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This study aimed to assess self-care behaviors among Nigerian T2DM patients receiving specialized endocrinology care and to identify the socio-demographic and clinical factors influencing these behaviors. We examined five key behavioral dimensions: diet, physical activity, blood glucose monitoring, foot care, and medication adherence, and investigated their relationships with glycemic control. Our findings provide important insights into the patterns of self-care behaviors and their determinants in this population, with significant implications for clinical practice and health policy in Nigeria and similar settings. These insights should be interpreted in context. Our participants were patients actively engaged with specialized endocrinology services, who may differ from the broader T2DM population in access, education, and engagement.

The most satisfactory behaviors observed were foot examination and medication adherence, with 82.44% of participants reporting that they inspect their feet and 62.60% stating that they strictly adhere to their medications. These findings are similar to those reported in other studies [19, 20]. The high foot care adherence may be partially attributed to cultural and religious practices, as 97.33% of participants identified as Muslim and 71.37% were of Hausa ethnicity, where regular foot washing is a religious practice. However, 73.28% and 70.61% did not perform self-monitoring of blood glucose in accordance with the recommendations of their healthcare providers over the past seven days and adhered to the recommended frequency as advised by their healthcare providers. Thus, the participants demonstrated suboptimal glycemic control. This is analogous to a prior study that similarly observed unsatisfactory and poor glycemic control among their study participants, which they reported to be potentially associated with noncompliance with self-care behaviors [21]. In alignment with our study findings and those of previous research, these investigations also demonstrated that the majority of participants in the study reported inadequate adherence to diabetic self-care practices, occurring less than four days a week [22]. Noncompliance with self-care is presumed to cause suboptimal health outcomes, diabetic complications, death, or, subsequently, increased healthcare costs [23].

Our regression analysis confirmed significant associations between certain self-care behaviors and glycemic control. Dietary habits (OR 0.72, P < 0.001), physical activity (OR 0.74, P < 0.001), and blood glucose monitoring (OR 0.22, P = 0.001) were significantly associated with improved glucose control, aligning with established literature on diabetes management [24, 25]. Specifically, dietary practices significantly influenced glycemic control, reinforcing the importance of nutritional counseling that addresses cultural dietary patterns in Nigerian populations [26,27,28]. Similarly, physical activity improves insulin sensitivity and helps lower blood glucose levels [29], while regular glucose monitoring enables timely treatment adjustments [30], forming a foundation for effective diabetes management.

Several sociodemographic and clinical factors influenced specific self-care behaviors. Male gender was associated with poorer dietary management (β = − 0.19, P < 0.01), lower foot care (β = − 0.13, P < 0.05), and reduced medication adherence (β = − 0.17, P < 0.01), but better exercise practices (β = 0.23, P < 0.001). This gender disparity suggests the need for tailored interventions addressing male-specific barriers to adherence [31, 32]. Age also emerged as a significant factor, with adults over 60 showing poorer dietary management (β = − 0.19, P < 0.05), potentially due to financial constraints or declining health [33].

Notably, Igbo participants showed distinct self-care patterns compared to the predominantly Hausa sample, including poorer dietary management (β = − 0.13, P < 0.05), lower blood glucose testing (β = − 0.16, P < 0.01), poorer foot care (β = − 0.49, P < 0.001), and reduced medication adherence (β = − 0.43, P < 0.001), but better exercise practices (β = 0.19, P < 0.01). These variations may reflect cultural, social, or structural factors and highlight the need for further investigation into how ethnicity influences diabetes care [34].

Marital status influenced self-care behaviors, with single individuals demonstrating better dietary management (β = 0.15, P < 0.05) and higher exercise adherence (β = 0.27, P < 0.001), but poorer blood glucose monitoring (β = − 0.18, P < 0.01). This may reflect greater flexibility in meal planning and physical activity for single individuals but potential challenges in maintaining consistent monitoring routines [35, 36].

Our findings revealed a complex relationship between diabetes duration and self-care behaviors. Patients with longer disease duration (> 20 years) demonstrated better medication adherence (β = 0.15, P < 0.05) and exercise practices (β = 0.13, P < 0.01), suggesting that long-term experience with the disease may foster better understanding of treatment importance and develop routines that support these aspects of self-management [37, 38]. However, the same group showed poorer foot care practices (β = − 0.19, P < 0.001), while those with 11–20 years duration exhibited poorer dietary management (β = − 0.21, P < 0.001). This indicates that duration-related self-care patterns are not uniform across all behavioral dimensions. The improved medication adherence among long-term patients aligns with previous research suggesting that extended experience with diabetes management can lead to better integration of medication routines into daily life [39]. Conversely, the decline in certain self-care practices with extended duration might reflect diabetes burnout, where the psychological burden of long-term disease management leads to reduced adherence in more demanding behavioral domains [40]. Diabetes burnout has been increasingly recognized as a critical psychological barrier to sustained self-management, associated with emotional exhaustion, detachment from care routines, and increased risk of complications [41]. Addressing burnout through ongoing mental health support and routine screening may be essential for preserving long-term adherence and quality of life in individuals with chronic diabetes. These findings highlight the need for targeted refresher education and psychological support for long-term diabetes patients, focusing on maintaining comprehensive self-care practices beyond medication adherence.

It is important to interpret these findings within the context of our study population, which comprised patients actively receiving care from specialized endocrinology clinics. The relatively high self-reported medication adherence (mean score = 3.58) suggests generally good adherence behavior in this clinically engaged group. However, medication adherence was not significantly associated with glycemic control in our regression analysis (P = 0.095), indicating that its direct impact on blood glucose levels could not be established. This may reflect selection bias: regular clinic attendees are typically more health-conscious, better educated, and more motivated to engage in self-care. Such characteristics may partly explain the favorable adherence patterns observed in this sample. Moreover, the predominance of Hausa ethnicity (71.37%) limits the generalizability of our findings to Nigeria’s broader and more ethnically diverse population.

For practice and policy implications, our findings suggest several important directions that may be organized into patient-level and system-level interventions. Patient-level interventions include culturally-sensitive educational programs targeting specific demographic groups, psychological support to address long-term disease fatigue, especially among patients with extended diabetes duration. Strengthening community-based support systems can also help promote daily self-care behaviors. On the system level, efforts should focus on subsidizing glucose monitoring supplies to reduce financial barriers, particularly for older adults and individuals from lower socioeconomic backgrounds, expanding access to specialized endocrinology services for underserved populations, and strengthening healthcare provider training in culturally competent communication to address beliefs and practices that influence self-care behaviors.

This study provides valuable insights into self-care behaviors among individuals with type 2 diabetes mellitus in Nigeria; however, it has several limitations. First, as the study was conducted in two specialized endocrinology clinics in a single urban area of Zamfara State, the findings may not be generalizable to the wider population of T2DM patients across Nigeria, particularly those in rural or underserved areas with limited access to specialized care. Second, the cross-sectional design limits causal inference between self-care practices and glycemic control. Third, by focusing on patients who were actively attending specialized clinics, the study population likely reflects individuals with relatively better health literacy, medication access, and care engagement, thus the findings may not reflect the realities of patients lacking regular access to healthcare. Future research should use community-based and longitudinal approaches to explore structural determinants and enhance representativeness across diverse settings.