-title":"Knowledge of hypertension and compliance with therapy among hypertensive patients in the Bamenda Health District of Cameroon: a cross-sectional study","volume":"6","author":"Akoko","year":"2017","journal-title":"Cardiol Ther"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.33546\/bnj.2199","article-title":"Factors influencing diabetes self-management among adults with type 2 diabetes mellitus in China","volume":"8","author":"Yang","year":"2022","journal-title":"Belitung Nurs J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.2337\/diacare.23.7.943","article-title":"The summary of diabetes self-care activities measure: results from 7 studies and a revised scale","volume":"23","author":"Toobert","year":"2000","journal-title":"Diabetes Care"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1177\/1043659608319239","article-title":"Adaptation and testing of instruments to measure diabetes self-management in people with type 2 diabetes in mainland China","volume":"19","author":"Yin","year":"2008","journal-title":"J Transcult Nurs"},{"key":"B24","doi-asserted-by":"publisher","DOI":"10.1177\/11786388241233534","article-title":"Self-care practices and the associated socio-demographic variables of persons with type 2 diabetes mellitus (T2dm) in Southeast, Nigeria","volume":"17","author":"Okafor","year":"2024","journal-title":"Nutr Metab Insights"},{"key":"B25","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1186\/s13104-018-3939-8","article-title":"Self-care practice and associated factors among diabetes mellitus patients on follow up in Benishangul Gumuz Regional State Public Hospitals, Western Ethiopia: a cross-sectional study","volume":"11","author":"Chali","year":"2018","journal-title":"BMC Res Notes"},{"key":"B26","doi-asserted-by":"publisher","DOI":"10.4103\/jfmpc.jfmpc_1611_24","article-title":"Self-care assessment among type 2 diabetes mellitus patients using summary of diabetes selfcare activities (SDSCA) scale attending NCD clinic of a tertiary care centre","volume":"14","author":"Thodika","year":"2025","journal-title":"J Family Med Prim Care"},{"key":"B27","doi-asserted-by":"publisher","DOI":"10.1016\/j.vhri.2018.06.003","article-title":"Medication adherence and diabetes self-care activities among patients with type 2 diabetes mellitus","volume":"18","author":"Jannoo","year":"2019","journal-title":"Value Health Reg Issues"},{"key":"B28","doi-asserted-by":"publisher","DOI":"10.2147\/ppa.s373302","article-title":"Self-care in patients with non-optimal diabetes management in Brazilian rural areas: a mixed-methods study","volume":"16","author":"Macedo","year":"2022","journal-title":"Patient Prefer Adherence"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.21315\/mjms2023.30.1.14","article-title":"Gender and ethnic differences in diabetes self care in Malaysia: an individual participant meta-analysis of summary of diabetes self care activities studies","volume":"30","author":"Teng","year":"2023","journal-title":"Malays J Med Sci"},{"key":"B30","doi-asserted-by":"publisher","first-page":"19118","DOI":"10.1038\/s41598-024-70000-w","article-title":"Self-care behaviors, medication adherence status, and associated factors among elderly individuals with type 2 diabetes","volume":"14","author":"Amerzadeh","year":"2024","journal-title":"Sci Rep"},{"key":"B31","doi-asserted-by":"publisher","DOI":"10.2147\/dmso.s236966","article-title":"Relationship between self-care behavior and cognitive function in hospitalized adult patients with type 2 diabetes: a cross-sectional study","volume":"13","author":"Yang","year":"2020","journal-title":"Diabetes Metab Syndr Obes"},{"key":"B32","doi-asserted-by":"publisher","DOI":"10.3892\/etm.2013.945","article-title":"Self-care practices of Chinese individuals with diabetes","volume":"5","author":"Zhou","year":"2013","journal-title":"Exp Ther Med"},{"key":"B33","doi-asserted-by":"publisher","DOI":"10.3349\/ymj.2023.0183","article-title":"Questionnaire-based survey of diabetes self-care activities and barriers among young Korean adults with early-onset diabetes","volume":"65","author":"Park","year":"2024","journal-title":"Yonsei Med J"},{"key":"B34","doi-asserted-by":"publisher","DOI":"10.1097\/md.0000000000034791","article-title":"The factors of perceived disease knowledge and self-care behavior in type 2 diabetic patients with chronic kidney disease: a cross-sectional study","volume":"102","author":"Wang","year":"2023","journal-title":"Med (Baltimore)"},{"key":"B35","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2022.771293","article-title":"A qualitative exploration of self-management behaviors and influencing factors in patients with type 2 diabetes","volume":"13","author":"Peng","year":"2022","journal-title":"Front Endocrinol (Lausanne)"},{"key":"B36","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0237710","article-title":"Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana","volume":"15","author":"Afaya","year":"2020","journal-title":"PloS One"},{"key":"B37","doi-asserted-by":"publisher","DOI":"10.18295\/squmj.2020.20.04.010","article-title":"Diabetes self-management and the associated factors among adult Omanis with type 1 diabetes","volume":"20","author":"Al-Hadhrami","year":"2020","journal-title":"Sultan Qaboos Univ Med J"},{"key":"B38","doi-asserted-by":"publisher","DOI":"10.11604\/pamj.2024.48.36.41041","article-title":"Self-care practices and its associated factors among adult diabetes mellitus patients in public hospitals of Sidama region, Southern Ethiopia: a cross-sectional study","volume":"48","author":"Kassie","year":"2024","journal-title":"Pan Afr Med J"},{"key":"B39","doi-asserted-by":"publisher","DOI":"10.4103\/ijcm.ijcm_236_19","article-title":"Diabetes self-care activities: a community-based survey in an urban slum in Hyderabad, India","volume":"45","author":"Chandrika","year":"2020","journal-title":"Indian J Community Med"},{"key":"B40","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.42741","article-title":"Diabetes self-care activities and their relationship with glycemic control in patients visiting Hayatabad Medical Complex, Peshawar","volume":"15","author":"Khan","year":"2023","journal-title":"Cureus"},{"key":"B41","doi-asserted-by":"publisher","DOI":"10.2147\/ppa.s374120","article-title":"Exercise adherence and compliance and its related factors among elderly patients with type 2 diabetes in China: a cross-sectional study","volume":"16","author":"Zhu","year":"2022","journal-title":"Patient Prefer Adherence"},{"key":"B42","doi-asserted-by":"publisher","DOI":"10.1177\/0300060515597933","article-title":"Diabetes self-care activities and health-related quality-of-life of individuals with type 1 diabetes mellitus in Shantou, China","volume":"44","author":"Lin","year":"2016","journal-title":"J Int Med Res"},{"key":"B43","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s41256-025-00427-9","article-title":"Self-care behaviors and glycemic control in Nigerian patients with type 2 diabetes: a pilot cross-sectional study","volume":"10","author":"Abdullahi","year":"2025","journal-title":"Glob Health Res Policy"},{"key":"B44","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2024-088088","article-title":"Factors associated with foot self-care behaviour and foot screening attendance in people with type 2 diabetes: a cross-sectional study in primary care","volume":"14","author":"Zhu","year":"2024","journal-title":"BMJ Open"},{"key":"B45","doi-asserted-by":"publisher","DOI":"10.7717\/peerj.19529","article-title":"Self-care practices and associated factors among type 2 diabetes mellitus patients attending public hospitals in Bale zone, Oromia region, Ethiopia","volume":"13","author":"Zemen","year":"2025","journal-title":"PeerJ"},{"key":"B46","doi-asserted-by":"publisher","DOI":"10.33314\/jnhrc.v22i04.5136","article-title":"Self-care practices among patients with diabetes mellitus","volume":"22","author":"Roka","year":"2025","journal-title":"J Nepal Health Res Counc"},{"key":"B47","doi-asserted-by":"publisher","first-page":"E9","DOI":"10.1097\/nnr.0000000000000401","article-title":"Self-management behaviors, glycemic control, and metabolic syndrome in type 2 diabetes","volume":"69","author":"Ji","year":"2020","journal-title":"Nurs Res"},{"key":"B48","doi-asserted-by":"publisher","DOI":"10.1002\/nop2.1834","article-title":"Diabetes self-management and its related factors among Chinese young adults with type 2 diabetes mellitus","volume":"10","author":"He","year":"2023","journal-title":"Nurs Open"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1874726\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T04:24:09Z","timestamp":1786595049000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1874726\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,13]]},"references-count":48,"alternative-id":["10.3389\/fendo.2026.1874726"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1874726","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,13]]},"article-number":"1874726"}}