Dietary practice and associated factors among type 2 diabetic patients: a cross sectional hospital based study, Addis Ababa, Ethiopia

Dietary practices and associated factors among adult diabetic patients at academic tertiary-level hospitals in central Ethiopia: convergent mixed study

BACKGROUND

Diabetes mellitus (DM) is one of the most prevalent chronic diseases worldwide. Despite the existence of national strategies to prevent potential complications, DM-related morbidities and mortality continue to rise in Ethiopia. Although studies have been conducted regarding dietary practices among DM patients in the country, there is a lack of in-depth understanding of the situation.

OBJECTIVE

To assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia in 2024.

METHODS

A concurrent mixed-methods study was conducted from January 01 to 30, 2024, involving 420 adult DM patients. Participants were selected using a simple random sampling technique for the quantitative study. A purposive sampling technique was used to select sixteen participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and in-depth interviews were conducted for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.

RESULT

Of 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (42.4%). Being female, residing in urban areas, having a family history of DM, and having good dietary knowledge were significantly associated with better dietary practices. From the qualitative analysis, two themes emerged "Living as before and not adhering to diabetic dietary recommendations" and "Barriers to adherence to effective eating practices."

CONCLUSIONS AND RECOMMENDATIONS

Less than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Patient-Perceived Challenges to Type 2 Diabetes Self-Management in Sub-Saharan Africa: A Qualitative Exploratory Study

PURPOSE

The purpose of the study was to explore patient-reported challenges influencing type 2 diabetes self-management in a diabetes center in Ethiopia.

METHODS

Exploratory qualitative interviews were conducted with purposively sampled patients with type 2 diabetes. Thematic data analysis was performed to identify challenges to diabetes self-management, and the themes were interpreted using Leininger's sunrise model.

RESULTS

Thirty patients with type 2 diabetes participated. Four themes were identified regarding challenges to type 2 diabetes self-management: (1) cultural values and beliefs, (2) kinship and social factors, (3) educational factors, and (4) economic conditions. Sociocultural factors and low income intersected to significantly impede effective diabetes self-management. Sociocultural contexts strongly influenced patient beliefs and interpretations related to diabetes self-care. Misconceptions and limited awareness of diabetes, reliance on herbal remedies, ritual fasting, and prioritization of family needs over individual needs also involved challenges for diabetes self-care. Poverty influenced access to diabetes care. Many patients faced difficulties in adhering to healthy diets for diabetes due to limited income and food costs, and some patients reduced medication doses, including insulin, to manage costs effectively.

CONCLUSION

The study highlighted the pressing need for comprehensive and culturally appropriate patient education and empowerment interventions involving various stakeholders to enhance knowledge, understanding, and self-efficacy in diabetes self-management. Urgent attention is needed to ensure patients have access to affordable and sustainable diabetes medications and healthy diets for diabetes through financial incentives. These findings can be considered in designing tailored strategies for improving self-management practice in diabetes care in Ethiopia.

Dietary adherence among persons with type 2 diabetes: A concurrent mixed methods study

BACKGROUND

Poor adherence to dietary recommendations among persons with type 2 diabetes (T2D) can lead to long-term complications with concomitant increases in healthcare costs and mortality rates. This study aimed to identify factors associated with dietary adherence and explore the barriers and facilitators to dietary adherence among persons with T2D.

METHODS

A concurrent mixed methods study was conducted in two hospitals in the Ashanti Region of Ghana. One hundred and forty-two (142) persons with T2D were consecutively sampled for the survey. Dietary adherence and diabetes-related nutritional knowledge (DRNK) were assessed using the Perceived Dietary Adherence Questionnaire (PDAQ) and an adapted form of the General Nutritional Knowledge Questionnaire (GNKQ-R) respectively. A purposive sample of fourteen participants was selected for interviews to explore the factors that influence dietary adherence. Qualitative data were analysed using NVivo version 20 software and presented as themes. Furthermore, binary logistic regression was performed using IBM SPSS version 29.0 to identify the factors associated with dietary adherence.

RESULTS

Nearly fifty-one percent (50.7%) of the participants in this study had good dietary adherence. In multivariable logistics regression, it was found that increase in DRNK (AOR = 1.099, 95% CI: 1.001-1.206, p = 0.041) score and living in an urban area (AOR = 3.041, 95% CI: 1.007-9.179, p = 0.047) were significantly associated with good dietary adherence. Inductive thematic analysis revealed four facilitators of dietary adherence (access to information on diet, individual food preferences and eating habits, perceived benefits of dietary adherence, and presence of social support) and four barriers (inability to afford recommended diets, barriers related to foods available in the environment, conflict between dietary recommendations and individual eating habits, and barriers related to the social environment).

CONCLUSION

The findings support the need for interventions including continuous dietary education tailored to individual preferences and dietary habits, expansion of poverty reduction social interventions and formulation of policies that will improve access to healthy foods in communities.

Self-care practice and its barriers among diabetes patients in North East Ethiopia: A facility-based cross-sectional study

Diabetes prevention and management through self-care practice is critical to reducing severe complications and death due to diabetes. Data on the prevalence of self-care practices will help us to design and implement prevention and management strategies to foster adherence and compliance with the interventions. This study was intended to assess self-care preparation and its barriers among diabetes patients in Northeast Ethiopia. A facility-based cross-sectional study was conducted among diabetes patients visiting Debre Berhan Town Public Health Institutions from March 10, 2021- April 10, 2021. A systematic random sampling technique was utilized to select 392 samples. Data were collected using a structured questionnaire adapted from Summary of Diabetes Self-Care Activities Measures. Reliability analysis was done using Cronbach's alpha test, and the Hosmer and Lemeshow test also checked for model fitness. Bivariate and multivariable binary logistic regression was done to identify the factors associated with dietary practices. For all statistically significant tests, p- a value < 0.05 was used as a cut-off point. The mean age of the respondents was 47.1 years, with a standard deviation (SD) of ± 13.4 years. The mean adherence to self-care practice was 29.00 ± 10.37 SD. More than half, 218 (61.1%) of the study subjects had poor self-care practices. In the multivariable logistic regression analysis, being a governmental worker (AOR = 7.06 (1.61-30.9) and having social support from partners (AOR = 5.83(3.01-11.3) showed a statistically significant association with good self-care practice. The current study showed that the overall level of self-care practice of study subjects was poor. Therefore, health facilities should provide adequate health education and promotion activities to enhance patients' level of adherence. In addition, families, partners, or friends of diabetes patients should be informed about their essential roles in patients' self-care practice.

Dietary knowledge assessment among the patients with type 2 diabetes in Madinah: A cross-sectional study

Background

There is a huge burden of nutrition-related non-communicable diseases, and diabetes is one of the leading chronic nutrition-related diseases affecting more than 500 million people globally. Collecting information regarding the awareness of dietary and nutrition knowledge among diabetic patients is the first step to developing a disease prevention program. Thus, this study primarily aims at assessing the dietary awareness of diabetes patients attending the diabetic centre in Madinah governorate, Saudi Arabia.

Methods

The study was started in November 2020 and ended in October 2021. The study participants (315) were type 2 diabetes mellitus (T2DM) patients attending a diabetic centre in Madinah, Saudi Arabia. A self-prepared dietary knowledge questionnaire (DKQ) was used in this research. The variables include balanced diet, food type, food choice, carbohydrate, protein, and fat. Knowledge score was, and the total score was levelled/categorized into 'good', 'average', and 'poor'. Data were analysed by SPSS v.26.

Results

The study results identified the current knowledge of T2DM patients about different dietary items. The knowledge score of 62.2% of participants showed an average level of dietary knowledge, which is statistically significant. When we separately evaluated their understanding of different dietary components, we found that T2DM patients had poor knowledge of carbohydrates (30.15%), fat, food choices (47.7%), and type (34.6%). However, they had acceptable knowledge of proteins (56.5%).

Conclusion

Our participants exhibited acceptable knowledge about proteins but poorer knowledge of other food groups. A healthy, well-balanced diet is essential for excellent glycaemic control. Educating and arranging a health education program regarding dietary knowledge is recommended, specially designed for diabetic patients so that patients can opt for a healthier lifestyle.

Dietary Practices Among Type 2 Diabetes Patients Visiting a Non-communicable Disease (NCD) Clinic in a District of Western India: A Cross-Sectional Study

BACKGROUND AND AIMS

Diabetes is becoming a major public health problem in the country. One of the most important lifestyle modifications necessary for diabetic patients is maintaining healthy dietary choices. These modifications in dietary practices are supposed to be followed lifelong, along with medication, for better glycemic control. Despite understanding the importance of dietary control and physical activity in the management of diabetes, adherence to these practices is poor. This study aimed to assess the dietary practices of type 2 diabetes mellitus (T2DM) patients and various factors that determine adherence to these healthy dietary practices. The secondary objective was to find the perceptions of participants about the role of diet in controlling diabetes and to find the perception-practice gap among study participants.

METHODOLOGY

It was a hospital-based cross-sectional study conducted among 450 T2DM patients visiting the non-communicable disease (NCD) clinics of tertiary care hospitals and community health centres (CHCs) of the study district. Dietary practice was assessed using a modified UK Diabetes and Diet Questionnaire (UKDDQ), considering the food patterns in the study area. Statistical tests like chi-square and ordinal logistic regression were applied using Jamovi software for univariate and multivariate analyses.

RESULTS

The healthiest food choices were abstinence from alcohol consumption (100%), avoiding processed meat (92.21%), high-fibre breakfast (70.4%), and daily consumption of vegetables (68.2%). Improper dietary practices were regular sugary drinks (38%) and high-glycemic-index food items (22.4%). The mean (SD) of the composite score was 68.02 (8.7) and the median score (interquartile range (IQR)) was 69 (60-76). Tertile analysis of the composite score revealed that with the increase in age, patients were less likely to be in the intermediate or upper tertile score (β = -0.0219, p = 0.016). Being female (odds ratio (OR) =0.603, CI: 0.395-0.917, p = 0.019) and living in a three-generation family made the patients less likely to be in the upper tertile score.

CONCLUSION

Nearly half of the participants had an overall healthy score. Dietary practices were healthy among the participants of lower ages, males, and those living in nuclear and joint families. The highest perception-practice gap was seen for fruit and rice consumption.

Dietary Practices and Associated Factors Among Adult Diabetic Patients at Academic Tertiary-Level Hospitals in Central Ethiopia: Convergent Mixed Study

Background

Diabetes mellitus (DM) is one of the most common chronic diseases globally. Despite the presence of national strategies to prevent potential sequelae DM has been associated with increased morbidities and mortality in Ethiopia, and the prevalence appears to be on the rise. Although studies have been conducted among DM patients in the country, there is a lack of information that could allow an in-depth understanding of the situation.

Objective

To assess dietary practices and associated factors among adult DM patients at academic tertiary-level hospitals in central Ethiopia.

Methods

The institution-based concurrent mixed-methods study was conducted from January 01 to 30 2024 involving 420 adult DM patients. Participants were selected using a simple random sampling technique for quantitative study. A purposive sampling technique was used to select 16 participants for qualitative analysis. For the quantitative study, a self-administered structured questionnaire was used to collect data, and an in-depth interview for the qualitative part. Multivariate binary logistic regressions were used to assess the explanatory variables associated with dietary practice. A thematic analysis was performed for qualitative data.

Result

Of 420 eligible participants, 406 (96.7%) participated in the study. The overall proportion of good dietary practices among participants was 172 (44.2%). The being female, urban residence a family history of DM, and good dietary were significantly associated with the dietary practice. From qualitative analysis, two themes have emerged; Living as before and not adhering to diabetic dietary recommendations and barriers to adherence to effective eating practice.

Conclusions and recommendations

Less than half of adult DM patients had good dietary practices. Sex, geographic location, family history of DM, and level of knowledge of diabetic diet were associated with dietary practice. Intervention programs on awareness creation and training to improve the dietary practice by stakeholders were recommended.

Dietary practice and associated factors among type 2 diabetic patients attending chronic follow-up in public hospitals, central Ethiopia, 2022

BACKGROUND

Diabetes Mellitus (DM) is affecting numerous Ethiopian populations regardless of environmental and social status. Diabetic people all over the world are commonly urged to acquire a healthy eating habit, which necessitates lifelong changes in food habits, beliefs, and meal patterns. Dietary management is considered one of the cornerstones of diabetes care, as it is an important component of the overall treatment plan. Choosing and following a healthy diet is important for everyone, especially people with diabetes.

OBJECTIVE

This study aims to assess dietary practices and associated factors among type 2 diabetes patients in the west Shewa Zone, Oromia Regional State, Ethiopia, in 2022.

METHODS

A hospital-based cross-sectional study design was conducted in West Shewa Zone public hospitals among 421 randomly selected type 2 diabetic patients from February 1 to March 30, 2022. Data were collected using a structured and pre-tested interviewer-administered questionnaire. Descriptive, bivariate, and multivariate binary logistic regression analyses were done using SPSS.

RESULTS

In this study, about 35.6% (95% CI: 30.9-39.9) of type 2 diabetes patients had good dietary practices. Diabetes knowledge (AOR 9 2; 95% CI 4.4-19.4), food-secured households (AOR 3.3; 95% CI 1.6-6.9), high self-efficacy (AOR 6.6; 95% CI 3.2-13.9), diabetes diet information from healthcare professionals (AOR 2.9; 95% CI 1.3-6.4), complete dietary change (AOR = 2.3; 95% CI 1.1-4.8), and female gender (AOR 3.6; 95% CI 1.6-8.1) were independent predictors of good dietary practice.

CONCLUSION

The proportion of patients with type 2 diabetes, who attended follow-up at West Shawa Public Hospitals and practiced good dietary habits, was low. Patients' household food insecurity, diabetes knowledge, self-efficacy, source of information on the diabetic diet, complete dietary change after diabetes diagnosis, and gender were all significantly associated with type 2 diabetic patients' dietary practices. Thus, promoting the provision of continuous, modified, and comprehensive education and advice on the importance of diabetes self-management, particularly adherence to dietary recommendations, is fundamental to decreasing the burden of diabetes complications and massive health expenses among diabetic patients.

Effect of using mobile phone communication on dietary management of Type 2 Diabetes Mellitus patients in Kenya

Purpose

Advancements in management of non-communicable diseases using regular reminders on lifestyle and dietary behaviors have been effectively achieved using mobile phones. This study evaluates the effects of regular communication using a mobile phone on dietary management of Type 2 Diabetes Mellitus (T2DM) among patients attending Kitui County Referral Hospital (KCRH) in Kenya.

Methods

Pre/post-study design among eligible and consenting T2DM patients visiting KCRH was used for this study. One hundred and thirty-eight T2DM patients were enrolled; 67 in the intervention group (IG) and 71 in the control group (CG). The IG received regular reminders on key dietary practices through their mobile phones for six months while the CG did not. The Net Effect of Intervention (NEI) and bivariate logistic regression were used to determine the impact of mobile phone communication intervention at p < 0.05. SPSS version 24 was used to analyze the data.

Results

The results revealed an increase of respondents who adhered to the meal plan in the IG from 47.8% to 59.7% compared to a decrease from 49.3% to 45.1% in CG with corresponding NEI increasing (16.1%) significantly (p < 0.05). The proportion of respondents with an increased frequency of meals increased from 41.8 to 47.8% in the IG compared to a reduction from 52.1% to 45.1% in the CG with corresponding NEI increasing (13.0%) significantly (p < 0.05).

Conclusion

Regular reminders on lifestyle and dietary behaviors using mobile phone communication improved adherence to dietary practices such as meal planning and frequency of meals in the management of T2DM.

Barriers and facilitators to type 2 diabetes management among slum-dwellers: A systematic review and qualitative meta-synthesis

Background and Aims

The prevalence of type 2 diabetes (T2D) is on the rise worldwide, especially in developing countries. There is a significant difference between the slum-dwellers and other urban dwellers in terms of T2D incidence rate and access to healthcare services. This review aimed to identify barriers and facilitators to T2D management among slum-dwellers.

Methods

A systematic review was conducted to identify barriers and facilitators to T2D management from January 1, 2002 to May 30, 2022. We searched MEDLINE via PubMed, Scopus, Web of Sciences, and Google Scholar. The inclusion criteria were: qualitative or mixed-methods research, published in English, focused on slum-dwellers and T2D or its complications, and assessed barriers and facilitators to T2D management among slum-dwellers. Quality appraisal was conducted using the QATSDD critical appraisal tool. A thematic approach was used for data analysis and synthesis.

Results

A total of 17 articles were included in this review. Three analytical themes were identified: (1) Individual factors consisting of four themes: lifestyle behaviors, informational, psychological, and financial factors; (2) Health system factors consisting of three themes: patient education processes, financial protection, and service delivery; and (3) Contextual factors consisting of three themes: family support, social support, and environmental factors.

Conclusion

Our review disclosed that the individual, health system, and context influence T2D management among slum-dwellers. Policymakers can use the findings of this review to reduce barriers and augment facilitators to improve healthcare utilization and self-care management among patients with T2D in slums.

Adherence to Dietary Recommendation and Its Associated Factors among People with Type 2 Diabetes: A Cross-Sectional Study in Nepal

Introduction

Intensive lifestyle modification including a healthy diet changes the diagnostic status of patient from prediabetes to nondiabetes. In type 2 diabetes, improper eating habits increase insulin resistance. This study is aimed at assessing adherence to the dietary recommendation and its associated factors among people with type 2 diabetes.

Methods

A cross-sectional descriptive study was conducted among systematically sampled type 2 diabetic patients using interview on Gandaki Medical College Teaching Hospital and Diabetes, Thyroid, and Endocrinology Care Center, Pokhara. The Perceived Dietary Adherence Questionnaire was used to assess dietary adherence. Data was entered in EpiData version 3.1 and analyzed on SPSS version 20. Logistic regression with adjusted odds ratio and the corresponding 95% confidence intervals were used to find out significance of association.

Results

Among 204 participants, only 15.7% of the participants had good dietary adherence. The mean age and standard deviation were 53.03 ± 11.90 years. Factors such as participants living in single family (AOR 2.7, 95% CI 1.0-7.4), participants who could afford recommended diet (AOR 2.9, 95% CI 1.0-8.3), participants having self-control on food (AOR 4.1, 95% CI 1.2-14.1), participants who were engaged in moderate to heavy physical activities (AOR 3.3, 95% CI 1.2-9.2), and participants who had adherence to medication (AOR 3.5, 95% CI 1.2-10.1) were significantly associated with adherence to dietary recommendation.

Conclusions

Adherence to dietary recommendation among people with type 2 diabetes was low. Factors such as family type, affordability of recommended diet, self-control on food, physical activity, and medication adherence were significantly associated with adherence to dietary recommendations among people with type 2 diabetes. These factors should be considered by nutrition counselors and clinical decision-makers in patient counseling regarding dietary adherence.

Level of dietary adherence and determinants among type 2 diabetes population in Ethiopian: A systemic review with meta-analysis

BACKGROUND

The beneficial effect of the dietary practice is significant reduction in the risk of developing diabetes related complication. Dietary practice among type 2 diabetes is not well-implemented in Ethiopia. Up to now, in the nation, several primary observational studies have been done on dietary adherence level and its determinants among type 2 diabetes. However, a comprehensive review that would have a lot of strong evidence for designing intervention is lacking. So, this review with a meta-analysis was conducted to bridge this gap.

METHODS

A systematic review of an observational study is conducted following the PRISMA checklist. Three reviewers have been searched and extracted from the World Health Organization- Hinari portal (SCOPUS, African Index Medicus, and African Journals Online databases), PubMed, Google Scholar and EMBASE. Articles' quality was assessed using the Newcastle-Ottawa Scale by two independent reviewers, and only studies with low and moderate risk were included in the final analysis. The review presented the pooled proportion dietary adherence among type2 diabetes and the odds ratios of risk factors favor to dietary adherence after checking for heterogeneity and publication bias. The review has been registered in PROSPERO with protocol number CRD42020149475.

RESULTS

We included 19 primary studies (with 6, 308 participants) in this meta-analysis. The pooled proportion of dietary adherence in the type 2 diabetes population was 41.05% (95% CI: 34.86-47.24, I2 = 93.1%). Educational level (Pooled Odds Ratio (POR): 3.29; 95%CI: 1.41-5.16; I2 = 91.1%), monthly income (POR: 2.50; 95%CI: 1.41-3.52; I2 = 0.0%), and who had dietary knowledge (POR: 2.19; 95%CI: 1.59-2.79; I2 = 0.0%) were statistically significant factors of dietary adherence.

CONCLUSION

The overall pooled proportion of dietary adherence among type 2 diabetes in Ethiopia was below half. Further works would be needed to improve dietary adherence in the type 2 diabetes population. So, factors that were identified might help to revise the plan set by the country, and further research might be required to health facility fidelity and dietary education according to diabetes recommended dietary guideline.

Applying the Reasoned Action Approach and Planning to Understand Diabetes Self-Management Behaviors

Individuals managing diabetes are required to adhere to self-management behaviors to ensure the optimal regulation of their blood glucose levels. This study examined the psychological determinants underlying three important diabetes self-management behaviors (e.g., physical activity, diet, and blood glucose monitoring) using the reasoned action approach (RAA) and planning. A cross-sectional design was used, with participants (N = 273) completing measures of RAA constructs (e.g., experiential and instrumental attitude, descriptive and injunctive norm, and capacity and autonomy) and planning (e.g., action and control planning) at time 1 and participation in the behaviors one week later at time 2. Regressions showed that RAA constructs accounted for good variance in intention and behavior in all behaviors. Intention towards diet and blood glucose monitoring was significantly predicted by instrumental attitude, injunctive norm, and capacity. Intention towards physical activity was significantly predicted by instrumental attitude, experiential attitude, injunctive norm, capacity, and autonomy. All behaviors were significantly predicted by intention, action planning, and coping planning. Additionally, capacity significantly predicted physical activity and autonomy significantly predicted diet and blood glucose monitoring. Successfully intervening in the influential psychological constructs identified in the study could ensure optimal blood glucose regulation in those managing diabetes.

Dietary knowledge and practice and its associated factors among type 2 diabetes patients on follow-up at public hospitals of Dire Dawa, Eastern Ethiopia

Objectives:

This study tried to assess the level of dietary knowledge and practice and associated factors among type 2 diabetes mellitus patients in public hospitals of Dire Dawa, Ethiopia.

Methods:

A facility-based cross-sectional study was conducted among 253 type 2 diabetes mellitus patients visiting follow-up clinic in public hospitals selected by systematic random sampling. Primary data were collected by face-to-face interview and checklist. The collected data were entered into SPSS version 22 and analyzed using proportion, percentage, and mean and standard deviation. Bivariate logistic regression analysis was used to identify candidate variables affecting dietary practice. Finally, all candidate independent variables were further adjusted on multivariate regression analysis with adjusted odds ratio and 95% confidence interval to identify factors independently associated with dietary practice. p-value ⩽0.05 declared as level of significance.

Results:

The level of poor dietary practice among type 2 diabetes mellitus patients was found to be 53.8%. Around 78.8% of participants had fasting blood sugar level ⩾130 mg/dL, and 52.8% found to have poor dietary knowledge. Moreover, there was no up-to-date nutritional guideline in follow-up clinic. Not getting nutrition advice from doctors/nurses, low duration of follow-up, lack of family support, and despondency were significantly associated with poor dietary practice ( p-value < 0.05).

Conclusion:

More than half of diabetes patients had poor dietary practice, which is in contrary with international recommendations of diabetic self-care. Habit of eating fruits and vegetables was poorly practiced and also patients’ knowledge of recommended nutrition was poor. Therefore, provision of robust nutritional education and counseling service, a system to strengthen family support as well as psychosocial support, is highly recommended.

Food security status of patients with type 2 diabetes and their adherence to dietary counselling from selected hospitals in Addis Ababa, Ethiopia: A cross-sectional study

Background

Even though adherence to dietary counselling for patients with diabetes is essential for improving health and preventing complications, access to an adequate and quality diet is challenging for patients living in a food-insecure household. The availability of data in this regard is limited in Ethiopia. Thus, this study assessed the food security status of patients with type 2 diabetes, their adherence to dietary counselling, and contributing factors at public hospitals in Addis Ababa, Ethiopia.

Methods

This was a facility-based cross-sectional study among 602 patients with Type 2 diabetes in Addis Ababa, Ethiopia, from July to August 2019. Patients were selected randomly after the total number of samples was proportionally allocated to four public hospitals. Relevant information was collected by trained data collectors using a pre-tested questionnaire. Data were entered into Epi-info version 7 and exported to SPSS version 24 for data analysis. Logistic regression analysis was employed to identify factors associated with adherence to dietary counselling.

Result

The proportion of nonadherence to dietary counselling among patients with type 2 diabetes was 67.3% (95%CI: 63.5%-71.1%). Nearly half (50.7%) of the respondents were food insecure. Of these, mildly food insecure, moderately food insecure, and severely food insecure were 8.5%, 29.2%, and 13%, respectively. Physical activity (AOR = 1.7; 95%CI: 1.1–2.9); diabetes knowledge (AOR = 1.8; 95%CI: 1.2–2.6); lack of access to information (AOR = 1.6; 95%CI: 1.1–2.6); moderately food insecure (AOR = 2.2; 95%CI: 1.3–3.7); and severely food insecure (AOR = 5.6; 95%CI: 2.1–15.0) were the major significant factors associated with nonadherence to dietary counselling.

Conclusion

Over two-thirds of patients with diabetes did not adhere to dietary counselling, which appears high. As a result, improving diabetes education, information access, and food security status should be considered to ensure dietary counselling adherence among type 2 diabetes patients.

Obesity among type 2 diabetes mellitus at Sidama Region, Southern Ethiopia

Background

Type 2 diabetes is becoming highly prevalent worldwide and it is one of the leading causes of mortality. The cause of mortality among these patients is mostly related to the dominant presence of modifiable cardiovascular risk factors such as obesity. The aim of the current study is therefore to determine the prevalence of obesity and its associated factors among patients with type 2 diabetes mellitus at Sidama region, Ethiopia.

Method

Institution-based cross-sectional study design was implemented to determine the prevalence of obesity and its associated factor among patients with type two diabetes at Hawassa University Comprehensive Specialized Hospital and Yirgalem General Hospital from October 16 2018 to December 21, 2018. A simple random sampling technique was implemented to select 314 study participants. After obtaining consent, different patients’ related data were collected using a questionnaire. Patients’ records were also reviewed. 4ml of the blood sample was collected from each study participant and analyzed for lipid profile test. Blood glucose level was done using COBAS INTEGRA 6000. A binary logistic regression was used to assess factors that have an association with obesity. A P-value of <0.05 was considered statistically significant.

Result

The majority of the study participants (67.2%) were male and 61.8% of the study participants were aged >45years. The overall prevalence of overweight and obesity among the study participants was 36.3% and 18.8% respectively. About 41% of the study participants have a normal BMI. Females were more obese (28.2% Vs 14.2%) than males and BMI stratification by sex was statistically significant (P = 0.02). Sex (AOR = 3.0, CI = 1.6–5.7, P-Value = 0.001) and TG (AOR = 3.6, CI = 1.6–8.3, P-Value = 0.003) are factors that were independently associated with obesity among type 2 DM patients.

Conclusion

Overweight and obesity among type two diabetic patients were prevalent. In addition, obesity and overweight disorder are common among T2DM and gender and triglycerides levels were associated with obesity.

Poor dietary practice and associated factors among type-2 diabetes mellitus patients on follow-up in Nigist Eleni Mohammed Memorial Teaching Hospital, Ethiopia

Introduction

good dietary practice is one of the top pillars of self-care among patients of diabetes mellitus. However, the dietary practice of patients attending health institutions in the study area was not studied. Therefore, the prevalence and associated factors of poor dietary practice were determined among diabetic patients on follow-up in Nigist Eleni Mohammed Memorial Referral and Teaching Hospital, Southern Ethiopia.

Methods

facility-based cross-sectional study design was employed on type-2 diabetes mellitus adult patients. The study was conducted from March to April 2020. Total sample size was 322. Systematic random sampling method was used to select the study respondents. Odds ratio and their 95% confidence intervals together with P-value ≤0.05 were used to identify independent predictors of poor dietary practice during multivariable logistic regression.

Results

the prevalence of the poor dietary practice among type diabetes patients was 53.7% (n=168). Low wealth status AOR 3.34, 95% CI: 1.50-7.41; p-value=0.003 and absence of family and friends support AOR 4.80, 95% CI: 2.54-9.0 and P-value<0.001 were associated factors with poor dietary practice among type-2 diabetes patients.

Conclusion

the overall prevalence of poor dietary practice among type-2 diabetic adult patients was high that not going in line with international recommendations on dietary management of the diabetes mellitus. Integrated governmental and non-governmental activities should be in place to improve the economic status of type-2 diabetic patients. Support from the family members is found to be essential factor to promote dietary practice among type-2 diabetic adult patients.

High atherogenic risk concomitant with elevated HbA1c among persons with type 2 diabetes mellitus in North Ethiopia

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic disease associated with worse clinical presentation. However, the current investigation practices in Ethiopia have limitations to demonstrate the scope of the clinical burden. Hence, this study was aimed at assessing the glycemic status and coronary heart disease (CHD) risk of persons with T2DM using HbA1c and atherogenic index of plasma (AIP).

METHOD

This institution-based cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Demographic, socioeconomic, and lifestyle data were collected through a face-to-face interview. Clinical information was retrieved from medical records whereas anthropometric and biochemical measurements were performed using the WHO protocols. Glycemic status was determined using HbA1c and CHD risk assessed using an atherogenic index of plasma (AIP). Gaussian variables were expressed using mean and standard deviation (SD), Log-normal variables using geometric mean and 95% CI and non- Gaussian variables using median and interquartile ranges. Categorical variables were summarized using absolute frequencies and percentages. Multivariable logistic regression was used to identify factors associated with glycemic control with a statistical significance set at 5%.

RESULT

A total of 195 male and 226 female subjects were involved in this study. The results demonstrated that 77% (324) had HbA1c value ≥7% and 87.2% (367) had high atherogenic risk for CHD. Besides, 57% and 67.9% of persons with T2DM had metabolic syndrome according to International Diabetes Federation (IDF) and the National Cholesterol Education Program-Adult treatment panel III (NCEP-ATP III) criteria, respectively. About 36.8% had one or more comorbidities. Having healthy eating behavior [AOR 1.95; CI 1.11-3.43] and taking metformin [AOR 4.88; CI 1.91-12.44] were associated with better glycemic outcomes.

CONCLUSION

High AIP level concomitant with poor glycemic control indicates increased risk for coronary heart disease among persons with T2DM in Northern Ethiopia.

Dietary Practice among Type 2 Diabetic Ppatients in Southern Ethiopia

BACKGROUND

Diabetic patients' dietary practice is critical to improve glycemic, lipid, and blood pressure control. However, a significant number of patients had poor dietary practice. In Ethiopia, more than half of diabetic patients were not practicing a healthy dietary approach. Therefore, this study assessed variables that were hardly addressed in previous studies. The aim of this study was to assess dietary practice and associated factors among patients with type 2 diabetes.

METHODS

A facility-based cross-sectional study was performed among patients with type 2 diabetes in Arba Minch General Hospital from April 21 to May 20, 2020. A systematic sampling technique was used to select 352 patients. The data were entered into EpiData version 3.1 and exported to SPSS version 21 for cleaning and analysis. Descriptive statistics were performed. All variables in bivariate analysis with p-value <0.25 were entered into a multivariable logistic regression model, and statistical significance was declared at a p-value of less than 0.05.

RESULTS

The prevalence of poor dietary practice was found to be 40.6% (95%CI (35.7-46.0)). After adjusting for other variables in multivariable analysis, not attending formal education (AOR = 3.0; 95%CI (1.6-5.5)), being at primary education level (AOR = 2.2; 95%CI (1.1-4.4)), being moderately food insecure (AOR = 5.3; 95%CI (2.8-9.9)), having depression (AOR = 5.9; 95%CI (3.0-11.4)), and not having nutrition education (AOR = 2.2; 95% (1.1-4.6)) were factors associated with poor dietary practice.

CONCLUSIONS

A significant proportion of patients had poor dietary practice. The poor dietary practice was significantly higher among those with no formal education, at the primary education level, from the moderately food-insecure household, having depression, and not having nutrition education. The results imply the need for strengthening health information dissemination concerning healthy dietary practice in the form of a package.

Dietary diversity (DD) and associated factors among Lactating women (LW) in Pawie district, Northwest, Ethiopia, 2019: community-based cross-sectional study

Background

Low Dietary Diversity (DD) result in severe problem among the vulnerable group in low-income countries (LICs), whose diets are predominantly starchy staples. Lactating Women (LW) from LICs are considered a nutritionally vulnerable group. It results in many consequences on the health and well-being of children, households, communities, and the nation. However, there is little empirical evidence on factors contributing to low DD among LW in Ethiopia and the proposed study site. Therefore, this study aimed at assessing the DD and associated factors among LW in Pawie district, Northwest Ethiopia.

Methods

A Community-based cross-sectional study was conducted among 806 LW from March to May 2019 G.C. DD assessed using 24 h dietary recall methods with structured questionnaires.

A mean dietary diversity score (DDS) was computed for ten food groups. Food insecurity measured using a 9-item Household Food Insecurity Access Scale (HFIAS). The multivariable logistic regression model was used to see the relevant associations. The variables which have a significant association with DD were identified based on AOR, P-value ≤ 0.05, and 95% Cl.

Results

A total of 806 LW aged 15–49 years were interviewed with a response rate of 100%. About two-third of LW had low DD (<5 food groups). Fathers occupation being daily laborer [AOR = 1.82, 95% CI (.339, 9.784)], birth interval less than 24 months [AOR = 3.7, 95 % CI (1.743, 7.885)], family size greater than six members [AOR = 1.55, 95 % CI (1.046, 2.313)] and food insecurity [AOR = 2.23, 95 % CI (1.626, 3.066)] were more likely associated with the low DD among LW compared to their counterpart.

Conclusion

The DD among LW was low. Low Dietary Diversity was statistically associated with low birth intervals, large family sizes, and food insecurity. Hence, attention should be paid to the identified factors of low DD of LW to improve their health, and that of their children as well as their family.

Dietary practice and associated factors among type 2 diabetic patients having followed up at the University of Gondar Comprehensive specialized hospital, northwest Ethiopia, 2019

Background

Diabetes is a chronic, metabolic disorder characterized by elevated level of blood glucose. In order to delay and prevent diabetes related complications, healthy meal planning and leading active life are very crucial. However, appropriate feeding practice among type 2 diabetic patients is low in many developing countries including Ethiopia. Therefore, the aim of this study was to assess dietary practice and associated factors among type 2 diabetic patients.

Methods

Institution based cross sectional study was conducted from July to December 2019. A total of 422 type 2 diabetic patients who had follow up at the diabetes clinic of the University of Gondar Comprehensive Specialized hospital were include in the study. Logistic regression was used to see the strength of the association between dependent and independent variables. In the logistic regression, both bivariable and multivariable logistic regression analysis were computed to identify factors associated with dietary practice.

Results

The overall prevalence of good dietary practice among type 2 diabetic patients was 46.7 % [95 % CI: 41.7, 51.4]. In the multivariable logistic regression analysis attending secondary and above education [AOR = 4.08, 95 % CI: 1.76, 9.46], high wealth status [AOR = 5.34, 95 % CI: 2.72, 10.50], presence of family support [AOR = 2.54, 95 % CI: 1.40, 4.63], and absence of difficulty of choosing food [AOR = 2.27, 95 % CI: 1.47, 3.53] were significantly associated with good dietary practice.

Conclusions

Less than half of the patients with type 2 diabetes had good dietary practice. Dietary practice was good among high economic status, presence of family support, high educational level and no difficulty of choosing food. Therefore, strengthening income generating activities, improving literacy rate of nations, developing family engagement and food choosing strategies by the health care providers, policy makers and the Government are very crucial to improve good dietary practice among type 2 diabetic patients.

Adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone public health hospitals

Introduction:

Adherence to diabetes self-care management is a lifestyle modification for people with diabetes which includes; medication, dietary practice and regular physical activity. The objective of this study was to assess the adherence to diabetes self-care management and associated factors among people with diabetes in Gamo Gofa Zone, Southern, Ethiopia, 2018.

Methods:

Institutional-based cross-sectional study design with a systematic random sampling technique was conducted. A total 635 diabetic participants were involved in this study. Data were collected using structured interviewer administered questionnaire. Data were analyzed using SPSS version 21. Descriptive statistics were employed to describe the study population in relation to the relevant variables. Binary and multivariable logistic regression was conducted to identify factors associated with the outcome variables. P-value < 0.05 with 95% confidence interval was used to declare statistical significance.

Results:

The prevalence of good adherence toward diabetes self-care management was 341 (53.7%), (95% confidence interval = 46.09, 61.31). Regarding diabetes self-care practices, poor adherence had been detected in blood sugar measurement practice, dietary feeding practice, physical exercise and eye examination practice. The multivariable analysis indicated that government workers [adjusted odds ratio = 2.74 (1.03, 7.30)], training on diabetes self-care practice [adjusted odds ratio = 3.13 (1.89, 5.16)], diabetes’ association membership [adjusted odds ratio = 1.59 (1.01, 2.50)], having personal glucometer at home [adjusted odds ratio = 2.70 (1.37, 5.33)], duration of diabetic illness >10 years [adjusted odds ratio = 9.59 (3.99, 23.05)] and people with diabetes who were not developing complication [adjusted odds ratio = 1.54 (1.01, 2.33)] were significantly associated with good adherence to diabetes self-care management practice.

Conclusion:

Significant number of diabetes patients had poor adherence to diabetes self-care practice. Special focus should be given to farmers with diabetes, those with diabetic complication and for those with duration of diabetes less than 10 years. Periodical training should be given for people with diabetes on dietary feeding, physical exercise and eye examination practice.

Eating behavior among persons with type 2 diabetes mellitus in North Ethiopia: a cross-sectional study

BACKGROUND

Diet is central to the management of type 2 diabetes mellitus (T2DM). Depending on the stage of the disease at which the recommended diet is initiated, optimal adherence can reduce HbA1c by about 1 to 2%. However, evidence on eating behavior is generally scarce including in Ethiopia. The present study aimed to assess the eating behavior of adults with T2DM in North Ethiopia.

METHODS

This cross-sectional study was conducted among 421 adults with T2DM from September to November 2019. Socio-demographic variables were collected using structured questionnaires; an asset-based wealth index was used to determine socioeconomic status. Three dimensions of eating behavior were assessed using Likert-type items: food selection, meal planning and calorie recognition. Raw Likert scores in each dimension were transformed to percent scales to maximum (%SM). Participants' behavior in each dimension was categorized into healthy and unhealthy taking 66.7% SM score as a cutoff. Overall eating behavior was determined by aggregating ranks scored in the three dimensions. Correlates of overall eating behavior were identified using Chi-square test and multinomial logistic regression with statistical significance set at P-value < 0.05.

RESULT

Only 1% of the participants had overall healthy eating behavior. Yet, overall unhealthy eating was apparent in 54.4%. By dimensions, healthy eating behaviors in food selection, meal planning and calorie recognition were seen in 43.5, 7.4 and 2.9% participants, respectively. Factors that were positively associated with having healthy eating behavior in one dimension relative to unhealthy in all were: receiving nutrition education [AOR 1.73; CI 1.09, 2.74], female gender [AOR 1.78; CI 1.03, 3.08] & being in 26-44 age category [AOR 3.7; CI 1.56, 8.85]. But, being in the poor [AOR 0.42; CI 0.16, 1.32] or average [AOR 0.54; CI 0.19, 1.55] socioeconomic strata were negatively associated. However, only receiving nutrition education [AOR 3.65; CI 1.31, 10.18] was significantly associated with having healthy behavior in two eating dimensions over unhealthy in all.

CONCLUSION

In North Ethiopia, the overall eating behavior of adults with T2DM is extremely poor. Diverse and integrated approaches including nutrition education during consultation should be implemented to address the gap.

Recommended dietary practice and associated factors among patients with diabetes at Debre Tabor General Hospital, northwest Ethiopia: institutional-based cross-sectional study design

OBJECTIVE

This study aimed to assess dietary practice and associated factors among patients with diabetes attending the Debre Tabor General Hospital.

DESIGN

Institutional-based cross-sectional study.

SETTING

Amhara regional state, Debre Tabor General Hospital.

PARTICIPANTS

Patients with diabetes attending the diabetics' clinic.

MEASUREMENTS

The study was conducted from February to March 2016. Simple random sampling technique was used to select the study participants and data were collected using a pretested structured interviewer administered questionnaire. Patients' dietary practice was assessed using the general advice for diabetic plan containing 11 items. The data were entered using Epi Info V.7 and analysed using SPSS V.20. Binary logistic regressions analysis was used to identify factors associated with poor dietary practice. Adjusted ORs (AORs) with corresponding 95% CI and p˂0.05 were used to identify significant factors affecting poor dietary practice.

RESULTS

A total of 390 patients with diabetes were participated in the study making a response rate of 96.5%. The overall proportion of poor dietary practice was 55.4% (95% CI 50.8% to 60.5%). Respondents of rural residence (AOR 1.99, 95% CI 1.21 to 3.28), Not getting diabetic nutrition education (AOR 3.32, 95% CI 2.02 to 5.44), difficulty to determine what to eat (AOR 5.49, 95% CI 3.34 to 9.02), not having family/friends support (AOR 2.50, 95% CI 1.46 to 4.27), worried about high cost of foods (AOR 2.12, 95% CI 1.29 to 3.49) were significantly associated with poor dietary practice.

CONCLUSIONS

More than half of patients with diabetes were had poor dietary practice. Rural dwellers, not getting nutrition education, difficulty of choosing foods, not getting family/friends support and worried about high cost of foods were positively and significantly associated with poor dietary practice. Hence, integration of diabetic based nutrition education with motivation particularly for rural patients is highly recommended.

Systematic Review and Meta-Analysis of Good Self-Care Practice among People Living with Type 2 Diabetes Mellitus in Ethiopia: A National Call to Bolster Lifestyle Changes

Background

Self-care practice is the mainstay of management for good glycemic control. Despite the presence of a few pocket studies, no comprehensive study was conducted in Ethiopia to demonstrate the overall good self-care practice among diabetic patients in Ethiopia. Therefore, we intended to conduct this systematic review and meta-analysis to estimate the overall good self-care practice among people living with type 2 diabetes mellitus (T2DM) in Ethiopia.

Methods

We systematically searched PubMed, Scopus, Science Direct, Cochrane library, Google scholar, and direct Google to retrieve relevant studies. Forest plot was used to present the pooled estimate of good self-care practice using DerSimonian and Laird's random-effects model. We checked publication bias using Egger's test and funnel plot. Potential heterogeneity was tested using the I-squared statistic. Moreover, subgroup and sensitivity analyses were performed.

Results

In this review, 12 primary studies (with a total sample size of 4030) were included. Because of the presence of heterogeneity, we employed a random-effects model. After running the random-effects model, the pooled estimate of overall good self-care practice was 51.12% (95% CI: 41.90–60.34). Furthermore, the pooled estimate of good dietary practice was 50.18% (95% CI: 32.75–67.60), good physical exercise practice was 48.29% (95% CI: 34.14–62.43), the good footcare practice was 63.61% (95% CI: 45.56–81.66), and appropriate self-monitoring of the blood glucose level was 31.89% (95% CI: −4.62–68.41). In this meta-analysis, there was serious interstudy variation, but there was no publication bias.

Conclusions

The overall good self-care practice among people living with T2DM was low which necessitates the need for designing strategies to increase the self-care practice. The health sector has to bolster awareness creation to allow better plasma glucose control and preventing diabetes-related complications. This trial is registered with CRD42019147694.

Prevalence and associated factors of overweight/obesity among type2 diabetic outpatients in Southwest Ethiopia

PURPOSE

Type 2 diabetes mellitus is a major global health threat worldwide. Obesity and overweight is major risk factor for its development. This study aimed to assess the prevalence and associated factors of overweight/obesity among diabetic outpatients at Jimma Medical Center, Southwest Ethiopia.

METHODS

Hospital-based, cross-sectional study was conducted during March 02 to June 30, 2020 among systematically selected participants at the study area. Bivariable and multivariable binary logistic regression were used to identify the factors associated with outcome variable. Variables with a p value of<0.25 on bivariable logistic regression were considered candidates for multivariable regression. On multivariable logistic regression variables with p-value of <0.05 were considered as significantly associated with overweight/obesity.

RESULTS

A total of 334 participants with mean age of 51.42 ± 13.33 years were included in the study. The prevalence of overweight/obesity among the study population was 36.2%. According to multivariable logistic regression analysis, residence (AOR = 1.8, 95%CI:1, 3), higher income tercile (AOR = 3.4, 95%CI:1.8, 6.7), family history of overweight and obesity (AOR = 1.9, 95%CI:1.1,3.4), comorbid hypertension (AOR = 2.4, 95%CI:1.4,4) and physical inactivity (AOR = 2.1, 95%CI:1.2,3.5) were significantly associated with overweight/obesity.

CONCLUSION

There was a high prevalence of overweight/obesity among study participants. It was found that higher income tercile, residence, family history of overweight and obesity, comorbid hypertension and physical inactivity were significantly associated with overweight/obesity.

Determinants of Dietary Adherence Among Type 2 Diabetes Patients Aimed COVID-19 at the University of Gondar Comprehensive Specialized Hospital

BACKGROUND

People with diabetes are proving to be at higher risk of severe coronavirus infection than the general population. Non-adherence to dietary recommendation is a critical problem in individuals with type 2 diabetes; particularly, in the era of coronavirus. This study aimed to explore determinants that affect adherence to the recommendations of diet during coronavirus pandemic.

OBJECTIVE

This study aimed to determine dietary adherence among diabetes type 2 patients aimed at coronavirus pandemic and its associated factors.

METHODS

An institutional-based cross-sectional study was conducted among type 2 diabetes patients on follow-up. Systematic random sampling was employed to get representative study participants. Dietary adherence was dichotomized and with logistic regression analysis to assess the association between dependent and explanatory variables. The degree of association was interpreted by using both crude odds ratios and adjusted odds ratios with 95% confidence intervals and P-values <0.05 were considered statistically significant.

RESULTS

In this study, 576 participants took part with a 99.3% response rate. The dietary adherence was found to be 48.3% with [95% CI (44.1-52.4)]. The educational level of College and above was [AOR=3.64, 95% CI (1.59-8.34)], being a government-employed [AOR=2.38, 95% CI (1.13-4.99)], being urban [AOR=1.30, 95% CI (1.09-2.42)], family size of less than five [AOR=1.27, 95% CI (1.08-1.97)], medium level of wealth-status[AOR=2.26, 95% CI (1.67-4.54)], family history of diabetes [AOR=2.18, 95% CI (1.14-4.19)], duration of diabetes more than 15 years [AOR=5.39, 95% CI (1.57-18.52)], and knowledge related to coronavirus [AOR=4.33,95% CI (2.71-6.92)] were significantly associated with adherence to the dietary recommendation.

CONCLUSION

The dietary adherence was relatively low aimed at coronavirus pandemic. Knowledge about COVID-19 was found significantly associated with dietary adherence.

RECOMMENDATIONS

There has to be a strong commitment to aware the community to minimize the risk of coronavirus severity among diabetes patients. This could be through adherence to dietary recommendations of particularly in the era of coronavirus pandemic.

Dietary Association with Glycemic Status Among Adults Clinically Diagnosed with Type 2 Diabetes in Malawi

We elucidated diet and its association with glycemic status among adults clinically diagnosed with type 2 diabetes mellitus (T2DM) through across-sectional study in Malawi. Glycosylated hemoglobin (A1C) and dietary intakes were assessed. Consumption of cereals, roots, and tubers and sweet, sugary food, including sweetened beverages, was significantly higher among participants with A1C≥8%. Fruit and vegetable intake were disproportionately low overall. Consuming adiet high in carbohydrates (OR: 1.167; CI = 1.107-1.231; p < .001) and having <3 meals/day (OR: 2.680; CI = 1.445-4.970; p = .002) were both associated with A1C≥8%. Therefore, dietary interventions for T2DM focusing on carbohydrate counting, total dietary quality, and meal planning are needed in Malawi.

Meta-Analysis of the Therapeutic Effect of Shenqi Jiangtang Granule on Type 2 Diabetes Mellitus

Objective

To systematically evaluate the effectiveness of Shenqi Jiangtang granule (SQJT) in the treatment of type 2 diabetes.

Methods

We searched CNKI, Wanfang Data, VIP, and PubMed databases to collect randomized controlled trials (RCT) of Shenqi Jiangtang granules in the treatment of type 2 diabetes. The search time was from January 2014 to the present. Data were extracted, and quality was evaluated. Metadata analysis of the extracted data was carried out using RevMa5.2 software. The final results are expressed in relative risk (RR), mean difference (MD), and 95% CI.

Results

This study included a total of 13 studies, 1160 subjects. Meta-analysis results showed that the test group was better than the control group (RR = 1.26, 95% CI 1.18–1.34, P < 0.00001). The fasting blood glucose, postprandial blood glucose, and glycated hemoglobin of the test group were also significantly better than those of the control group.

Conclusion

Shenqi Jiangtang granules have a certain clinical effect and low adverse reaction rate for the treatment or adjuvant treatment of type 2 diabetes. At present, the drug has been widely used in clinical practice, but a large number of large-sample clinical trials are needed to further verify its specific efficacy and safety.

Perceived barriers and facilitators to diet and physical activity among adults diagnosed with type 2 diabetes in Malawi

Diet and physical activity are crucial to Type 2 diabetes mellitus (T2DM) self-management. However, socio-environmental, and cultural factors can impede lifestyle behaviours, and hence T2DM management. This study aimed to identify barriers, facilitators and support for diet and physical activity among adults with T2DM in Malawi selected from a larger clinical assessment study, conducted in urban and semi-urban public hospitals. Four focus group discussions were conducted, and audio-recorded, transcribed verbatim, coded, then organised and analysed using thematic analysis. Emergent themes included: family, friends, and health worker ties that facilitated both diet and physical activity as socio-support systems. Diabetes peer groups occurred more often in urban than semi-urban areas. Dietary barriers to self-management of T2DM included: cost and access to food; lack of knowledge on what and how much to eat; challenges of separate preparation and purchase of food; dilemmas of what to eat during functions and travel; and conflicting dietary information from different sources. Comorbidities and fear of public ridicule were key perceived barriers to participants being physically active. Therefore, socio-environmental factors should be considered by nutritionists, dietitians, and health workers when developing and providing nutrition and physical activity education to adults with T2DM in Malawi.

Dietary non-adherence and associated factors among individuals with diabetes who are on treatment follow up at Felege-Hiwot Referral Hospital, Northwest Ethiopia

Difficulty in adhering to the recommended diet is a common problem in individuals with diabetes mellitus (DM). Dietary non-adherence among diabetic individuals leads to diabetes related complication and death. As far as our search established, there is a scarcity of scientific evidence of dietary non-adherence of individuals with diabetes to the recommended diet in Ethiopia, specifically in the Northwest part of the country. Hence, this study aims to assess the dietary non-adherence and associated factors among individuals with diabetes at Felege-Hiwot Referral Hospital, Bahir Dar city, Northwest Ethiopia. An institution-based cross-sectional study was conducted on 385 systematically selected individuals with diabetes following their treatment from March to April 2017. Quantitative data were collected using a pre-tested and structured questionnaire. The dependent variable association with explanatory variables was determined using logistic regression. Statistical significance was considered at p-value <0.05 with 95% CI. The overall proportion of dietary non-adherence among participants was 46.8% (95% CI: 41.1-52.0). Living rurally (AOR = 3. 75; 95% CI: 2.12-6.63), duration of diabetes less than 5 years (AOR = 2. 81; 95% CI: 1.22-6.50), did not receive nutritional education (AOR = 5. 88; 95% CI: 3.30-10.48), poor social support (AOR = 3. 84; 95% CI: 1.74-8.46) and did not make choices when eating out (AOR = 3. 49; 95% CI: 2.09-5.81) were significantly associated with dietary non-adherence. Nearly half of the individuals with diabetes involved in this study did not adhere to the recommended diet. This problem could be addressed through the provision of nutritional education and strengthening social support to adhere to diabetes dietary recommendations. Therefore, health professional and nutritional educators should take appropriate action to increase the proportion of dietary adherence of individuals with diabetes.

Level of Adherence to the Dietary Recommendation and Glycemic Control Among Patients with Type 2 Diabetes Mellitus in Eastern Ethiopia: A Cross-Sectional Study

BACKGROUND

Dietary modification is the cornerstone and initial recommendation in the management of diabetes mellitus. Adhering to the recommended dietary practice has a significant role in diabetic control, but not uniformly practised.

OBJECTIVE

To assess dietary adherence and glycemic control among type 2 diabetic patients on follow-up at Dilchora Referral Hospital (DRH), Dire Dawa, Eastern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted from 22 August to 23 October 2019, at DRH. Data were collected through an interviewer-administered questionnaire. The Perceived Dietary Adherence Questionnaire (PDAQ) was used to estimate the level of dietary adherence. Glycemic control was measured using fasting blood glucose. Multivariate logistic regression analyses were employed to identify factors associated with dietary adherence.

RESULTS

Of the 307 included patients, 62.5% were poorly adherent to the recommended diet. Lack of dietary education (83.38%) and inability to afford a healthy diet (71.33%) were the perceived barriers to practice dietary recommendation. More than half (54.7%) failed to achieve the recommended fasting blood glucose target. In multivariate logistic regression, patients who were adherent to dietary recommendations were 3.56 times more likely to have good glycemic control. Those patients living in urban areas, having monthly income greater than 1000 Ethiopia Birr, family history of the disease, duration of treatment greater than 10 years and who received counseling were more likely to have good dietary adherence.

CONCLUSION

The level of adherence to the dietary recommendation and glycemic control was low. Healthcare providers should be proactive in tackling the barrier for non-adherence and should promote adherence to dietary recommendations in T2DM patients.

Facilitators and Barriers to Chronic Disease Self-Management and Mobile Health Interventions for People Living With Diabetes and Hypertension in Cambodia: Qualitative Study

Background

In many low- and middle-income countries (LMICs), heart disease and stroke are the leading causes of death as cardiovascular risk factors such as diabetes and hypertension rapidly increase. The Cambodian nongovernmental organization, MoPoTsyo, trains local residents with diabetes to be peer educators (PEs) to deliver chronic disease self-management training and medications to 14,000 people with hypertension and/or diabetes in Cambodia. We collaborated with MoPoTsyo to develop a mobile-based messaging intervention (mobile health; mHealth) to link MoPoTsyo’s database, PEs, pharmacies, clinics, and people living with diabetes and/or hypertension to improve adherence to evidence-based treatment guidelines.

Objective

This study aimed to understand the facilitators and barriers to chronic disease management and the acceptability, appropriateness, and feasibility of mHealth to support chronic disease management and strengthen community-clinical linkages to existing services.

Methods

We conducted an exploratory qualitative study using semistructured interviews and focus groups with PEs and people living with diabetes and/or hypertension. Interviews were recorded and conducted in Khmer script, transcribed and translated into the English language, and uploaded into Atlas.ti for analysis. We used a thematic analysis to identify key facilitators and barriers to disease management and opportunities for mHealth content and format. The information-motivation-behavioral model was used to guide data collection, analysis, and message development.

Results

We conducted six focus groups (N=59) and 11 interviews in one urban municipality and five rural operating districts from three provinces in October 2016. PE network participants desired mHealth to address barriers to chronic disease management through reminders about medications, laboratory tests and doctor’s consultations, education on how to incorporate self-management into their daily lives, and support for obstacles to disease management. Participants preferred mobile-based voice messages to arrive at dinnertime for improved phone access and family support. They desired voice messages over texts to communicate trust and increase accessibility for persons with limited literacy, vision, and smartphone access. PEs shared similar views and perceived mHealth as acceptable and feasible for supporting their work. We developed 34 educational, supportive, and reminder mHealth messages based on these findings.

Conclusions

These mHealth messages are currently being tested in a cluster randomized controlled trial (#1R21TW010160) to improve diabetes and hypertension control in Cambodia. This study has implications for practice and policies in Cambodia and other LMICs and low-resource US settings that are working to engage PEs and build community-clinical linkages to facilitate chronic disease management.

Level of self-care practice among diabetic patients in Ethiopia: a systematic review and meta-analysis

BACKGROUND

Diabetes Mellitus (DM) is increasingly become a serious global public health concern in developed and developing countries including Ethiopia. It imposes significant burden of care on the individual, health care professionals and health system. As the result, immense need of self-care behaviors in multiple domains like food choices, physical activity, foot care, and blood glucose monitoring is required. However, there is no national study on diabetic self-care practices in Ethiopia. This meta-analysis, therefore, aims to estimate the pooled level of self-care practice among individuals living with diabetes mellitus in Ethiopia.

METHODS

The systematic review was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. We systematically searched the databases: PubMed /MEDLINE, EMBASE, Google Scholar, and Science Direct for studies conducted in Ethiopia about self-care practice of diabetes patients. We have included all cross-sectional studies, which were published until August 20th,2019. Data were analyzed using STATA™ version 14.1 software, and the pooled prevalence with 95% confidence intervals (CI) were presented using tables and forest plots. The presence of statistical heterogeneity within the included studies was evaluated using I-squared statistic. We used Higgins and Egger's test to identify evidence of publication bias. The random-effects meta-analysis model was employed to estimate the pooled proportion of good diabetic self-care practices.

RESULTS

We included 35 studies (with 11,103 participants) in this meta-analysis. The overall pooled prevalence of good diabetes self-care behavior among diabetic patients was 49% (95% CI:43, 56%). When categorized by the major domains of diabetes self-care, the pooled estimate of dietary practice was 50% (95% CI:42, 58%), for self- monitoring of blood glucose was 28% (95% CI:19, 37%), for recommended physical activity was 49% (95% CI:38, 59%), and for diabetic foot-care was 58% (95% CI: 41, 74%).

CONCLUSION

More than half of diabetic patients in Ethiopia had poor diabetes self-care practice. High percentage of diabetic patients also had poor dietary practice, self- monitoring of blood glucose, physical activity, and diabetic foot care. Therefore, intervention programs should focus on improving the knowledge level of diabetic patients to improve the self-care practice of diabetic patients.

Prevalence and Predictors of Nonadherence to Diet and Physical Activity Recommendations among Type 2 Diabetes Patients in Southwest Ethiopia: A Cross-Sectional Study

BACKGROUND

Nonadherence to lifestyle modification recommendations is a major challenge in the management of diabetes mellitus. This study was conducted to measure the prevalence and predictors of nonadherence to diet and physical activity recommendations among type 2 diabetes patients (T2D).

METHODS

A cross-sectional study involving 322 type 2 diabetes patients was conducted from April 1 to June 30, 2019. Data were collected through face-to-face interviews using structured and pretested questionnaire. Data on sociodemographic, psychosocial, and clinical characteristics were collected. Descriptive analytical results were reported in text, tables, and figures. Logistic regression was conducted to identify predictors of nonadherence to diet and physical activity. Variables with p value ≤0.25 in bivariate logistic regression were considered as candidates for multivariable regression. Multivariate logistic regression was performed to identify independent predictors. Odds ratios and their 95% confidence intervals together with p value ≤0.25 in bivariate logistic regression were considered as candidates for multivariable regression. Multivariate logistic regression was performed to identify independent predictors. Odds ratios and their 95% confidence intervals together with.

RESULT

The rate of nonadherence to physical activity and diet was 64.3% and 36%, respectively. Female gender (AOR: 2.6, 95% CI [1.52-4.56]), age > 60 years (AOR: 2.9, 95% CI [1.12-7.42]), being illiterate (AOR: 4.2, 95% CI [1.86-9.73]), diabetes duration of >5 years (AOR: 2.5, 95% CI [1.42-4.41]), and lack of social support (AOR: 2.4, 95% CI [1.42-4.35]) were independent predictors of nonadherence to physical activity recommendations. Factors associated with nonadherence to dietary recommendations were being male (AOR = 2.8, 95% CI: [1.35-5.65]), age > 60 years (AOR = 6.3, 95% CI: [2.21-18.17]), khat chewing (AOR = 8.0, 95% CI: [3.86-16.7]), lack of social support (AOR = 15.26, 95% CI = [7.45-32.8]), and doctor's instructions or advice regarding diet (AOR = 8.9, 95% CI = [4.26-18.9]).

CONCLUSION

The rate of nonadherence to diet and physical activity recommendations was high in the study area. Predictors of nonadherence to physical activity are female gender, age > 60 years, being illiterate, diabetes duration of >5 years, and lack of social support. Predictors of nonadherence to diet are being male, khat chewing, lack of social support, and doctor's instructions or advice regarding diet.

Magnitude of overweight and associated factors among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia: a cross-sectional study

OBJECTIVE

To assess magnitude of overweight and associated factors among type 2 diabetes mellitus patients at Mekelle public hospitals, Tigray, Ethiopia.

RESULTS

A total of 365 participants were enrolled in this study. One hundred ninety-eight (54.2%) of the participants were males and 288 (78.9%) of the study participants were from an urban residence. In this study 161 (44.1%) and 12 (3.3%) of the study subjects were alcohol consumers and smokers respectively. Besides, 166 (45%) of the study participants had poor dietary intake and around 302 (82.7%) had low level of vigorous physical activity. The proportion of individuals who were overweight using body mass index as a measure was 149 (40.8%) and the proportion of individuals who had central obesity using waist circumference as a measure was 194 (53.2%). The magnitude of overweight among study participants from urban residence and alcohol consumers was 138 (92.6%) and 93 (62.4%) respectively. Residence area, alcohol consumption, physical activities, central obesity and dietary intake were the determinant factors for overweight among type 2 diabetes mellitus patients.

Determinants of hypertension among diabetic patients in Public Hospitals of the Central Zone, Tigray, Ethiopia 2018: unmatched case-control study

Introduction

Hypertension, among diabetic patients, is a worldwide public-health challenge and a leading modifiable risk factor for other cardiovascular diseases. The main purpose of this study was to identify determinants of hypertension among diabetic patients.

Methods

Data were collected from January to March 2018 using an interviewer-administered structured questionnaire. Data collectors and supervisors were trained before the period of data collection. The questionnaire was pretested on 5% of the sample at Suhul hospital. Bivariable logistic regression was employed to examine the crude associations between the outcome variable and determinant variables. This was followed by multivariable analysis to examine the determinants of hypertension among diabetic patients by selecting variables which had p value ≤0.2 in the bivariable analysis.

Results

The age range of the respondents was 18-80 years, with the median age of 51.56±14.92 years. Not attending diabetes mellitus education sessions (AOR=2.61, 95% CI (1.12,6.1), duration since diagnosis with diabetes (AOR=8.52; 95% CI (1.97, 36.84), poor glycemic control (AOR=22.99, 95CI (5.92,89.28), overweight (AOR=4.84, 95%CI (1.42,16.51), and non-adherence to diabetes medication (AOR=4.66, 95% CI (2.22,9.79), diet (AOR=9.70,95% CI (3.34,28.22), exercise (AOR= 5.47, 95% CI (2.35,12.75), and self-monitoring blood glucose (AOR=6.62, 95% CI (3.16, 13.86) were found to be the determinants of hypertension among diabetic patients.

Conclusion

This research concludes that longer duration with diabetes, nonattendance of diabetes education sessions, poor glycemic control, and not-adherence to antidiabetic medications, diet, exercise and self-monitoring blood glucose were found to be the determinants of hypertension among diabetic patients.

Exploring the barriers and facilitators of dietary self-care for type 2 diabetes: a qualitative study in Ghana

Background: There is an increasing prevalence of type 2 diabetes (T2D) globally and countries in Sub Sahara Africa, such as Ghana are contending with the epidemic. The main objective ofthis study was to explore the barriers and facilitators of T2D self-care as perceived by patients and health providers (HPs) in Ghana. Methods: A maximum variation sample of 33 adult patients with a range of demographic features, diabetic conditions and self-care regimens and 3 providers were purposely selected from the specialist diabetes clinic of a private hospital in Accra, Ghana. Data were collected using in-depth interviews, which were recorded and transcribed; and non-participant observational field notes-that were analyzed thematically through directed content analysis. Results: The findings reveal that T2D adult patients face many inter-related challenges to diabetes self-care, than enabling factors that fell into four major domains:1) the counselling process and context (patients missing follow-up appointments, unacceptance of diagnosis); 2)recommended food and diet regimens (changing habitual diets, dislike and confusion about recommended diets); 3) social aspects (social functions interfering with dietary regimens, family members diverting patient from dietary goals) and 4) fears (non-disclosure to family member/pretense of being well). Conclusion: Integrated self-management interventions are needed to address these barriers, including tailoring dietary education to patients' specific needs, guiding patients on how tomanage diet during social occasions and among family members; and as well, providing mental health support. Future research should focus on T2D self-care behaviours and practices outside the clinic, including home, work and shopping environments.

Adherence to dietary recommendation and associated factors among diabetic patients in Ethiopian teaching hospitals

Introduction

Dietary management is considered to be one of the cornerstones of diabetes care. Improvement of dietary practice alone can reduce glycosylated hemoglobin (HbA1c) by an absolute 1 to 2% with the greatest impact at the initial stages of diabetes.

Methods

Data from Hospital based cross sectional study were used to assess the level of dietary adherence and its determinants among diabetic patients. The morisky 8 item medication adherence scale was used to develop 10 item tool for evaluation of dietary adherence. Multiple logistic regression was conducted to identify factors which affect dietary adherence and variables with P vale < 0.05 were considered statistically significant.

Results

More than half of 303 participants (55.7%) were found to be non-adherent to the recommended dietary approach. Gathering with family and friends and eating out were the major reasons for not being compliant with the recommended regimen. Attending diabetic nutrition education (AOR=2.8 95% C 1.97, 5.61) and having the disease for more than 10 years (AOR 2.9 95% CI 1.32, 5.84) were statistically significant with adherence to dietary recommendation.

Conclusion

Non-adherence to recommended dietary practice was observed in more than fifty percent of patients; it is therefore a major public health problem. Attending diabetic nutrition education and length of diabetes greater than 10 years were the factors associated with adherence to dietary recommendation. This findings indicate that it is important to design strategies to help patients understand their dietary regimens and improve their adherence.

Predictors of self-care activities of outpatient diabetic residents in Harar and Dire Dawa: A hospital-based cross-sectional study

OBJECTIVES

Diabetes mellitus is a metabolic disorder of major public health importance due to its prevalence and potential health complication. The success of long-term maintenance therapy of diabetes patients depends largely on their ability to adherence to self-care practices. Africa's most populous country, Ethiopia, has the highest burden of diabetes mellitus. However, studies on self-care activities of diabetic patients are limited. Therefore, this study measures the level of self-care activities of diabetic patients in a follow-up clinic of public hospitals in Harar and Dire Dawa, Eastern Ethiopia.

METHODS

A hospital-based cross-sectional study was conducted on 320 randomly selected diabetic patients in Harar and Dire Dawa. A standard diabetic self-care activity interview tool was used to collect the data. Data were entered into Epi-data v 3.1 and STATA v 14.2 was used for analysis. Our outcome variable, self-care activities, has three ordered categories and a robust Ordinal logistic regression was used to identify predictors. All statistical tests with p-value <0.05 were considered as statistically significant.

RESULTS

The self-care activities of study participants were rated good for 38.1% (95% confidence interval: 32.94, 43.60). Being rural residents (adjusted odds ratio = 0.38, 95% confidence interval: 0.17, 0.82), attended secondary education (adjusted odds ratio = 2.96, 95% confidence interval: 1.51, 5.78), uncontrolled blood glucose (adjusted odds ratio = 1.68, 95% confidence interval: 1.02, 2.79), and had diabetic complications (one, adjusted odds ratio = 1.91, 95% confidence interval: 1.08, 3.38; two or more, adjusted odds ratio = 4.71, 95% confidence interval: 1.81, 12.25) were significantly associated with the better diabetes mellitus self-care activities.

CONCLUSION

Significant number of diabetes mellitus patients living in rural areas did not adhere to diabetic self-care activities. This is more evident among participants who have limited or no formal education and patients with controlled blood glucose level. Therefore, individualized diabetic lifestyle education programs in follow-up clinics should target these population groups to improve self-care.

Factors associated with glycaemic control in patients with diabetes mellitus: A systematic literature review

OBJECTIVES

To perform a systematic review search and critically review the empirical evidence concerning the factors affecting glycaemic control in patients with type 1 or 2 diabetes mellitus.

BACKGROUND

Previous primary studies have investigated the factors associated with glycaemic control among patients with type 1 or 2 diabetes, but attempts to amalgamate these evidences have been methodologically limited. Hence, a robust review of the evidence is essential to explore factors that can be addressed to promote good glycaemic control in patients with diabetes.

DESIGN

Mixed-method systematic review using the Preferred Reporting Items for Systematic review and Meta-Analysis 2009 flow diagram, integrating evidence from qualitative and quantitative studies (see Supporting Information File S1).

METHODS

A systematic review of the literature published between 2006-2017 was conducted in seven electronic databases (CINAHL, MEDLINE, Scopus, EMBASE, PsycINFO, PubMed and ScienceDirect) using the search terms "diabetes mellitus," "glycemic control," "self-concept," "knowledge," "self-efficacy," "empowerment," "race," "ethnicity," "duration," "medication," "obesity" and "comorbidity."

RESULTS

A total of 1,582 articles were initially retrieved, and 24 of these articles were included in this systematic literature review. The overall empirical evidence suggested that higher socio-economic status, greater dietary knowledge, and higher self-efficacy and empowerment improve glycaemic control among patients with diabetes mellitus.

CONCLUSIONS

This review presented the factors associated with glycaemic control that may pose significant socio-economic problems to most nations worldwide and impede development nationally, regionally and even globally. Greater emphasis needs to be placed on implementing lifestyle changes on a societal level to stem the tide of the epidemic.

RELEVANCE TO CLINICAL PRACTICE

There is a need to implement self-management initiatives, that incorporate dietary knowledge, to empower patients with diabetes in their own care. Future public health policy must be geared towards increasing the capability of dealing with the rising incidence of diabetes and implementing primary prevention.

Development and psychometric evaluation of the diabetic Men's dietary behaviors inventory based on the theory of reasoned action

Background

Unhealthy dietary behaviors have progressively increased the prevalence of diabetes mellitus. Thus, assessing such behaviors and their associated beliefs by valid measurement tools seems essential. This study sought to develop and evaluate the psychometric properties of the Diabetic Men’s Dietary Behaviors Inventory based on the Theory of Reasoned Action.

Methods

Initially, a preliminary 78-item inventory on diabetic men’s dietary beliefs and behaviors was developed based on the six constructs of the Theory of Reasoned Action. Then, psychometric evaluation methods were employed to select the most appropriate items and also to validate the inventory. The validity of the inventory was assessed through face, content, and construct validity assessment. For construct validity assessment, a sample of 206 diabetic men was selected from two educational, research and healthcare settings located in Isfahan, Iran. The inventory was completed for all men through interviewing them. The reliability of the inventory was evaluated through internal consistency assessment.

Results

The preliminary inventory contained 78 items, 33 of which were excluded during the phases of psychometric evaluation. Exploratory factor analysis revealed a five-factor structure for the inventory; the factor loads ranged from 0.41 to 0.80. All items were significantly correlated with the inventory. Cronbach’s alpha values of all factors were greater than 0.6, denoting the high internal consistency of the inventory.

Conclusion

The Diabetic Men’s Dietary Behaviors Inventory is a valid and reliable instrument for evaluating diabetic men’s dietary perceptions and behaviors.

Level of adherence to dietary recommendations and barriers among type 2 diabetic patients: a cross-sectional study in an Ethiopian hospital

Background

Limited data are available regarding the level of adherence and barriers to dietary recommendations in individuals with type 2 diabetes in Africa including Ethiopia. Therefore, this study aimed at assessing the level of dietary adherence and its barriers among patients with type 2 diabetes in northwest Ethiopia.

Methods

A prospective hospital-based cross-sectional study was conducted from August to October 2017 at Debre Tabor General Hospital, Northwest Ethiopia. The Perceived Dietary Adherence Questionnaire (PDAQ) was used for dietary adherence measurement. Multivariate logistic regression was done to identify the barriers influencing dietary adherence.

Result

A significant percentage (74.3%) of the study participants had poor adherence to dietary recommendations. The highest mean score was obtained for the question regarding consuming foods high in sugar with a mean 5.49 ± 1.20 times a week. On the other hand, our participants had a low consumption of fruits and vegetables and foods high in omega-3 fats with a mean of 1.84 ± 1.96 and 0.1 ± 0.62 times a week respectively. According to the survey of participants, lack of knowledge, lack of diet education, inability to afford the cost of healthy diet and poor awareness about the benefit of dietary recommendations were the most cited reasons for poor dietary adherence. In multivariate logistics regression, low level of educational status, the presence of co-morbidities, lack of previous exposure to dietary education and low monthly income were statistically significant factors associated with non-adherence.

Conclusion

The rate of non-adherence to dietary recommendation among patients with T2DM was found to be high in northwest Ethiopia. Hence, providing customized health education about the potential benefit of proper dietary recommendations in controlling blood glucose is recommended. Health care providers should be proactive in promoting adherence to dietary recommendations in patients with T2DM.

Dietary practice and associated factors among type 2 diabetic patients in Felege Hiwot Regional Referral Hospital, Bahir Dar, Ethiopia

OBJECTIVE

Even if patient's dietary practice is a gold standard measure to manage type 2 diabetes, there is a limited study in the area. Therefore, the objective of this study was to assess dietary practice and associated factors among type 2 diabetic patients.

RESULT

The study revealed that only 35.9% of the patients had good dietary practice. Attending above primary education [AOR = 1.9, 95% CI (1.1, 3.2)], having family support [AOR = 2.6, 95% CI (1.6, 4.2)], and receiving nutrition education [AOR = 2.5, 95% CI (1.5, 4.2)] were independent predictors for good dietary practice. Thus, the findings indicate the need to improve a method of nutrition education both for the patients and their families. Moreover, the government needs to improve literacy rate of citizens.

Adherence to and factors associated with self-care behaviours in type 2 diabetes patients in Ghana

BACKGROUND

Previous research has failed to examine more than one self-care behaviour in type 2 diabetes patients in Ghana. The purpose of this study is to investigate adult Ghanaian type 2 diabetes patients' adherence to four self-care activities: diet (general and specific), exercise, self-monitoring of blood glucose (SMBG) and foot care.

METHODS

Consenting type 2 diabetes patients attending diabetes outpatient clinic appointments at three hospitals in the Tamale Metropolis of Ghana completed a cross-sectional survey comprising the Summary of Diabetes Self-Care Activities Measure, and questions about demographic characteristics and diabetes history. Height and weight were also measured. Multiple linear regression analyses were conducted to identify the factors associated with adherence to each of the four self-care behaviours.

RESULTS

In the last 7 days, participants exercised for a mean (SD) of 4.78 (2.09) days and followed diet, foot care and SMBG for a mean (SD) of 4.40 (1.52), 2.86 (2.16) and 2.15 (0.65) days, respectively. More education was associated with a higher frequency of reported participation in exercise (r = 0.168, p = 0.022), following a healthy diet (r = 0.223, p = 0.002) and foot care (r = 0.153, p = 0.037) in the last 7 days. Males reported performing SMBG (r = 0.198, p = 0.007) more frequently than their female counterparts.

CONCLUSION

Adherence to diet, SMBG and checking of feet were relatively low. People with low education and women may need additional support to improve adherence to self-care behaviours in this type 2 diabetes population.