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©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
Exploring the relationship between health knowledge, health literacy, self-care, self-efficacy, and glycemic control among adults with type 2 diabetes mellitus
Sasikala D Amirthalingam, Malanashita Ganeson, Chandramani Thuraisingham, Verna K M Lee, Chun Wai Chan, Lokman H Sulaiman, Sivarajan Ramasamy, Mohamad A Bujang, Cheong Lieng Teng
Sasikala D Amirthalingam, Malanashita Ganeson, Chandramani Thuraisingham, Verna K M Lee, Chun Wai Chan, Cheong Lieng Teng, Department of Family Medicine, IMU University, Seremban 70300, Negeri Sembilan, Malaysia
Lokman H Sulaiman, School of Medicine, IMU University, Kuala Lumpur 57000, Federal Territory, Malaysia
Sivarajan Ramasamy, Non-Communicable Disease Unit, Department of State Health, Seremban 70300, Negeri Sembilan, Malaysia
Mohamad A Bujang, Clinical Research Centre, Sarawak General Hospital, Ministry of Health Malaysia, Kuching 93586, Negeri Sarawak, Malaysia
Author contributions: Amirthalingam SD, Ganeson M, Thuraisingham C, Lee VKM, Sulaiman LH, Ramasamy S, and Teng CL developed the study protocol; Amirthalingam SD, Ganeson M, Thuraisingham C, Lee VKM, and Teng CL assisted in the data collection; Teng CL and Bujang MA performed the statistical analysis; Amirthalingam SD, Ganeson M, Thuraisingham C, Lee VKM, Chan CW, Sulaiman LH, Ramasamy S, Bujang MA, and Teng CL participated in the manuscript writing and read and approved the final manuscript.
Supported by the IMU University Internal Grant, No. CSc-Sem6(12)2022.
Institutional review board statement: This study obtained ethical approval from Research and Ethics Committee of IMU University, No. CSc-Sem6(12)2022.
Informed consent statement: All participants gave informed written consent prior to the study.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
STROBE statement: The authors have read the STROBE Statement—a checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-a checklist of items.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Cheong Lieng Teng, Professor, Department of Family Medicine, IMU University, Jalan Dr Muthu, Seremban 70300, Negeri Sembilan, Malaysia.
cheonglieng_teng@imu.edu.my
Received: January 13, 2025
Revised: March 30, 2025
Accepted: July 28, 2025
Published online: September 15, 2025
Processing time: 241 Days and 22.4 Hours
BACKGROUND
Adults with type 2 diabetes mellitus (T2DM) in Malaysia continue to have substantial comorbidities and struggle to achieve glycemic targets.
AIM
To comprehensively evaluate diabetes self-care and glycemic control using multiple self-reporting questionnaires.
METHODS
Adults diagnosed with T2DM attending the Seremban Health Clinic were recruited in this cross-sectional study. Eligible participants were recruited based on a consecutive sampling technique, first-come-first-served-basis if they fulfilled the inclusion and exclusion criteria. In addition to the usual sociodemographic, clinical, and laboratory data, the participants answered seven specific self-reporting questionnaires. This report was focused on six key variables: Glycemic control; self-care; self-efficacy; diabetes knowledge; health literacy; and medication adherence.
RESULTS
A total of 100 adults with T2DM participated. The proportions of participants achieving specific thresholds in the key variables were: Acceptable glycemic control 39.4%; adequate diabetes knowledge 59.6%; sufficient or higher health literacy 80.2%; and medication adherence 51.0%. The mean self-efficacy score was 110.6 (73.3% of maximum), and the mean self-care score was 30.7 (43.9% of maximum). A statistically significant linear correlation was observed for eight pairs of key variables with Pearson’s correlation values varying between 0.21 to 0.55. Self-efficacy had a relatively higher correlation while glycated hemoglobin was not correlated with other key variables. Path analysis was conducted to examine the relationships among diabetes self-efficacy (Diabetes Management Self Efficacy scale score), self-care behavior (Summary of Diabetes Self-Care Activities score), and glycemic control, but the model demonstrated a poor fit (χ² = 28.1, P < 0.001).
CONCLUSION
We found substantial suboptimal glycemic control and low self-care practices but acceptable levels of diabetes knowledge, self-efficacy, health literacy and medication adherence among the patients with T2DM. In spite of the correlations between self-care, self-efficacy, and medication adherence, it was surprising that self-care did not correlate with glycemic control. Prospective cohort studies are needed to explore whether these factors influence diabetes outcomes.
Core Tip: A comprehensive evaluation of multiple variables among adults with type 2 diabetes mellitus revealed substantial suboptimal glycemic control and low self-care practices but acceptable diabetes knowledge, self-efficacy, health literacy, and medication adherence. Self-care was associated with self-efficacy and medication adherence. Prospective cohort studies are needed to explore whether these factors influence diabetes outcomes.
