The study was carried out in Nyeri County referral hospital, located in central regional Kenya. The County lies between Mount Kenya and the Aberdare ranges with Agriculture as the main economic activity. The majority of the people living in Nyeri County are predominantly farmers growing tea and coffee as cash crops alongside food crops such as maize, beans, assorted vegetables, and sweet potatoes. Other communities living in the county are mostly engaged in their own businesses or employed by the government. Nyeri County is home to 845,863 people (male 49% and female 51%).

A facility-based, cross-sectional study was conducted at the diabetes clinic and Diabetes outpatient clinic (DOPC). The study duration was from 8th August 2022 till 30th October 2022.

245 participants were recruited for the study.

Participants were recruited using a purposive sampling method. The procedure involved asking about the area of residence among the patients seeking diabetes care and selecting eligible individuals who met the inclusion criteria for participation in the interview. The inclusion criteria were: individuals must be diagnosed with type II diabetes and reside in a rural area within Nyeri County. Other inclusion criteria the participant must be 20 years and above and registered for follow-up in a hospital within Nyeri County. Patients being seen in the emergency or in-patient department, and patients who did not have at least one available record of HbA1c from the last six months were excluded. All patients were included after attaining informed consent. The majority of the participants were under treatment, except two found to have discontinued treatment and medications during the time of the interview.

Data was collected from the participants using a structured paper-based questionnaire improved from the Summary of Diabetes Self-Care Activities Measure. It included biodata information, Duration of DM and treatment, and HbA1c record from the last six months.

In order to assess their status of self-care, the Summary of Diabetes Self-care Activities (SDSCA) Questionnaire was used. The seven items of SDSCA are used to assess self-care activities. They are divided into 7 subscales: blood glucose testing subscale (item 7, 8, 3A), Diet subscale (item 1, 2, 3, 4, 1A, 5A), Physical exercise subscale (item 5, 6, 2A), smoking subscale (item 11, 12A, 13A, 14A), foot care subscale (item 9, 10, 9A, 10A, 11A), medications subscale (item 6A, 7A, 8A) and self-care recommendations subscale (item 1A, 2A, 3A, 4A). The questionnaire asks patients about their diabetes self-care activities during the past 7 days. If they were sick during the past 7 days, we went back to the last 7 days that they were not sick.

Scoring instructions were. Step 1: For items 1 - 10, use the number of days per week on a scale of 0 - 7. Step 2: Scoring Scales; general Diet = Mean number of days for items 1 and 2 and Specific Diet = Mean number of days for items 3, and 4 where the scale was (0 = 7, 1 = 6, 2 = 5, 3 = 4, 4 = 3, 5 = 2, 6 = 1, 7 = 0); exercise = Mean number of days for items 5 and 6; Blood-Glucose Testing = Mean number of days for items 7 and 8. Foot-Care = Mean number of days for items 9 and 10; Smoking Status = Item 11 (0 = nonsmoker, 1 = smoker), and number of cigarettes smoked per day.

Scoring for Additional Items such as; Recommended regimen = Items 1A - 4A, and items 12A - 14A, no scoring required; Diet = Use total number of days for item 5A; Medications = Use item 6A - OR - 7A AND 8A, use total number of days for item 6A, use mean number of days if both 7A and 8A are applicable. Lastly; Foot-Care = Mean number of days for items 9A - 11A, after reversing 10A and including items 9 and 10.

For data entry and statistical analysis, SPSS for Windows version 27 was utilized. Patient characteristics were presented as frequency and percentages and compared using Chi square test. For SDSCA overall and its subscales mean and standard deviation (SD) were calculated and for comparison independent sample t-test was applied. The p value ≤ 0.05 was taken as significant.

Before commencing data collection, we conducted a pre-test of the questionnaire for consistency and suitability at a non-participating institution, namely Murang’a County Referral Hospital. The reliability of the SDSCA questionnaire was assessed using Cronbach’s alpha test, yielding an overall reliability coefficient of 0.746. The questionnaire was initially prepared in English, translated into the Kikuyu version, and subsequently translated back into English to ensure accuracy. Data collection involved the participation of four nurses and four clinical officers who were trained a month prior to the study’s commencement. Furthermore, all research assistants underwent a pre-testing session before the actual study. Throughout the data collection process, debriefing meetings were held at the end of each day to review data and identify any potential omissions or errors.

The data was entered into Microsoft Excel and subsequent analysis using IBM SPSS Statistics version 22. The reliability of the data was assessed through Cronbach’s alpha test, while model fitness was evaluated using the Hosmer and Lemeshow test. Descriptive statistics were computed to provide a summary of most variables. Bivariate analysis was conducted to explore the potential association between diabetes self-management practices and the presence of microvascular complications. To ensure the stability of estimates in the subsequent model, only variables with a p-value less than 0.2 in bivariate analysis were included in the subsequent model analysis. Multiple logistic regression analysis was then employed to describe the association between diabetes self-management and microvascular complications. A significance level of p < 0.05 was used for all statistically significant tests.

Both written and verbal informed consent for participation was also obtained from all the participants. For written consent, all participants signed the consent form in the questionnaire. Verbal consent was witnessed by the nurse or clinical officer in-charge of the clinic. The study was approved by the Ethical Review Committee of Jomo Kenyatta University of Agriculture and Technology (JKU/2/4/896B), and the National Commission for Science, Technology and Innovation (NACOSTI/P/22/18990) and Nyeri county department of health (CGN/HEALTH/HRM/6/VOL.II).

This study was conducted within a group displaying particular characteristics. It is uncertain whether other groups in different rural areas possess similar traits. Consequently, caution should be exercised when generalizing the findings. However, it does offer insights into the degree of association between diabetes self-management and MVCs, which can guide the development of interventions.

A total of two hundred and forty-five (245) individuals diagnosed with Diabetes were involved in the study. Of these, 96 (39.2%) were male and 149 (60.8%) were female. The majority of participants were aged over sixty-one years 148 (60.4%) and married 168 (68.6%). Most of the participants occupation was farming 175 (71.4%) ( Table 1 ).

The study result revealed that most 180 (73.5%) respondents had no family history of diabetes. Most 232 (94.7%) of the respondents were non-smokers. More than two-thirds of the respondents (69%) have experienced diseases more significant than five years of duration. Of the total respondents more than half, 144 (58.8%) had poor glycemic control ( Table 2 ).

The prevalence of Diabetes microvascular complications among the participants was found to be 56.78%, 25.3%, and 14.7% for neuropathy, retinopathy, and nephropathy, respectively. Univariate and bivariate analysis revealed a significant association between age and level of education with all three microvascular complications. Additionally, marital status showed an association with nephropathy and neuropathy, while Hb1Ac levels were associated with nephropathy ( Table 3 ).

As indicated in Table 2 , multiple regression analysis indicated a significant association between the sum scale scores of dietary activities, blood glucose testing, physical activity, foot care, and neuropathy at a 95% CI, with a p-value (p < 0.001). Furthermore, scores on the subscales for blood glucose testing and foot care activities were significantly correlated with retinopathy (p < 0.001). Additionally, significant correlations were identified between the presence of nephropathy and the subscales for dietary activities, foot care, and physical activity (p < 0.001), as detailed in ( Table 4 ).

Values are presented as number (%) and P value for associations.

SD, standard deviation; OR, odds ratio; CI, confidence interval. *p < 0.05.