Faith as Medicine: A 12-Month Longitudinal Study of Spirituality and Diabetes Self-Management in Turkish Adults

Type 2 diabetes requires sustained lifestyle modifications that can be psychologically challenging. Spirituality may serve as an important coping resource, yet longitudinal evidence remains limited in Muslim populations where spiritual beliefs are deeply integrated into daily life and health practices. To examine longitudinal relationships between spirituality, religious coping, and diabetes self-management behaviors, quality of life, and glycemic control among Turkish adults with type 2 diabetes over 12 months, and to test theoretical pathways through which spirituality influences health outcomes. A prospective study of 240 Turkish adults with type 2 diabetes from endocrinology clinics in Istanbul and Bursa (January 2023-June 2024). Participants completed validated questionnaires measuring spirituality (FACIT-Sp), religious coping (Brief RCOPE), diabetes self-care activities (SDSCA), quality of life (DQOL), and diabetes distress at baseline, 6 months, and 12 months. HbA1c levels were obtained at each time point. Linear mixed-effects models examined relationships between spirituality variables and outcomes, with mediation analysis testing positive religious coping as a mediating mechanism. Of 240 participants enrolled, 218 (90.8%) completed 12-month follow-up. Mean age was 53.4 years (SD = 9.6), 52.1% were female, and mean diabetes duration was 7.2 years. Higher baseline spirituality was significantly associated with better trajectories across all outcomes: self-care behaviors (β = 0.28, SE = 0.07, p < 0.001), quality of life (β = - 0.23, SE = 0.08, p = 0.008), and glycemic control (β = - 0.19, SE = 0.09, p = 0.021). Positive religious coping partially mediated the relationship between spirituality and self-care behaviors (indirect effect: β = 0.15, 95% CI 0.08-0.24, representing 35.7% of total effect). Participants in the highest spirituality tertile showed significantly greater HbA1c improvements compared to the lowest tertile (- 0.8% vs - 0.3%, p = 0.012). Age moderated these relationships, with stronger effects among older participants. Spirituality represents a valuable resource for diabetes self-management among Turkish adults, with positive religious coping serving as a key mediating mechanism. Healthcare providers should consider spiritual assessment as part of comprehensive diabetes care. The findings support developing culturally adapted, spiritually-informed diabetes interventions that integrate Islamic perspectives with evidence-based medical care.