Introduction
Diabetes mellitus is one of the most common chronic diseases in the 21st century, which threatens the life of people. The global prevalence of diabetes was estimated at 9% (463 million people) in 2019. It is estimated that this amount will reach 783 million people by 2045. Diabetic patients in Iran make up 1.5-2% of the total population and 7.8% of the population over 4 years of age. Complications of diabetes affect different aspects of life in patients, including psychological, physical, social, economic, family, and sexual function. The primary goal of treatments, especially in chronic disease, is to improve the quality of life by reducing the effects of the disease. By affecting different dimensions of life, diabetes reduces the quality of life of patients; it is necessary to use treatments and measures to improve their quality of life and health status. Diabetes requires daily monitoring of blood sugar, repeated injections, continuous clinical visits, and precise exercise and diet program to achieve satisfactory control. Nutritional treatment is an essential component in the treatment program of people with diabetes. The nutritional treatment program should be adjusted based on the goals and needs of each patient. The type of nutrition and food items affect the human body and mind; depending on the type of food, the person’s temperament changes. Each food has its own temperament. The training given to the diabetic patients is based on the general view of proper nutrition for all diabetic patients. So far, various methods have been proposed for improving the knowledge and attitude of diabetic patients, but no study has been conducted for the nutrition education of patients based on their temperament. Since the nutrition in diabetic patients is the simplest and easiest way to affect their quality of life, the present study aims to investigate the effect of a self-care training program based on temperament modification on the quality of life of patients with type 2 diabetes (T2D).
Methods
In this quasi-experimental study, 110 patients with T2D were selected by a convenience sampling method and were randomly divided into two groups of intervention and control using the random number table. After obtaining informed consent from them, they completed a demographic from and the World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire, and their temperament was diagnosed by a doctor expert in Iranian traditional medicine. The intervention group received 4 sessions of self-care training based on temperament modification each for 45 minutes. The control group received routine treatment without any intervention. Then, they completed the WHOQOL-BREF questionnaire again three months after the intervention. Data were analyzed in SPSS software, version 22 using chi-square test, paired t-test, and independent t-test. The significant level was set at 0.05.
Results
The majority of patients in the intervention group were female (n=30, 54.5%), while most of the were male in the control group (n=34, 61.8%). There was no significant difference between the two groups in terms of gender (P=0.429). The mean age was 49.7±15.8 years in the intervention group and 53.9±12.9 years in the control group. There was no significant difference between the two group in terms of age (P=0.175). As presented in Table 1, before the intervention, there was no significant difference in the quality of life score between the intervention (83.2±11.9) and control (85±9.4) groups (P=0.194).


After the intervention, the difference in the quality of life score was significant between the intervention (87.7±11.3) and control (85.1±9.5) groups (P=0.044). There was no significant difference in the quality of life score in the control group before and after the intervention (P=0.244).
Discussion
The self-care training program based on temperament modification can increase the quality of life of patients with T2D. This program is suggested to improve the quality of life of these patients.

Ethical Considerations
Compliance with ethical guidelines
This study has the approval code for the research plan No. 2683 from the Research Council of Arak University of Medical Sciences, and the approval code of ethics (Code: IR.ARAKMU.REC. 1395.232). The study was performed in accordance with the standards as outlined in the Declaration of Helsinki . This study is according to the moral protocol in research Centre of Health Ministry.

Funding
Arak University of Medical Sciences supported this study.

Authors' contributions
All authors equally contributed to preparing this article.

Conflicts of interest
The authors declare no conflict of interest.

Acknowledgements
Hereby, the researchers would like to sincerely thank all patients participating in the study. Also, they would like to express their deepest appreciation to the Student Research Committee of Arak University of Medical Sciences for their support and guidance for approving and funding.


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