Document Type : Original Article


1 Department of Epidemiology and Biostatistics, Faculty of Health, Neurology and Neurosciences Research Center, Qom University of Medical Sciences, Qom

2 Department of Health Education and Promotion, School of Health, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran


BACKGROUND: Social support is one of the most effective factors on the diabetic self‑care. This
study aimed to assess social support and its relationship to self‑care in type 2 diabetic patients in
Qom, Iran.
STUDY DESIGN: A cross‑sectional study was conducted on 325 diabetics attending the Diabetes
Mellitus Association.
METHODS: Patients who meet inclusion and exclusion criteria were selected using random sampling
method. Data were collected by the Summary of Diabetes Self‑Care Activities and Multidimensional
Scale of Perceived Social Support, with hemoglobin A1
C test. Data were analyzed using descriptive
statistics and independent t‑test, analysis of variance, Pearson correlation, and linear regression
test, using 0.05 as the critical significance level, provided by SPSS software.
RESULTS: The mean and standard deviation of self‑care and social support scores were
4.31 ± 2.7 and 50.32 ± 11.09, respectively. The mean level of glycosylated hemoglobin (HbA1
C) of
patients was 7.54. There was a significant difference between mean score of self‑care behaviors
and social support according to gender and marital status (P < 0.05). The regression analysis
showed that disease duration was the only variable which had a significant effect on the level
of HbA1
C (P < 0.001). Pearson correlation coefficient indicated that self‑care and social support
significantly correlated (r = 0.489, P > 0.001) and also predictive power of social support was 0.28.
Self‑care was significantly better in diabetics with HbA1
C ≤7%. Patients who had higher HbA1
C felt
less, but not significant, social support.
CONCLUSIONS: This study indicated the relationship between social support and self‑care behaviors
in type 2 diabetic patients. Interventions that focus on improving the social support and self‑care of
diabetic control may be more effective in improving glycemic control.


1. Al‑Khawaldeh OA, Al‑Hassan MA, Froelicher ES. Self‑efficacy,
self‑management, and glycemic control in adults with type 2
diabetes mellitus. J Diabetes Complications 2012;26:10‑6.
2. Schoenberg NE, Traywick LS, Jacobs‑Lawson J, Kart CS. Diabetes
self‑care among a multiethnic sample of older adults. J Cross Cult
Gerontol 2008;23:361‑76.
3. Shirinzadeh M, Shakerhosseini R. Nutritional value assessment
and adequacy of dietary intake in type 2 diabetic patients. IJEM
4. Helduser JW, Bolin JN, Vuong AM, Moudouni DM, Begaye DS,
Huber JC Jr., et al. Factors associated with successful completion
of the chronic disease self‑management program by adults with
type 2 diabetes. Fam Community Health 2013;36:147‑57.
5. Hunt KJ, Gebregziabher M, Lynch CP, Echols C, Mauldin PD,
Egede LE, et al. Impact of diabetes control on mortality by race
in a national cohort of veterans. Ann Epidemiol 2013;23:74‑9.
6. Jordan DN, Jordan JL. Self‑care behaviors of Filipino‑American
adults with type 2 diabetes mellitus. J Diabetes Complications
7. Povey RC, Clark‑Carter D. Diabetes and healthy eating:
Asystematic review of the literature. Diabetes Educ 2007;33:931‑59.
8. Asche C, LaFleur J, Conner C. A review of diabetes treatment
adherence and the association with clinical and economic
outcomes. Clin Ther 2011;33:74‑109.
9. Beard E, Clark M, Hurel S, Cooke D. Do people with diabetes
understand their clinical marker of long‑term glycemic
control (HbA1c levels) and does this predict diabetes self‑care
behaviours and hbA1c? Patient Educ Couns 2010;80:227‑32.
10. Vosoghi Karkazloo N, Abootalebi Daryasari G, Farahani B,
Mohammadnezhad E, Sajjadi A. The study of self‑care agency
in patients with diabetes (Ardabil). Mod Care 2012;8:197‑204.
11. Mohebi S, Azadbakht L, FeiziA, Sharifirad G, KargarM. Structural
role of perceived benefits and barriers to self‑care in patients with
diabetes. J Educ Health Promot 2013;2:37.
12. Mohebi S, Azadbakht L, Feizi A, Sharifirad G, Kargar M. Review
the key role of self‑efficacy in diabetes care. J Educ Health Promot
13. Tang TS, FunnellMM, BrownMB, KurlanderJE. Self‑management
support in “real‑world” settings: An empowerment‑based
intervention. Patient Educ Couns 2010;79:178‑84.
14. Tang TS, Brown MB, Funnell MM, Anderson RM. Social support,
quality of life, and self‑care behaviors among African Americans
with type 2 diabetes. Diabetes Educ 2008;34:266‑76.
15. Stopford R, Winkley K, Ismail K. Social support and glycemic
control in type 2 diabetes: A systematic review of observational
studies. Patient Educ Couns 2013;93:549‑58.
16. Rad GS, Bakht LA, Feizi A, Mohebi S. Importance of social support
in diabetes care. J Educ Health Promot 2013;2:62.17. Keogh KM, Smith SM, White P, McGilloway S, Kelly A, Gibney J,
et al. Psychological family intervention for poorly controlled type 2
diabetes. Am J Manag Care 2011;17:105‑13.
18. Tol A, Baghbanian A, Rahimi A, Shojaeizadeh D, Mohebbi B,
Majlessi F. The Relationship between perceived social support
from family and diabetes control among patients with diabetes
type 1 and type 2. J Diabetes Metab Disord 2011;10:21‑8.
19. Hatakeyama I, Maruko T, Ida Y, Tsuruoka A, Maehata E.
Fundamental and clinical evaluation for glycosylated hemoglobin
measurement kit “Determiner HbA 1C” using latex aggregation
immunoassay. Igaku Yakugaku 1999;41:1181‑6.
20. Toobert DJ, Hampson SE, Glasgow RE. The summary of diabetes
self‑care activities measure: Results from 7 studies and a revised
scale. Diab Care 2000;23:943‑50.
21. Pourisharif H, BabapourJ, Zamani R, Besharat MA, Mehryar AH,
Rajab A. The effectiveness of motivational interviewing in
improving health outcomes in adults with type 2 diabetes.
Procedia Soc Behav Sci 2010;5:1580‑4.
22. Zimet GD, Dahlem NW, Zimet SG, Farley GK. The
multidimensional scale of perceived social support. J Pers Assess
23. Besharat M. Psychometric Properties and Factor Structure of the
Multidimensional Scale Perceived Social Support. Unpublished
Research Report Tehran University; 2003.
24. Meunier J, Dorchy H, Luminet O. Does family cohesiveness and
parental alexithymia predict glycaemic control in children and
adolescents with diabetes? Diab Metab 2008;34:473‑81.
25. Matsuzawa T, Sakurai T, Kuranaga M, Endo H, Yokono K.
Predictive factors for hospitalized and institutionalized
care‑giving of the aged patients with diabetes mellitus in Japan.
Kobe J Med Sci 2011;56:173‑83.
26. Baquedano IR, dos Santos MA, Teixeira CR, Martins TA,
Zanetti ML. Factors related to self‑care in diabetes mellitus
patients attended at Emergency Service in Mexico. Rev Esc Enferm
USP 2010;44:1017‑23.
27. Gao J, Wang J, Zheng P, Haardörfer R, Kegler MC, Zhu Y, et al.
Effects of self‑care, self‑efficacy, social support on glycemic control
in adults with type 2 diabetes. BMC Fam Pract 2013;14:66.
28. Noroozi A, Tahmasebi R, Rekabpour SJ. Effective social
support resources in self‑management of diabetic patients in
Bushehr (2011‑12). ISMJ 2013;16:250‑9.
29. Parham M, Rasooli A, Safaeipuor R, Mohebi S. Assessment of
effects of self‑caring on diabetics patients Qom diabites association
2013. J Sabzevar Univ Med Sci 2014;21:473‑84.
30. Mohebi S, Azadbakht L, Feyzi A, Sharifirad G, Hozuri M,
Sherbafchi M. Relationship of perceived social support with
receiving macronutrients in women with metabolic syndrome;
A cross sectional study using path analysis study. 2013;15:121‑31.
31. Shaw BA, Gallant MP, Riley‑Jacome M, Spokane LS. Assessing
sources of support for diabetes self‑care in urban and rural
underserved communities. J Community Health 2006;31:393‑412.
32. Saedinejat S, Chahipour M, Esmaeily HV, Ghonche H,
Fathalizadeh S, Omidbakhsh R. Role of family support in self
care of Type II diabetic patients. IJEM 2014;16:95‑102.
33. Bohanny W, Wu SF, Liu CY, Yeh SH, Tsay SL, Wang TJ,
et al. Health literacy, self‑efficacy, and self‑care behaviors in
patients with type 2 diabetes mellitus. J Am Assoc Nurse Pract
34. Wong M, Gucciardi E, Li L, Grace SL. Gender and nutrition
management in type 2 diabetes. Can J Diet Pract Res 2005;66:215‑20.
35. Mohebi S AL, Feyzi A, Hozoori M, Sharifirad G. Effect of social
support from husband on the control of risk factors for metabolic
syndrome. IJEM 2014;16:11‑9.
36. Skinner TC, John M, Hampson SE. Social support and personal
models of diabetes as predictors of self‑care and well‑being:
A longitudinal study of adolescents with diabetes. J Pediatr
Psychol 2000;25:257‑67.
37. Mayberry LS, Osborn CY. Family support, medication adherence,
and glycemic control among adults with type 2 diabetes. Diab
Care 2012;35:1239‑45.
38. Nouhjah S. Self‑care behaviors and related factors in women with
type 2 diabetes. Iran J Endocrinol Metabol 2015;16:393‑401.
39. Adwan MA, Najjar YW. The relationship between demographic
variables and diabetes self‑management in diabetic patients in
Amman city/Jordan. Glob J Health Sci 2013;5:213‑20.
40. Liang CC, Tsan KW, Ma SM, Chow SF, Wu CC. The relationship
between fasting glucose and HbA1c among customers of health
examination services. Formos J Endocrin Metab 2010;1:1‑5.
41. Hunt CW, Wilder B, Steele MM, Grant JS, Pryor ER, Moneyham L.
Relationships among self‑efficacy, social support, social problem
solving, and self‑management in a rural sample living with type 2
diabetes mellitus. Research and theory for nursing practice.
42. Dehghan H, Charkazi A, Kouchaki GM, Zadeh BP, Dehghan BA,
Matlabi M, et al. General self‑efficacy and diabetes management
self‑efficacy of diabetic patients referred to diabetes clinic of Aq
Qala, North of Iran. J Diab Metab Disord 2017;16:8.
43. Epple C, Wright AL, Joish VN, Bauer M. The role of active family
nutritional support in navajos’ type 2 diabetes metabolic control.
Diab Care 2003;26:2829‑34.
44. Rajati F, Mostafavi F, Sharifirad G, Sadeghi M, Tavakol K, Feizi A,
et al. A theory‑based exercise intervention in patients with heart
failure: A protocol for randomized, controlled trial. J Res Med Sci
45. Hasandokht T, Farajzadegan Z, Siadat ZD, Paknahad Z, Rajati F.
Lifestyle interventions for hypertension treatment among Iranian
women in primary health‑care settings: Results of a randomized
controlled trial. Journal of research in medical sciences: the official
journal of Isfahan University of Medical Sciences. 2015;20(1):54‑61.
46. van Dam HA, van der Horst FG, Knoops L, Ryckman RM,
Crebolder HF, van den Borne BH. Social support in diabetes:
a systematic review of controlled intervention studies. Patient
education and counseling. 2005;59(1):1‑12.