Self-regulation in blood glucose management among middle-aged and older adults with type 2 diabetes in a rural and semi-rural setting: A qualitative study

Type 2 diabetes mellitus (T2DM) is a chronic metabolic disease with increasing prevalence, particularly among middle-aged and older adults. Effective blood glucose management is essential for preventing complications and improving quality of life. Although self-regulation has been widely examined in diabetes management, little is known about how middle-aged and older adults living in rural and semi-rural settings apply self-regulation strategies in daily life. This qualitative study explored the blood glucose management experiences of individuals aged 50 years and older with T2DM using Zimmerman’s cyclical self-regulated learning model. Face-to-face interviews were conducted with 16 hospitalized participants meeting the rural or semi-rural residence criterion. Data were analyzed using an inductive-deductive hybrid thematic approach and organized with MAXQDA 20. Three main themes and 13 subthemes were identified: preparation and awareness, barriers and management behaviors, and self-evaluation and internal awareness. During the forethought phase, participants described knowledge, motivation, awareness, and planning but also reported misconceptions about diet and blood glucose management. In the performance phase, behavioral, emotional, cognitive, and social barriers, comorbidities, and poor adherence to dietary recommendations were common. During self-reflection, participants recognized physical symptoms and emotional influences but rarely reported systematically evaluating outcomes or modifying subsequent management behaviors. The findings indicate that inadequate knowledge, emotional challenges, comorbidities, limited social support, and ineffective coping strategies may disrupt the cyclical self-regulation process. Educational interventions for middle-aged and older adults in rural and semi-rural settings should strengthen knowledge, support self-management behaviors, and promote evaluation of outcomes and adaptation of future actions.