BACKGROUND: Although clinical guideline of gestational diabetes mellitus (GDM) is well-defined, still influence of the household environment and caregiver support on patient's adherence to self-management remains under-explored. OBJECTIVE: This study aimed to identify the patient, household, and caregiver-level determinants of GDM self-management in Dhaka, Bangladesh. METHODS: This cross-sectional study was conducted among 251 dyads of GDM patients including their caregivers across four tertiary hospitals in Dhaka. Diabetes self-management (DSM) was evaluated using the validated Diabetes Self-Management Questionnaire (DSMQ) (Cronbach's alpha = 0.74), supplemented by a pretested, semi-structured instrument assessing caregiver knowledge and support. Predictors of suboptimal DSM were identified using multivariable logistic regression with backward elimination in STATA. Model discrimination was validated using the area under the receiver operating characteristic curve (AUC-ROC). RESULTS: Suboptimal DSM was observed in 68.5% of participants. Domain-specific analysis revealed critical gaps in glycemic monitoring (82.5%), dietary control (75.7%), and physical activity (73.3%), while healthcare utilization (56.2%) showed higher adherence. Multivariable modeling demonstrated that household architecture was a dominant predictor; living in nuclear or extended families significantly increased the odds of suboptimal DSM compared to living alone. Further determinants included clinical complexity (comorbidities, family history) and reproductive history (parity ≥2). Notably, caregiver-level factors, specifically poor knowledge and inadequate support (prevalent in >50% of caregivers), were robustly associated with deficient glycemic monitoring and healthcare utilization (AUC = 0.78). CONCLUSION: The findings suggest that the household unit, rather than the individual patient, is the functional unit of GDM care. Transitioning toward family-centered therapeutic models is essential to improve maternal and neonatal outcomes in GDM cases.
Banu et al. (Mon,) studied this question.
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