Beyond the prescription: self-management practices and their sociodemographic determinants among type 2 diabetes patients visiting physicians

The prevalence of type 2 diabetes mellitus (T2DM) is rising steeply across South Asia, and day-to-day self-management largely determines whether patients avoid complications. However, local evidence on which patients struggle most remains limited. This exploratory study examined the pattern and determinants of self-management among adults with T2DM visiting physicians in Sargodha, Punjab, Pakistan. Between July and August 2025, 483 eligible patients were recruited by consecutive sampling across five outpatient clinics and hospital-linked pharmacies. A structured, interviewer-administered questionnaire adapted from a previously published regional instrument captured nine recommended self-care practices and sociodemographic and clinical characteristics; each interview lasted approximately ten minutes. The proportion of patients reporting each practice was summarized with Wilson confidence intervals (CIs), and a practice-count index (0–9) was derived. Because the internal consistency of the nine items was low (Kuder–Richardson 20 = −0.11; mean interitem φ = 0.08; Kaiser–Meyer–Olkin [KMO] = 0.56), practices were analyzed individually, and adequate self-management was defined a priori as adherence to at least five of nine practices. Associations were tested using chi-square tests, t tests and multivariable binary logistic regression, with Poisson regression as a sensitivity analysis. Adherence was highest for home and periodic blood glucose monitoring (68.1% and 67.3%, respectively) and lowest for three-monthly glycated hemoglobin (HbA1c) testing (26.5%) and stress-management techniques (45.5%). Overall, 70.8% achieved adequate self-management. In the adjusted analysis, younger age (adjusted odds ratio [aOR] 0.96 per year; 95% CI 0.94–0.98) and being married rather than unmarried (unmarried aOR 0.37; 95% CI 0.20–0.67) independently predicted adequate self-management (likelihood ratio χ² = 28.8, p = 0.001; area under the curve 0.66). Education, income, family system, disease duration, family history and smoking status were not independent predictors. Diabetes self-care in this setting is uneven, with striking underuse of laboratory monitoring and stress management. Older and unmarried patients warrant targeted support.