The elderly population in rural China is substantial, and health services are insufficient, leading to a lower level of self-management and a higher risk of mortality among patients with type 2 diabetes mellitus (T2DM). Improving diabetes knowledge can enhance self-efficacy, diabetes self-management (DSM), and quality of life (QoL). Therefore, diabetes knowledge and self-efficacy are pivotal for DSM and QoL of T2DM patients.

To elucidate the pathways through which diabetes knowledge and self-efficacy influence DSM and QoL among rural T2DM patients.

A cross-sectional study design was used to sample 2 193 rural T2DM patients from Binhai County, Jiangsu Province, in August 2022, employing randomized whole-cluster sampling. The Diabetes Patient Knowledge Scale (ADKnowl), the Self-Efficacy Scale for Chronic Diseases (SECD6), the Self-Management Behavioral Scale for Diabetic Patients (SDSCA), and the Diabetes Survival Quality Specificity Scale (DSQL) were utilized to assess the participants. A total of 2 010 (91.66%) valid questionnaires were obtained. A model was developed based on the Integrated Theory of Health Behavior Change (ITHBC), and multiple linear regression analyses were conducted to explore the impact of the ADKnowl and SECD6 scores on the SDSCA and DSQL scores.

The ADKnowl, SECD6, SDSCA, and DSQL scores of rural T2DM patients were (52.5±16.5), (6.4±1.2), (37.9±6.9) and (48.3±8.6). The results of multiple linear regression analysis showed that the direct effect of ADKnowl scores on SDSCA scores was 0.156 (P<0.05), the mediating effect of SECD6 scores in it was 0.012 (P<0.05), and the indirect effect accounted for 7.1% of the total effect; the direct effect of ADKnowl scores on DSQL scores was -0.048 (P<0.05), in which the indirect effects of SECD6 score and SDSCA score were -0.041 and -0.012 (P<0.05), accounting for 40.6% and 11.9% of the total effect, respectively. In addition, foot care (β=0.352) and diet (β=0.161) dimension scores in ADKnowl had a positive effect on SDSCA scores (P<0.05), and reducing the risk of complications (β=-0.213), exercise (β=-0.117), and diet (β=-0.197) dimension scores had a negative effect on DSQL scores (P<0.05). Symptom management self-efficacy (β=-0.115), and disease co-management self-efficacy (β=-0.397) dimension scores in SECD6 had a negative effect on DSQL scores (P<0.05) .

Diabetes knowledge improves the level of DSM and QoL in rural T2DM patients, with a positive mediating effect of self-efficacy and self-management. Additionally, the acquisition of diabetes-related knowledge, such as diet, exercise, and foot care, significantly improves the level of DSM and QoL of patients. It is recommended that multisectoral collaboration, long-term health education, and social support resources be provided to enhance healthcare professionals' attention to the knowledge and self-efficacy of diabetic patients, effectively improving DSM and QoL of rural T2DM patients.

由于老年人口多、卫生服务不足，中国农村2型糖尿病患者的自我管理水平较低，死亡风险更高。提高糖尿病知识掌握度有助于帮助患者提升自我效能，增强自我管理，提高生活质量。因此，糖尿病知识掌握情况和自我效能对患者的自我管理和生存质量至关重要。

了解糖尿病知识、自我效能对农村2型糖尿病患者自我管理和生存质量的影响路径。

采用横断面设计，于2022年8月采用随机整群抽样法在江苏省滨海县抽取农村2型糖尿病患者2 193例。采用糖尿病患者知识量表（ADKnowl）、慢性病自我效能量表（SECD6）、糖尿病患者自我管理行为量表（SDSCA）、糖尿病生存质量特异性量表（DSQL）对纳入患者进行调查，最终回收有效问卷2 010份（91.66%）。基于健康行为改变综合理论（ITHBC）构建模型，采用多元线性回归分析探讨ADKnowl、SECD6得分对SDSCA、DSQL得分的影响路径。

农村2型糖尿病患者的ADKnowl、SECD6、SDSCA、DSQL得分分别为（52.5±16.5）、（6.4±1.2）、（37.9±6.9）、（48.3±8.6）分。多元线性回归分析结果显示：ADKnowl得分对SDSCA得分的直接效应为0.156（P<0.05），SECD6得分在其中的中介效应为0.012（P<0.05），间接效应占总效应的7.1%；ADKnowl得分对DSQL得分的直接效应为-0.048（P<0.05），SECD6得分和SDSCA得分在其中的间接效应分别为-0.041和-0.012（P<0.05），分别占总效应的40.6%和11.9%。此外，ADKnowl中足部护理（β=0.352）和饮食（β=0.161）维度得分对SDSCA得分有正向影响（P<0.05），减少并发症的危险（β=-0.213）、运动（β=-0.117）、饮食（β=-0.197）维度得分对DSQL得分有负向影响（P<0.05）；SECD6中症状管理自我效能（β=-0.115）、疾病共性管理自我效能（β=-0.397）维度得分对DSQL得分有负向影响（P<0.05）。

糖尿病知识可以改善农村2型糖尿病患者的自我管理和生存质量水平，且自我效能和自我管理存在积极的中介效应。此外，饮食、锻炼、足部护理等糖尿病相关知识的获取可明显改善患者的自我管理和生存质量水平。建议多部门协同，长期开展相关方面的健康教育并提供社会支持资源，增强医护人员对糖尿病患者知识水平和自我效能的重视，切实提高农村糖尿病患者的自我管理行为和生存质量水平。