today , the process of diseases and mortality has been transformed in the world and communicable diseases have been replaced with and non - communicable diseases . mortality resulted from these diseases exceeds in asian countries up to 2 - 5 times more than other diseases . estimations of world health organization ( who ) indicate this will increase in 2025 to about 333 million people . studies in iran show that approximately 7.7% or 2 million adults age between 25 - 64 years will suffer from diabetes . doubtless by increasing life expectancy in iran , diabetes side effects prevalence increases as well . this and increase of diabetes incidence has changed it to one of main country 's health worries within next decades . an important fact for health care providers to keep in mind is that the non pharmacological treatment strategies are equally , if not more , important than the pharmacological treatment options available . diabetes self - management education ( dsme ) is the cornerstone in the treatment of diabetes . knowledge is power , and the more patients know about diabetes and how they can self - manage or control their disease , the better their chances are of minimizing and preventing complications . the ultimate goal of dsme is to empower the patient to be the responsible party in the management of the disease . although , self - care practices of individuals are influenced by a complex interaction of biological and psychosocial factors , dietary intake , medication use , physical activity and self monitoring of blood glucose ( smbg ) are the four main cornerstones of overall diabetes management . it has been claimed that as much as 98% of diabetes care is self - care . self - care in diabetes falls mostly on the patients and their families ( anderson 1995 , jacobson 1996 ) . it is essential that the individuals with diabetes adhere to self - care , to prevent the complications associated with diabetes ( such as retinopathy , nephropathy , neuropathy and cardiovascular disease ) ( dcct 1993 ) , to maintain or achieve a good quality of life and , moreover , to achieve subjective well - being and a sense of control over diabetes . self - care activities may seem to be more troubling and often involves basic changes in life style in a way that in spite of side effect of disease , many patients partially ignore physicians and consequently diabetes side effects increase . however , heisler , rubbin and mahmoudi indicate that positive effect of self - care on glucose and hba1c control . parchman showed that diabetic patients having continuous self - care , had lower alc hemoglobin . walston ka , kitis and schiling results indicate that low glucose in self - care persons are more appropriate . however , different findings show that self - care condition in diabetic patients is inappropriate . active participation and taking responsibility is the main principle in self - care to control the impact of illness . although , in general self - care behaviors do not lead to suitable metabolic control , and ignorance causes weakness in patient 's metabolic condition . a few of several factors influence on self - care behaviors whether directly or indirectly that involve biological , psychological , economic , socio - cultural and medical care systems of the community . some studies also have measured the role of demographical factor such as age on self - care . and some others have assessed socio - economic factors like low education level , low income social factors like low personal and family quality in diabetes self - management and self - care . however , knowledge and attitude role has been assessed in self - care behaviors , other personal factors seem to be necessary . some scholars believe that knowledge increase in diabetes patients alone can not be sufficient enough in initiation and self - care behaviors and assured they are long lasting . in other words , knowledge , attitude and performance hold no direct and simple relationship in relation to self - care . today , evidences show that one of effective factors in self - care of chronic patients , especially diabetes , is self - efficacy . self - efficacy is the pre - requisite of this behavior , since acts as the independent part of basic personal skills . of course , it can be said that self - efficacy role in initiation and maintenance of medical behaviors have been confirmed by several investigations in other subjects . people 's judgment of their capabilities to organize and execute courses of action required to attain designed types of performance and expect the outcomes . it is a pre - requisite of behavior , since is considered as an independent part of basic personal skills . self - efficacy is an important concept derived from social cognitive theory that refers to people 's beliefs and judgments on for executing the duties and responsibilities . the theorists believe that humans possess a self - management system through which control their own thoughts , emotion and behaviors and thus significantly determine their own destiny . therefore , this study attempts to explain the self - efficacy role in self - care of diabetes patients . it is a type of review study that data were collected through data bases and search pubmed proquest scopus engine such as elsevier and key words of self - efficacy , diabetes , and self - care and cross - sectional , cohort , clinical trial and systematic review of related articles . persin language articles were selected by use of data bases such as medlib and iranmedex . the time span for articles was from 1990 to late 2011 . the findings of previous studies show that self - efficacy in diabetes patients is unsuitable . keshavarzi showed that target group had no appropriate self - efficacy to receive healthy nutrition . some studies like charron prochonwink though showed that self - efficacy of young girls is in reasonable level . investigated diabetes diets behaviors found a positive meaningful correlation between self - efficacy and food self - care behaviors . bernal , wen and kavanagh also indicate that self - efficacy directly relate to self - care . in the regression analysis some variables in aalto 's study self - efficacy had highest relationship with glucose self - care . in another study , aljasem studied about the obstacles and self - efficacy of self - care behaviors in diabetes type 2 , 4 - 10% of self - care variance is explained by self - efficacy . bernal investigated about the correlation of self - efficacy in diabetes self - care of spanish adults . the result shows that self - efficacy had a relationship with self - care in food and insulin use . wen investigated about the family support , diet and physical exercises among mexican - american people suffering from diabetes type 2 , he found that increase in self - efficacy lead to more healthier diet . stuifbergen , et al . also found that increase of self - efficacy related to the hygienic behaviors cause the improvement and development of these behaviors . krichbaum and norris indicated that self - efficacy had a significantly positive impact on hygienic behaviors of diabetes patients . in a study , bonds , et al . reached a significantly direct relationship between personal self - efficacy and self - care . walker and woon 's study also indicate the predictive role of self - efficacy on nutrition behaviors based on regression analysis . tan showed a principally direct relationship between self - efficacy and predictive behaviors in chinese type 2 diabetic people . few domestic studies have also shown similar results . according to morovati study , self - efficacy , intensity and perceived sensitivity it is a strong effect and predicts 38 % of self - efficacy behaviors variance . hossien nejad study indicate that a considerable relationship exist between nutrition behaviors mean score and self - efficacy based on bivariable regression . in his study , mazloumi found a strong correlation between self - efficacy and predictive behaviors form diabetes type 2 . shakiba zadeh indicate that self - efficacy directly relates to self - care and 51% of self - care changes explained by self - efficacy and obstacles . unlike previous studies results , gillibrand and chlebowy found no meaningful relationship between self - efficacy and glycemic control . as mentioned , some of studies have showed that knowledge plays a vital role in appropriate control of glucose . though , a number of investigators expressed that knowledge alone can not lead to increase in self - care . knight , et al . states that knowledge and behavior have a quantitative relation and knowledge is necessary for behavior and behavioral changes but not sufficient . perhaps , clich interference repetition and lack of attention to behavioral changes and absolute care to knowledge is an important factor in achievement of interferences . therefore , it is demanding for medical care providers to know the predictive factors of self - care behaviors in diabetic patients . on the other hand , today , increase in patients trust to their abilities in diabetes care , is a vital factor in active self - management . it shows that self - efficacy provides a suitable framework for understanding and predicting commitment towards self - care behaviors and effectiveness of self - management in diabetes treatment . problems faced with changes in life style like nutritious habits , smoking , and exercise requires a high level of self - confidence and achieving to self - efficacy is more difficult . based on bandora , self - efficacy is the strongest construct in predicting behavior change in person and usually those show highest behavior change hold higher self - efficacy to act a certain behavior . self - efficacy affects person 's motivation and pushes it to try and continue the behavior . self - efficacy defined as the person 's trust to its abilities for exploring a behavior . in other words , self - efficacy consists of the people 's trust to themselves in executing a special act . in fact , self - efficacy enables people to use skills in dealing with obstacles and creates fabulous acts . therefore , self - efficacy is a vital factor in executing successful performance and human skills necessary for doing it . efficient performance needs either skill or judgment in ability to execute those skills . on the other hand , people who believe in their self - efficacy double try to resolve obstacles and problems . self - efficacy refers to people 's judgment in relation to their abilities in doing works and inspired by different sources such as achievements , failures , and others success or loss and verbal encourage . those persons , who possess higher personal self - efficacy , have more perseverance , are luckier and experience less fear . to develop people 's belief to their ability self - efficacy due to diabetes care behaviors , their inner control source can be improved . to reach it , they have to receive trainings in order to plan the diabetes cares due to control their disease and be their main factor in preventing diabetes side effects . investigators have stated the following factors in creation of personal self - efficacy : 
 primary judgment that a certain work or duty is possible to happen.this duty or plan ( if complicated ) , is divided into smaller and easier sub - plans . this situation indeed , leads to experience of small achievement feeling in process of learning in person.repetition exists in action and behavior to be carried out.in doing a special behavior , reward , reinforcement , recognition and understanding present . primary judgment that a certain work or duty is possible to happen . this duty or plan ( this situation indeed , leads to experience of small achievement feeling in process of learning in person . repetition exists in action and behavior to be carried out . in doing a special behavior , reward , reinforcement , recognition and understanding present . except the first factor in fact , the instructors easily establish these factors in their training interferences . to reinforce the patient assumption of being practical , the similar behaviors cab be executed by patients highlighted or present evidence in performance of that special behavior by other patients . in regard to second factor , establishment of self - efficacy through behavior division into smaller behaviors or concept to sub - concepts , more emphasis has been put on feedback or reinforcement in the patient in each stage . the third factor , is repetition and leads to creation of self - skill and consequently self - efficacy in person , is possible to be used by medical staff . last but not the least factor , recognition , reward and reinforcement for doing each small behavior can establish self - confidence and self - esteem . in the process of chronic diseases , self - efficacy is vital and it is expected that diabetic patients control 95% of their own disease personally . a significant part of caring these patients is at home and self - efficacy here plays a vital role . it also indirectly via perceived obstacles and determination of commitment level or patience in following performance - map , influences motivation . self - efficacy indeed is people 's judgment and expectation in influencing ability on favorite incidence thorough personal trials . in other words , more powerful judgment , more active the person is and do the best in trial and following a behavior to achieve a goal . therefore , a low self - efficacy person , less possibly tries to change a habit a fixed behavior . according to the studies , since self - efficacy affects performance and behavior , this feeling can be determinant in people 's success in self - care of diabetic patients , especially in nutritious behaviors . therefore , in the process of self - care process in diabetic patients , self - efficacy is crucial .
introduction and aims : diabetes is one of the chronic and prevalent diseases in the world . 
 diabetic patients number has increased 7 times during last 20 years . 
 if this current situation continues , diabetic patients population will be 350 millions ones in 2030 . 
 it means that 7 millions people will be added annually . up to now 
 , different uncontrollable factors have been monitored in self - caring of this disease for managing and preventing from its early and late side effects . 
 this research is conducted to study the role of self - efficacy as a determinant agent in self - caring of diabetic patients.study method : this is a narrative review study in which various information banks and search motors such as pubmed , proquest , scopus , elsevier were reviewed . 
 diabetes , self - care and self efficacy keywords from cross sectional , cohort , clinical experimental studies and systematic review were also used in the study construction . 
 iranian banks such as iranmedex , medline and also different articles from domestic research and scientific magazines were selected . 
 time spectrum of reviewed studies was supposed to be published from 1990 up to 2011.results:self-care situation among diabetic patients not only is unsatisfactory but also the studies results show that self - efficacy rate is low among them . 
 the findings of the studies prove that there is a direct relation between self - efficacy and self - care in the patients in a way that this construct owns the predictability power of self - care behavior.conclusion:self-caring has a significant role in controlling of diabetes disease . 
 self - efficacy can induce motivation directly take health promoting behavior through efficacy expectations . 
 it also affects motivation , indirectly , through perceived barriers and determining commitment or stability for following function map . 
 so , self - efficacy is very important in changing self - care behavior process .