Untangling the Role of Social Support in Type 2 Diabetes: Insights from a Mixed Methods Study in Quito, Ecuador

Marta Puig-García^1,2*Ana Henriques³Andrea Bravo-Díaz⁴María José Sanchís-Ramón²Mariana Amorim³Sergio Morales-Garzón²Jessica Pinto-Delgado⁴Elisa Chilet Rosell^1,2Lucy Anne Parker^1,2

• ¹Centro de Investigacion Biomedica en Red de Epidemiologia y Salud Publica, Madrid, Spain
• ²Department of Public Health, History of Science and Gynecology, Miguel Hernández University of Elche, Alicante, Spain
• ³Universidade do Porto Laboratorio Associado ara a Investigacao Integrativa e Translacional em Saude Populacional, Porto, Portugal
• ⁴Pontificia Universidad Catolica del Ecuador, Quito, Ecuador

Introduction: Type 2 diabetes (T2DM) requires sustained behavioral changes to achieve glycaemic control (GC) and prevent complications. Social support (SS) is key for self-care in chronic conditions, yet its impact on GC in low-resource settings remains understudied. This study explores the role of SS in T2DM management in a low-income community in Quito, Ecuador. Methods: We employed a mixed-methods approach with a parallel convergent design. A retrospective cohort study was conducted with 332 adults aged 25–88 years with T2DM, recruited from public health facilities in district D1706. Quantitative data were collected using structured questionnaires, including the Multidimensional Scale of Perceived Social Support (MSPSS); GC was assessed through clinical records. Logistic regression models were used to examine associations between SS and GC, reporting crude and adjusted odds ratios (ORs) with 95% confidence intervals. In parallel, 16 semi-structured interviews were conducted with adults with T2DM and analyzed thematically using framework analysis. Results: Of the 332 participants, 263 had at least one glucose measurement and 28.6% achieved good GC. Those with better control reported slightly higher SS. While the overall SS score was not strongly associated with GC, the subscale of family support showed a positive association (adjusted OR: 1.07; 95% CI: 1.00-1.14 per MSPSS point). Qualitative findings highlighted the importance of emotional and instrumental family support, the perceived loss of friendship-based support, and the supportive role of community-based diabetes clubs. This is a provisional file, not the final typeset article Discussion: The association between family support and glycaemic control highlights the need to incorporate family dynamics into T2DM management strategies. However, expanding support networks beyond the family, such as through peer and community-based resources, may further enhance coping capacity and overall well-being. Interventions that integrate emotional, instrumental, and informational support from diverse sources could play a critical role in improving self-management and optimizing health outcomes.