Abstract
Introduction
Diabetes mellitus (DM) is increasing globally, especially in middle-income countries, with type 2 diabetes (T2D) accounting for 90–95% of cases. Cambodia has seen a significant increase, with over 91,000 T2DM cases in 2022. T2DM complications, including kidney disease and cardiovascular issues, are prevalent, and the financial burden is high. Self-care behaviors, including dietary adherence, physical activity, foot care, blood glucose monitoring, and medication adherence, are crucial but often lacking, leading to worse outcomes. This study aimed to assess self-care behaviors and their associated factors in T2D patients at Kampong Speu referral hospital to improve management health outcomes.
Methods
A cross-sectional descriptive study was conducted with 196 patients aged 18 to 69 years who were diagnosed with T2D at Kampong Speu Referral Hospital, Cambodia. The study used a questionnaire to assess patients’ self-care behavior using the summary of diabetes self-care activities (SDSCA). Data analysis was performed via STATA version 17, which employed descriptive statistics (frequency, percentage) to describe patient demographics, medical status, and self-care behaviors. Chi-square tests and univariate logistic regression were used to identify factors associated with self-care behaviors. Statistical significance was determined at a p value < 0.05.
Results
The mean age of the patients was 56.9 years. More than half of the patients were women (56.1%). Most of them had social health protection schemes (78.6%). Approximately one-third (31.1%) had an HbA1c ≥ 7%, fasting blood glucose was 65.3%, and 39.8% were obese with BMI ≥ 25 kg/m². Close to 72.0% of the patients had comorbidities (i.e., hypertension, neuropathy) and diabetes complications (65.8%). The percentage of patients with self-care knowledge was high (78.3%). The patients reporting different dimensions of self-care behaviors in the past week included physical activities (97.9%), medication adherence (86.7%), dietary adherence (38.8%), foot care (30.6%), and blood glucose monitoring (4.6%). A lack of follow-up of HBA1c (OR = 0.30; 95% CI 0.13–0.70) and poorly controlled HbA1c (OR = 0.25; 95% CI: 0.09–0.62) and having T2D over 10 years (OR = 0.34; 95% CI: 0.14–0.84) were associated with poor dietary adherence. There was an association between education level and blood glucose monitoring (p value <0.05). Furthermore, patients with T2D comorbidities were associated with foot care (OR = 2.13; 95% CI: 1.01–2.49).
Conclusion
The study highlights high self-care knowledge but very low blood glucose control, such as HbA1c among T2D patients. The study also identified some demographic and clinical challenges among diabetic patients, including a longer duration of T2D, educational attainment, HbA1c monitoring, and diabetic comorbidities, that were associated with some dimensions of the self-care behaviors (dietary adherence, blood glucose monitoring, and food care). Therefore, healthcare providers should tailor health interventions for diabetic patients and encourage diabetes self-care management, particularly regular HbA1c monitoring. Continuing targeted support could substantially improve health outcomes for patients with T2D.