Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

Figures & data

Table 1 Participants’ Sociodemographic, Clinical, and Psychological Characteristics (n=520)

Characteristics	N (%)
Age, years, mean (SD)	55.86 (11.8)
25–35 Years	25 (4.8)
36–45 Years	80 (15.4)
46–55 Years	159 (30.6)
56–65 Years	149 (28.7)
>65 Years	107 (20.6)
Gender
Female	255(49)
Male	265(51)
Marital status
Single	25 (4.8)
Currently married	405(77.9)
Widow	79(15.2)
Divorce	11(2.1)
Educational level
Illiterate	97(18.7)
Primary	170(32.7)
Secondary	134(25.8)
Diploma	54(10.4)
Bachelor’s Degree	52(10)
Higher education.	13(2.5)
Employment status
No	354(68.1)
Yes	166(31.9)
Household monthly income, JD’s, mean (SD)	312.8 (188)
Household sizes, persons, mean (SD)	4.8 (2.4)
Health insurance
Yes.	432 (83.1)
No.	88 (16.9)
Smoking status
Yes	112 (21.5)
No	408 (78.5)
Comorbidities
Yes	275 (52.9)
No	245 (47.1)
BMI (kg/m^2), mean (SD)	30.07 (5.88)
Underweight (<18.5kg/m^2)	2 (0.40)
Normal weight (18.5–24.9kg/m^2)	89 (17.1)
Overweight (25–29.9 kg/m^2)	207 (39.8)
Obese (≥30kg/m^2)	222 (42.7)
Pre-obese-I (30–34.9 kg/m^2)	133 (25.6)
Obese class-II (35–39.9 kg/m^2)	52 (10.0)
Obese class-III (≥40 kg/m^2)	37 (7.1)
Diabetes duration, years, mean (SD)	8.1 (6.38)
1–5 years	255 (49)
6–10 years	129 (24.8)
11–15 years	78 (15)
16–20 years	38 (7.3)
> 20 years	20 (3.8)
Treatment types
OHA alone	336 (64.6)
Insulin alone	140 (26.9)
OHA & insulin	44 (8.5)
Previous diabetes education
Yes	59 (11.3)
No	461 (88.7)
Diabetes education setting
Clinic	14 (23.7)
Hospital	28 (47.5)
UNRWA clinics	11(18.6)
Medicine without Border	6 (10.2)
Help with diabetes self-care at home
Yes	255 (49)
No	265 (51)
Psychological support
Yes	430 (82.7)
No	90 (17.3)
HbA1c, %, mean (SD)	9.29 (2.06)
Glycemic control status
Good control <7%	38 (7.3%)
Poor control ≥7%	482 (92.7%)

Notes: Data presented as n (%) or mean and standard deviation (SD); Household size= the number of family members who live in the same home.

Abbreviations: JD’s, Jordan dinars; BMI, body mass index; OHA, oral hypoglycemic agents; HbA1c, glycated hemoglobin.

Table 2 Participants’ Psychological Distress

PHQ-4 Items	Mean (SD)	N (%)
Little interest or pleasure in doing things	1.31 (1.02)
Feeling down, depressed, or hopeless	1.09 (1.34)
Feeling nervous, anxious or on edge	1.50 (1.75)
Not being able to stop or control worrying	1.59 (1.06)
Total score	5.51(3.83)
None (0–2)		122 (23.5)
Mild distress (3–5)		151 (29)
Moderate distress (6–8)		156 (30)
Severe distress (9–12)		91 (17.5)

Abbreviations: PHQ-4, the 4-items Patient Health Questionnaire; SD, standard deviation.

Table 3 Diabetes Self-Care Activities and Its Correlation with HbA1c (n = 520)

SDSCA Subscales	Items	Mean (SD) Days/Week^a	Correlation with HbA1c	p-value
Diet		3.71 (1.42)	−0.50	<0.001
General diet		3.4 (2.41)	−0.422	<0.001
	1. Follow a healthy eating plan in the last week	3.32 (2.50)
	2. Follow your eating plan over the past month	3.48 (2.47)
Specific diet		3.91 (1.45)	−0.362	<0.001
	3. Eat 2–3 servings of fruits	3.87 (2.08)
	4. Eat five or more servings of vegetables	5.10 (1.97)
	5. Eat high-fat foods such as red meat or whole-fat dairy products (Reverse scoring item)	2.75 (2.1)
Exercise		1.05 (1.19)	−0.577	<0.001
	6. Participate in at least 30 minutes of physical activity (Total minutes of continuous activity, including walking)	1.93 (2.26)
	7. Participate in a specific exercise session (such as walking and biking)	0.18 (0.56)
Blood sugar testing		1.52(1.58)	−0.315	<0.001
	8. Test for blood sugar	2.1 (2.16)
	9. Test blood sugar the number of times recommended by your health care provider	0.94 (1.43)
Foot care		3.66 (2.08)	−0.203	<0.001
	10. Checked your feet	2.93 (2.98)
	11. Inspect the inside of your shoes	2.58 (2.93)
	12. Wash your feet	5.96 (2.21)
	13. Dry between your toes after washing	3.16 (3.1)
Medication		6.33 (1.45)	0.019	0.663
	14. Inject insulin according to recommended doses (n=184)	6.49 (1.34)
	15. Take OHA at the recommended dosage (n= 380)	6.17 (1.65)
Overall mean score	Unsatisfactory (<4): 79.2%. Satisfactory level (≥4): 20.8%;	3.25 (0.88)	−0.168	<0.001

Notes: ^aScale scores range: 0–7; Test of association: Pearson’s correlation coefficients (r). Adapted with permission from Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care: Results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943-950. SDSCA Copyright 2000 Oregon Research Institute, Eugene, Oregon. All rights reserved.⁵¹

Abbreviations: SDSCA, Summary of Diabetes Self-Care Activities; HbA1c, glycated hemoglobin; SD, standard deviation; OHA, oral hypoglycemic agents.

Table 4 Bivariate Association Between Participants’ Characteristics and HbA1c (n=520)

Characteristics	HbA1c Mean (SD)	Test of Association	p-value
Age, years,		0.08^a	0.069
25–35 years	8.84 (2.11)	1.488^b	0.204
36–45 years	8.93 (2.12)
46–55 years	9.29 (1.71)
56–65 years	9.55 (2.30)
>65 years	9.32 (2.08)
Gender
Female	9.43 (9.43)	1.516^c	0.130
Male	9.16 (9.16)
Marital status
Single	8.76 (2.07)	1.32^c	0.188
Ever married	9.32 (2.05)
Education level
Illiterate	9.70 (2.31)	5.91^b	<0.001
Primary	9.74 (2.14)
Secondary	9.02 (1.74)
Diploma	8.74 (1.90)
Bachelor’s Degree	8.70 (1.72)
Higher education.	7.94 (1.85)
Employment status
No	9.49 (2.07)	3.18^c	0.002
Yes	8.88 (2.0)
Household monthly income, JD’s,		−0.254^a	<0.001
Household sizes, persons		−0.025^a	0.569
Comorbidities
Yes	9.39 (2.12)	−1.171^c	0.242
No	9.18 (2.0)
BMI (kg/m^2)		0.329^a	<0.001
Underweight (<18.5kg/m^2)	7.50(1.70)
Normal Weight (18.5–24.9kg/m^2)	8.91(1.74)	16.81^b	<0.001
Overweight (25–29.9 kg/m^2)	8.74(1.72)
0bese (≥30kg/m^2)
Pre-obese class I	9.64(2.04)
Obese class II	9.67(2.04)
Obese class III	11.63(2.61)
Diabetes duration, years		0.129^a	0.003
1–5 Years	9.08 (1.96)	2.68^b	0.031
6–10 Years	9.48 (2.02)
11–15 Years	9.33 (2.14)
16–20 Years	9.33 (2.10)
> 20 Years	10.49 (2.66)
Treatment types
OHA alone	9.03 (1.94)	8.26^b	<0.001
Insulin alone	9.82(2.27)
OHA & insulin	9.63 (1.85)
Health insurance
Yes.	9.31 (2.02)	0.529^c	0.597
No.	9.19 (2.23)
Smoking status
Yes	9.31 (2.03)	0.37^c	0.772
No	9.24 (2.16)
Previous diabetes education
Yes	9.33(2.06)	1.24^c	0.216
No	8.98 (2.0)
Help with diabetes self-care at home
Yes	9.43 (1.96)	1.67^c	0.095
No	9.44 (2.14)
Psychological support
Yes	9.18 (2.02)	2.72^c	0.007
No	9.83 (2.16)
Psychological distress		0.131^a	0.003

Notes: ^aPearson’s correlation coefficients (r); ^bOne-way analysis of variance; ^cIndependent sample t-test; Household size= the number of family members who live in the same home.

Abbreviations: HbA1c, glycated hemoglobin; SD, standard deviation; JD’s, Jordan Dinars; BMI, body mass index; OHA, oral hypoglycemic agents.

Table 5 Summary of Hierarchical Regression Analysis for Variables Predicting HbA1c Levels (Glycemic Control)

Predictors	Step 1					Step 2
	B	SE	β	t	p-value	B	SE	β	t	p-value
(Constant)	7.404	0.763		9.70	<0.001	9.919	0.629		15.8	<0.001
Age (years)	−0.004	0.009	−0.024	−0.47	0.640	0.001	0.007	0.008	0.20	0.844
Gender (male)	−0.253	0.185	−0.061	−1.36	0.174	−0.134	0.147	−0.032	−0.91	0.365
Marital status (ever married)	0.222	0.401	0.023	0.56	0.579	0.070	0.315	0.007	0.22	0.824
Education level (≥secondary)	−0.568	0.186	−0.138	−3.05	0.002	−0.076	0.151	−0.018	−0.50	0.617
Employment status (employed)	−0.188	0.210	−0.043	−0.89	0.372	−0.146	0.166	−0.033	−0.88	0.379
Income	−0.002	0.001	−0.150	−3.25	0.001	−0.001	0.000	−0.080	−2.17	0.030
Comorbidities (yes)	−0.239	0.185	−0.058	−1.29	0.197	−0.066	0.146	−0.016	−0.45	0.651
BMI	0.104	0.014	0.297	7.26	<0.001	0.061	0.012	0.174	5.29	<0.001
Diabetes duration (years)	0.011	0.015	0.033	0.70	0.484	0.006	0.012	0.019	0.51	0.609
Treatment type (use Insulin)	0.671	0.184	0.156	3.65	<0.001	0.643	0.149	0.0149	4.31	<0.001
Previous diabetes education (yes)	−0.385	0.262	−0.059	−1.47	0.141	−0.240	0.206	−0.037	−1.16	0.245
Help with diabetes self-care (yes)	−0.289	0.172	−0.070	−1.68	0.093	−0.168	0.137	−0.041	−1.22	0.222
Psychological support (yes)	−0.319	0.223	−0.059	−1.43	0.154	0.081	0.177	0.015	0.05	0.647
Psychological stress	0.045	0.022	0.083	2.05	0.041	0.025	0.017	0.047	1.46	0.145
General diet						−0.179	0.029	−0.209	−6.25	<0.001
Specific diet						−0.217	0.048	−0.153	−4.49	<0.001
Exercise						−0.616	0.060	−0.363	−10.3	<0.001
Blood sugar testing						−0.188	0.045	−0.143	−4.15	<0.001
Foot care						−0.017	0.034	−0.018	−0.519	0.604
R	0.47					0.73
R^2 (%)	22.3					52.6
F	10.25				<0.001	28.98				<0.001
F for change in R^2						63.52				<0.001

Abbreviations: HbA1c, glycated hemoglobin; B, unstandardized coefficient; SE, standard error; β, standardized coefficient; BMI, body mass index.

Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes self-care: results from 7 studies and a revised scale. Diabetes Care. 2000;23(7):943–950. doi:10.2337/diacare.23.7.943

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