Diabetes Self-Care, Psychological Distress, and Quality of Life Among People with Type 2 Diabetes in Low-Income Urban Communities: An Exploratory Mixed-Methods Study in Hyderabad, India

Diabetes Mellitus (DM) poses a growing public health challenge in India. This study explores diabetes management practices, barriers to care, diabetes-related psychological distress, and quality of life (QoL) among adults living with type 2 diabetes mellitus (T2DM) in the low-income urban communities of Hyderabad, India. This exploratory, mixed-methods study involved 107 adults. Quantitative data on medication adherence, lifestyle practices, diabetes-related emotional distress, and QoL were assessed using structured interviews. Gender-segregated focus group discussions explored participants lived experiences. Quantitative data were analysed using descriptive statistics and regression models; while qualitative data were analysed using grounded theory-informed approach. Overall, diabetes self-care practices were suboptimal (mean score: 3.2 out of 7). Medication adherence was high (96%), but diet, physical activity, and glucose monitoring were limited. Female sex and multimorbidity were associated with poorer self-management, whereas unemployment was associated with better adherence. Nearly 40% of participants were identified as potentially experiencing diabetes-related emotional distress. QoL was low, particularly in the social domain. Qualitative findings highlighted lack of awareness, economic constraints, time poverty, and gendered responsibilities as key barriers to effective self-care. Socioeconomic, gender, and health-related factors influence diabetes self-care. Multidimensional, gender-sensitive and family-centred interventions that integrate medical, educational, and psychosocial support are essential in low-income urban communities.