Predictors of diabetes self-management and glycemic control among patients with diabetes mellitus in conflict-affected Palestine.

Abstract

Poor glycemic control and inadequate self-management drive the global diabetes mellitus (DM) burden. In conflict-affected Palestine, structural barriers worsen outcomes, yet diabetes management self-efficacy (DMSE) remains understudied. To assess diabetes management self-efficacy and glycemic control, their interrelationship, and the independent predictors of each among patients with diabetes mellitus in conflict-affected Palestine. A cross-sectional study was conducted among 418 adults with type 1 or type 2 DM attending governmental diabetes clinics in the Hebron governorate, West Bank, Palestine. Data were collected using the Arabic-validated Diabetes Management Self-Efficacy Scale (DMSES) and a structured clinical questionnaire. Non-parametric tests and two multiple linear regression models were applied to identify independent predictors, with HbA1c and DMSE scores specified as the two dependent variables. Glycated hemoglobin (HbA1c) was suboptimal (median = 7.50, IQR = 2.30), while DMSE was moderate (median = 3.45/5, IQR = 1.10). Blood glucose management was the strongest subdomain, whereas physical exercise was the weakest. Former smoking (β = 0.202, 95% CI: 0.430, 1.494, p < .001), lower physical activity frequency (β = 0.156, 95% CI: 0.098, 0.455, p = .003), and diabetes-related complications (β =-0.154, 95% CI: -1.132, - 0.210, p = .004) independently predicted higher HbA1c. Lower physical activity (β =-0.177, 95% CI: -0.208, - 0.060, p < .001), longer disease duration (β =-0.135, 95% CI: -0.177, - 0.021, p = .013), lower income (β = 0.163, 95% CI: 0.081, 0.348, p = .002), and lower education (β = 0.127, 95% CI: 0.018, 0.227, p = .022) independently predicted lower DMSE. Clinical, behavioral, and socioeconomic factors independently predicted glycemic control and self-efficacy. The DMSE-HbA1c disconnect indicates structural barriers impede self-management behavior. Integrating clinical education with economic and structural support is essential to improve diabetes outcomes in conflict-affected settings.