In an observational investigation conducted at a secondary care hospital in rural Tamil Nadu, India, clinical researchers discovered that consistent self-care routines, rather than theoretical knowledge of diabetes mellitus, serve as an independent determinant of satisfactory glycemic control among adults living with type 2 diabetes. The cross-sectional study evaluated one hundred and thirty adult outpatients to assess baseline disease awareness, daily self-management behaviors, and clinical biomarkers including glycated hemoglobin, fasting plasma glucose, and postprandial blood sugar concentrations. Strikingly, only thirty-three point one percent of the enrolled participants maintained satisfactory glycemic control under established clinical standards, despite nearly three-quarters demonstrating adequate factual comprehension on standardized evaluation instruments. Multivariable logistic regression modeling established that patients adhering to recommended self-care routines achieved nearly three times higher odds of maintaining target blood glucose levels compared to those with deficient self-care. Conversely, possessing adequate disease knowledge showed no statistically significant direct association with glycemic outcomes, underscoring a notable operational divide between health literacy and behavioral practice in rural healthcare environments.
The study arrives against the backdrop of an expanding public health crisis in India, which currently records the second highest burden of diabetes mellitus globally, following China. According to epidemiological data from the National Family Health Survey of India covering 2019 through 2021, an estimated seventy-five million individuals across the country live with diabetes mellitus, with national projections estimating that this figure will escalate to one hundred and thirty million by 2045. Diabetes mellitus, as formally defined by the World Health Organization, represents a chronic metabolic disorder marked by elevated concentrations of circulating glucose, stemming from impaired pancreatic insulin secretion in type 1 diabetes or diminished peripheral insulin utilization in type 2 diabetes. Type 2 diabetes accounts for approximately ninety percent of all documented presentations, predisposing individuals over the long term to debilitating multi-systemic vascular complications, including accelerated progression toward chronic kidney disease, diabetic neuropathy, cardiovascular morbidity, and cognitive decline such as Alzheimer disease. While therapeutic pharmacology and clinical guidance have advanced considerably, favorable long-term prognosis hinges on sustained behavioral adherence in everyday domestic environments.
To investigate these dynamic behavioral and metabolic patterns within an underserved demographic, the investigators situated their evaluation within a two-hundred-and-ninety-nine-bed secondary level healthcare facility operating a weekday diabetic outpatient clinic in rural Tamil Nadu. Eligible participants were required to be at least thirty years of age at their initial clinical interview, have a confirmed medical diagnosis of type 2 diabetes established at least twelve months prior, and present documented laboratory metrics dating within the preceding three months. Individuals presenting with alternative forms of diabetes, severe cognitive impairment, or terminal medical conditions were excluded from enrollment. Following the provision of comprehensive verbal explanations and written informed consent, each enrolled individual received a dedicated personal diabetic diary to log clinical histories, prescribed pharmacological regimens, and laboratory outcomes. Participants were required to bring these personalized records to subsequent clinical appointments, while investigators compiled all extracted variables confidentially using anonymized alphanumeric coding to preserve participant confidentiality throughout the empirical investigation.
Determining an adequate study cohort required statistical sample size estimation grounded in single-proportion sampling methodology, using previously published rural regional prevalence figures for average diabetes knowledge. Assuming an expected baseline knowledge prevalence of forty-five point five percent, a nine percent margin of absolute precision, and standard normal distribution Z-scores corresponding to a ninety-five percent confidence interval, the mathematical framework established a minimum recruitment threshold of one hundred and eighteen participants. The team ultimately enrolled one hundred and thirty individuals, comprising sixty-two men representing forty-seven point seven percent and sixty-eight women representing fifty-two point three percent. The median cohort age was fifty-five years, ranging from forty to eighty-five years, with forty-one point five percent concentrated between fifty and fifty-nine years. Socioeconomic status was classified using the modified Kuppuswamy scale adjusted for the 2021 consumer price index, identifying sixty-six point nine percent within the upper-middle class and twenty-seven point seven percent across lower-middle and upper-lower classifications. Overweight individuals constituted fifty-five point four percent of the sample, while thirty-eight point five percent had normal weight and six point two percent met criteria for clinical obesity.
Evaluation of participant health literacy revealed stark contradictions between perceived subjective awareness and objective biochemical targets necessary for effective chronic disease management. When asked to evaluate their personal comprehension of type 2 diabetes, eighty point eight percent of participants classified their overall understanding as fair, ten percent rated it as good, and nine point two percent described it as poor. However, when queried about concrete physiological metrics, ninety-three point eight percent of respondents admitted to having no knowledge regarding the recommended hemoglobin A1C thresholds defining satisfactory glycemic regulation. Furthermore, forty-three point one percent could not identify normal fasting blood sugar parameters, and forty-five point four percent were unaware of postprandial glucose targets. In contrast, awareness of acute and systemic pathological consequences remained relatively preserved: eighty-three point eight percent recognized that health complications stem from severe hypoglycemic or hyperglycemic swings, and forty-four point six percent demonstrated baseline familiarity with diabetic complications affecting the ocular structures, renal parenchyma, cardiovascular system, and peripheral neurological pathways.
Pharmacological profiles compiled across the patient population illustrated heavy reliance on oral hypoglycemic agents, alongside notable procedural challenges among individuals requiring exogenous insulin therapy. Eighty-seven point seven percent of participants relied exclusively on oral hypoglycemic agents, with fifty-six point nine percent prescribed dual-action combinations of biguanides and sulfonylureas, while twelve point three percent received combined regimens incorporating both oral medications and injectable insulin. Ninety-five point four percent of patients reported managing their pharmacotherapy independently without relying on household caregivers. Among the sixteen individuals administering insulin, primary subcutaneous injection sites included combined rotation between the thigh and anterior abdominal wall in fifty percent, and combined usage across thighs, abdomen, and arms in twenty-five percent. While ninety-three point eight percent maintained proper domestic cold-chain storage utilizing household refrigeration, one participant relied on an evaporative pot-in-pot clay cooler. Crucially, repeated syringe reuse was universal among insulin users: sixty-eight point eight percent reused disposable insulin syringes more than twice, and thirty-one point two percent reused them exactly twice before disposal.
Self-reported monitoring practices and behavioral habits showed varied engagement across clinical disciplines, alongside critical lapses in personal documentation. Exactly half of the cohort reported obtaining laboratory blood glucose tests once per month, while the remaining fifty percent checked their blood glucose once every two months. Urine glucose testing was conducted every six months by forty-eight point five percent and every two months by nineteen point two percent. Annual ophthalmological screenings were reported by ninety-five point four percent of respondents, yet eighty-seven point seven percent admitted that they never preserved or maintained personal records of their laboratory investigations. Daily structured physical exercise was reported by fifty-eight point five percent of the participants, whereas twenty-four point six percent reported complete absence of physical activity. Regarding acute complications, twenty percent of participants experienced symptomatic hypoglycemic episodes, and fifty-three point one percent consistently carried confectioneries or sweets to self-treat sudden neuroglycopenic symptoms during their routine daily activities outside clinical settings.
Standardized measurement of knowledge and self-care was conducted using culturally adapted instruments translated into the local vernacular. Diabetes knowledge was evaluated with the twenty-four-item Diabetes Knowledge Questionnaire, developed by the Starr County Diabetes Education Study, where correct responses yield one point, establishing a validated cut-off score of twelve to distinguish adequate from poor disease knowledge. Self-care practices were quantified using the sixteen-item Diabetes Self-Management Questionnaire across four sub-scales: glucose management, dietary control, physical activity, and healthcare utilization. Scoring transformed Likert ratings into a ten-point scale, designating scores of five or greater as satisfactory self-management. Both questionnaires underwent forward translation into Tamil by bilingual social workers and care coordinators, followed by expert clinical review and blinded back-translation into English. Overall, seventy-three point nine percent of participants attained adequate knowledge scores of twelve or higher on the questionnaire, while fifty point eight percent scored five or higher on the self-management assessment, leaving forty-nine point two percent with inadequate self-care practices.
Multivariable logistic regression analysis was conducted using the simultaneous Enter method, integrating variables showing significance during univariate screening to identify independent predictors while evaluating goodness-of-fit via likelihood-ratio and Hosmer-Lemeshow tests. Satisfactory glycemic control—defined as glycated hemoglobin below seven percent, or fasting glucose below one hundred and thirty milligrams per deciliter alongside postprandial glucose below one hundred and eighty milligrams per deciliter when glycated hemoglobin was unavailable—was independently predicted by age older than fifty-five years, with an odds ratio of three point zero one. Disease duration under ten years likewise predicted satisfactory control with an odds ratio of three point seven seven, and satisfactory self-management scoring yielded an odds ratio of two point seven seven. Conversely, diabetes knowledge scores showed no independent association with glycemic success. Poor self-management was independently predicted by deficient knowledge, with an odds ratio of four point six three, and female gender, with an odds ratio of four point two eight. Lower socioeconomic status and prolonged disease duration exceeding ten years independently predicted poor diabetes knowledge.
These analytical findings provide vital real-world insight into rural chronic disease management while highlighting important structural limitations inherent to the observational design. The single-center setting within rural Tamil Nadu restricts immediate generalizability across diverse urban centers or disparate socioeconomic environments. Furthermore, because sample sizing followed single-proportion estimation for prevalence rather than multivariable statistical power calculations, regression coefficients retain wider confidence intervals. Pragmatic reliance on fasting and postprandial glucose values for thirty-three patients unable to afford glycated hemoglobin testing introduces clinical variability, though statistical adjustment confirmed the assessment method did not alter independent associations. Dichotomizing continuous parameters such as age and disease duration may also compress underlying nuance, and formal internal psychometric consistency was not re-tested locally. Nevertheless, the study underscores that theoretical awareness alone cannot guarantee metabolic stability unless structured public health initiatives actively empower rural patients—particularly women and those navigating extended disease duration—to translate biological comprehension into rigorous, sustained domestic self-care routines.
Subject of Research: Determinants of glycemic control, disease knowledge, and self-care practices among adults with type 2 diabetes in rural India
Article Title: Association of diabetes knowledge and self-care practices with glycemic control among adults with type 2 diabetes in rural Tamil Nadu, India
Article References: Jose, S. E., Poulose, J. V., & Rajamani, I. (2026). Association of diabetes knowledge and self-care practices with glycemic control among adults with type 2 diabetes in rural Tamil Nadu, India. Discover Public Health, 23(1), Article 1748. https://doi.org/10.1186/s12982-026-03266-2
Image Credits: AI Generated
DOI: 10.1186/s12982-026-03266-2
Keywords: type 2 diabetes, glycemic control, self-care practices, Diabetes Knowledge Questionnaire, Diabetes Self-Management Questionnaire, rural healthcare, Tamil Nadu, hemoglobin A1c, fasting blood sugar, postprandial blood sugar, oral hypoglycemic agents, insulin therapy, syringe reuse, modified Kuppuswamy scale, disease duration, patient education, cross-sectional study
