Association between educational attainment and diabetes self-management, glycemic control, and health outcomes among older Nigerian adults with type 2 diabetes.
Abstract
BACKGROUND/
Objective
This study investigated how educational disparities affect self-management practices, glycemic control, and diabetes-related health outcomes among older adults living with type 2 diabetes in Nigeria. Findings were interpreted to identify implications for geriatric nursing practice, education, research, and policy in low-resource settings.
Methods
A multicenter, cross-sectional study was conducted from April 2023 to May 2025 across 30 communities in Nigeria's six geopolitical zones. A stratified cluster sampling technique was employed, enrolling 896 participants aged ≥60 years with confirmed type 2 diabetes. Data were collected using the validated Type 2 Diabetes Assessment Questionnaire (T2DAQ) through domiciliary and clinic-based interviews. Statistical analyses included descriptive summaries, chi-square tests, and logistic regression, with significance set at p ≤ 0.05.
Results
Of the 896 participants, 65.3% had lower education. Higher education was significantly associated with better diabetes knowledge, medication adherence (42.6%vs. 22.8%; p = 0.034), dietary compliance (38.1%vs. 33.3%; p = 0.011), and glycemic control (p = 0.024). Urban residency (OR = 2.0), absence of comorbidities (OR = 0.63), and alcohol use (OR = 1.72) predicted higher education, while tobacco use and rural residence were negatively associated.
Conclusions
Educational attainment significantly influences diabetes self-management and outcomes among older Nigerian adults. Geriatric nursing should incorporate health literacy screening and simplified, culturally tailored education. Nurse training curricula must emphasize adaptive strategies for low-literacy patients. Policy reforms should embed structured Diabetes Self-Management Education (DSME) into primary care. Future research should evaluate longitudinal impacts of education-sensitive interventions to promote equitable chronic disease care in aging populations.