Predictors of diabetes self-management and glycemic control among patients with diabetes mellitus in conflict-affected Palestine

BACKGROUND: Poor glycemic control and inadequate self-management drive the global diabetes mellitus (DM) burden. In conflict-affected Palestine, structural barriers worsen outcomes, yet diabetes management self-efficacy (DMSE) remains understudied. AIM: To assess diabetes management self-efficacy and glycemic control, their interrelationship, and the independent predictors of each among patients with diabetes mellitus in conflict-affected Palestine. METHODS: A cross-sectional study was conducted among 418 adults with type 1 or type 2 DM attending governmental diabetes clinics in the Hebron governorate, West Bank, Palestine. Data were collected using the Arabic-validated Diabetes Management Self-Efficacy Scale (DMSES) and a structured clinical questionnaire. Non-parametric tests and two multiple linear regression models were applied to identify independent predictors, with HbA1c and DMSE scores specified as the two dependent variables. RESULTS: Glycated hemoglobin (HbA1c) was suboptimal (median = 7.50, IQR = 2.30), while DMSE was moderate (median = 3.45/5, IQR = 1.10). Blood glucose management was the strongest subdomain, whereas physical exercise was the weakest. Former smoking (β = 0.202, 95% CI: 0.430, 1.494, p < .001), lower physical activity frequency (β = 0.156, 95% CI: 0.098, 0.455, p = .003), and diabetes-related complications (β =-0.154, 95% CI: -1.132, - 0.210, p = .004) independently predicted higher HbA1c. Lower physical activity (β =-0.177, 95% CI: -0.208, - 0.060, p < .001), longer disease duration (β =-0.135, 95% CI: -0.177, - 0.021, p = .013), lower income (β = 0.163, 95% CI: 0.081, 0.348, p = .002), and lower education (β = 0.127, 95% CI: 0.018, 0.227, p = .022) independently predicted lower DMSE. CONCLUSION: Clinical, behavioral, and socioeconomic factors independently predicted glycemic control and self-efficacy. The DMSE-HbA1c disconnect indicates structural barriers impede self-management behavior. Integrating clinical education with economic and structural support is essential to improve diabetes outcomes in conflict-affected settings.