Behavioral and Psychological Factors Associated with Diabetes Self-Management in Adults with Diabetes

Diabetes self-management (DSM) is essential for optimal glycemic control and prevention of complications. Psychological factors, particularly fear of hypoglycemia (FOH), may be associated with self-management behaviors, yet their relationship with glycemic outcomes remains unclear.

To examine the associations between FOH, DSM, and glycemic control (HbA1c) and to identify demographic and clinical factors associated with DSM among adults with diabetes.

A cross-sectional descriptive correlational study was conducted among 180 adults attending outpatient clinics at Qassim University Medical City between October 2025 and January 2026. Data were collected using a structured questionnaire including demographic and clinical variables, the Diabetes Self-Management Questionnaire (DSMQ), and a validated FOH screening tool. Glycemic control was assessed using the most recent HbA1c value documented in the medical record within the previous three months. Pearson's correlation and multiple linear regression analyses were performed using SPSS version 26.

The mean DSM score was 26.71 ± 3.57, indicating a moderately acceptable level, with physical activity as the lowest-performing domain. The mean HbA1c was 7.95 ± 1.85%, reflecting suboptimal control. FOH was positively associated with DSM (r = 0.49, p < 0.001) but not with HbA1c. DSM was not significantly correlated with HbA1c. In the regression analysis, FOH showed the strongest independent association with DSM (β = 0.44, p < 0.001). The model explained 50.1% of the variance.

FOH was significantly associated with DSM; however, the cross-sectional design does not allow conclusions regarding whether this association reflects adaptive concern, maladaptive fear, or greater self-care awareness. The lack of association between FOH, DSM, and HbA1c highlights the complexity of glycemic control and supports the need for integrated, patient-centered interventions addressing both behavioral and psychological aspects of diabetes care.