A study of 893 individuals found that those with type 2 diabetes (T2D) had significantly lower growth mindsets toward blood glucose control and lower self-efficacy toward general health, blood glucose, and cholesterol compared to those without T2D. Among those with T2D, lower growth mindsets and self-efficacy were associated with higher HbA1c.
A cross-sectional study in Oman (n = 225) found a mean self-efficacy score of only 29.99 out of 60 (below the midpoint cutoff of 30), indicating that roughly half of people with type 2 had low confidence in managing their disease, and this was associated with a mean HbA1c of 8.23%.
Self-efficacy refers to an individual’s belief in their own capability to execute the behaviors necessary to produce specific outcomes or to manage prospective situations.
Self-efficacy is critical to those with diabetes in order for self-management behaviors to be adopted in the areas of medications, nutrition, physical activity, blood glucose monitoring, healthy coping, reducing risks and problem solving.
What are some barriers that promote low self-efficacy with those who have diabetes?
- Psychological and Emotional Barriers
- Knowledge and Skill Deficits
- Structural and Socioeconomic Barriers (SDOH)
- Disease-Related Factors
There are many barriers and complexities that hinder increasing self-efficacy. We may feel at times as healthcare professionals that we are trying to move several boulder(s) up several mountains. Don’t despair, there is help and hope along the way!
Increasing Self-Efficacy with those who have diabetes:
When providing diabetes self-management education and support (DSMES), health care professionals need to consider a person’s level of self-efficacy for self-care behaviors, alongside treatment burden and social/family support. The ADA Standards of Care 2026 recommend several evidence-based behavioral strategies to build self-efficacy:
Strategies to Build Self-Efficacy within DSMES
- Motivational interviewing
- Collaborative goal setting and action planning
- Problem-solving skills training
- Self-monitoring of health behaviors
- Facilitating social support opportunities
- Cognitive behavioral techniques to reframe negative thoughts, SMART goal setting, and “importance” and “confidence” rulers can also help.
The ADA Standards of Care (2026) recommend routine psychosocial screening and referral to behavioral health professionals as part of comprehensive diabetes care, with particular attention to diabetes distress, depression, social support, and social determinants of health.
Our call to action is to assess self-efficacy to those we serve who have diabetes.
Partnering with them to empower, equip and increase their self-efficacy in the areas they are ready and needing it the most. As health care professionals we make a difference in what we say, do and how we connect in their journey with diabetes.
- Encourage the small wins which are stackable, and affirm those with diabetes to keep making progress.
- Help them recognize the positive self-management behaviors they are doing, and not minimize it.
- Encourage them to reflect on what is working, and continue to reach out to their support team.
- As health care professions keep providing support, and partner with them through their barriers and challenges.
- Be their biggest cheerleader, “You can do this and you are doing it!”
Remind them that the key to diabetes self-management is about progress not perfection! They are empowered to bring about the changes they want to see both now and in the future.
References:
- Lo CJ, Lee L, Yu W, Tai ES, Yew TW, Ding IL. Mindsets and self-efficacy beliefs among individuals with type 2 diabetes. Sci Rep. 2023 Nov 21;13(1):20383. doi: 10.1038/s41598-023-47617-4. PMID: 37990071; PMCID: PMC10663547. https://pubmed.ncbi.nlm.nih.gov/37990071/
- AlShezawi IA, Rawwad THA, Aldirawi AA, Alwawi AA, Fazari HSA, Shah AH. Exploring the impact of self-efficacy on glycemic control in Omani type 2 diabetes patients. Front Endocrinol (Lausanne). 2025 Jul 25;16:1597274. doi: 10.3389/fendo.2025.1597274. PMID: 40786180; PMCID: PMC12331482. https://pubmed.ncbi.nlm.nih.gov/40786180/
- Young-Hyman D, de Groot M, Hill-Briggs F, Gonzalez JS, Hood K, Peyrot M. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care. 2016 Dec;39(12):2126-2140. doi: 10.2337/dc16-2053. Erratum in: Diabetes Care. 2017 Feb;40(2):287. doi: 10.2337/dc17-er02. Erratum in: Diabetes Care. 2017 May;40(5):726. doi: 10.2337/dc17-er05. PMID: 27879358; PMCID: PMC5127231. https://pmc.ncbi.nlm.nih.gov/articles/PMC5127231/
- American Diabetes Association Professional Practice Committee for Diabetes*. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2026. Diabetes Care. 2026 Jan 1;49(Supplement_1):S89-S131. doi: 10.2337/dc26-S005. PMID: 41358898; PMCID: PMC12690188. https://pmc.ncbi.nlm.nih.gov/articles/PMC12690188/
Join Lilly Mees, LMSW, CDCES on July 23rd for our
Level 5 | A Foundation for Diabetes Self-Management Education and Support (DSMES) Webinar | 1.5 CEs
Set the stage for effective diabetes education and master the foundational principles that drive real outcomes for people with diabetes.
Diabetes self-management education and support (DSMES) is essential for helping people with diabetes build knowledge and become empowered to manage their condition. Delivering the right content matters, and so does HOW that education is delivered. This course explores the behavioral strategies that support person-centered DSMES, helping you connect more effectively with the people you serve.
Course Topics:
Emphasis is on HOW Diabetes Education is delivered to the person with diabetes
- Reflective listening to confirm understanding by restating
- Body language and creating a safe space
- Using strength perspective language
- Inspiring Hope with Truth
- Partnering Together
- Addressing SDOH, language, and learning barriers
