Adherence to Diabetes Dietary Guidelines Assessed Using a Validated Questionnaire Predicts Glucose Control in Adults With Type 2 Diabetes

Social network interventions for dietary adherence among adults with type 2 diabetes: a systematic review and meta-analysis protocol

INTRODUCTION

Optimal adherence to recommended diets is crucial to achieving long-term glycaemic control among individuals with type 2 diabetes (T2D) individuals. However, there is limited evidence on the effectiveness of interventions that target dietary adherence through social networks. Since social networks can influence individuals' health behaviours, it is important to thoroughly evaluate the impact of social network interventions on dietary adherence in adults with T2D. This systematic review protocol aimed to provide insights into future interventions and improve diabetes management strategies.

METHOD AND ANALYSIS

PubMed, Embase, CINAHL Complete, Cochrane Central Register of Controlled Trials, ProQuest Dissertations and Theses and Google Scholar will be searched from inception to December 2023 for relevant randomised and non-randomised controlled trials of at least 3 months' duration. In addition, studies that compared interventions involving the social networks (families, friends and peers) of adults with T2D with usual care, no intervention or an intervention with no explicit social network component will be included. Two reviewers will independently screen search outputs according to inclusion and exclusion criteria, critically evaluate the selected literature and extract data on the study setting, design, participants' characteristics, interventions, controls, social network functions and duration of follow-up, using a standard data extraction form. Quantitative data analysis will be performed where studies are homogeneous in characteristics and provide adequate outcome data for meta-analysis. Otherwise, data will be synthesised using narrative synthesis. Finally, trials will be assessed for bias risk and overall evidence certainty using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system.

ETHICS AND DISSEMINATION

Ethical approval is not required for literature-based studies. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023441223.

Self-care behaviors, medication adherence status, and associated factors among elderly individuals with type 2 diabetes

Elderly individuals face an increased likelihood of developing chronic diseases such as diabetes. Self-care practices and medication adherence play crucial roles in preventing complications and adverse effects of this condition. Therefore, this study aimed to determine self-care behaviors, medication adherence status, and related factors among elderly patients with type 2 diabetes. This descriptive-analytical study was conducted on 374 elderly patients with type 2 diabetes who visited educational healthcare centers in Qazvin, Iran, during 2023 (March-September). Sampling was performed using the convenience method. Data collection instruments included a demographic characteristics checklist, the summary of diabetes self-care activities questionnaire, and the Morisky medication adherence scale. Data analysis was conducted using SPSS-22 software, employing the Kolmogorov-Smirnov test, mean, standard deviation, univariate and multivariate regression analyses. The significance level was set at p ≤ 0.05. The mean age of participants was 67.56 ± 5.93 years. In the self-care questionnaire, the highest score pertained to adherence to the diet recommended by the treating physician (3.16 ± 1.87). In contrast, the lowest scores were related to the frequency of checking inside shoes (0.17 ± 0.93) and foot examination (0.31 ± 1.07), respectively. Furthermore, results in self-care behaviors indicated that with increasing education levels, self-monitoring of blood glucose (SMBG) significantly decreased (P = 0.048). This variable was considerably higher in rural residents than in urban dwellers (P = 0.016). Additionally, the frequency of blood glucose measurements was significantly higher in urban residents than in rural inhabitants (p = 0.006). Based on the results, the mean score for medication adherence among patients was 5.53 ± 1.65. Based on our findings, the level of self-care in physical activity, SMBG, and foot care among the elderly is below average. Furthermore, medication adherence in these patients is poor. We expect that managers and policymakers take steps to reduce complications and improve these two variables by developing educational programs on self-care and emphasizing the importance of treatment adherence for these patients.

Precision nutrition for type 2 diabetes in Benin: leveraging linear goal programming to optimize diets with emphasis on adequacy, affordability, accessibility, and culture

Background

Nutrition and diet are critical to managing Type 2 diabetes (T2D). Low-income households often face challenges maintaining a healthy and balanced diet due to food insecurity, availability, and cost. To address this issue, we used a linear goal programming (LGP) model to develop nutritionally adequate, affordable, accessible, and culturally acceptable diets for persons with T2D in Benin, a French-speaking sub-Saharan country. The goal was to help persons with T2D manage their condition more effectively.

Methods

We compiled a robust list of local commonly consumed foods in Benin, and calculated their nutritional value using West African food composition tables and food costs per serving from a market survey. Using mathematical optimization techniques, we designed dietary plans that meet the daily nutrient intake recommended by the World Health Organization (WHO) to prevent chronic diseases in normal adults. While adhering to dietary constraints of T2D, we developed optimized diet plans with varying energy levels that meet all nutrient requirements while considering availability, acceptability, and budgetary constraints.

Results

Fifty-two food items and recipes were evaluated to create six low-cost daily menus. Menu 1 was the most affordable at CFA 1,127 (USD 1.88), providing 1890 kcal of energy, while Menu 6 was the most expensive at CFA 1,227 (USD 2.05), providing 1749 kcal. All the menus met the daily WHO minimum requirements for carbohydrates, fat, cholesterol, and fiber content, while other nutrients such as protein, vitamin C, and iron reached the upper limits of the acceptable value range.

Conclusion

Linear goal programming can be an effective tool in helping to obtain optimized adequate, accessible, and culturally acceptable diets at minimal cost by interpreting and translating dietary recommendations into a nutritional model, based on local market prices.

Investigating the relationship between inhibitory control and dietary adherence among patients with type 2 diabetes mellitus based on subjective and objective measures

BACKGROUND

Dietary management has been recommended as the cornerstone of type 2 diabetes mellitus (T2DM) management. However, low adherence to dietary recommendations has been identified in both developed and developing countries. Previous research suggests that inhibitory control influences eating behavior, but few studies have been conducted in patients with T2DM. Thus, we aimed to explore the relationship between inhibitory control and dietary adherence among patients with T2DM.

METHODS

A total of 393 patients with T2DM from the endocrinology departments of three tertiary hospitals in China were enrolled by the convenience sampling method. Dietary adherence was measured by the Dietary Behavior Adherence Scale for Patients with Type 2 Diabetes Mellitus. Additionally, inhibitory control was subjectively measured by the Behavior Rating Inventory of Executive Function-Adult version (BRIEF-A) and objectively assessed by the stop signal task (SST) and the Stroop task. The relationship between inhibitory control and dietary adherence was analyzed using Pearson correlation analysis and hierarchical regression analysis.

RESULTS

Subjectively measured inhibitory control had a significant predictive effect for dietary adherence after controlling for demographic and clinical variables. Adding the inhibitory control variable to the regression equation resulted in the following values: overall model F (19, 373) = 7.096, p < 0.001, increase in R2 value by 0.069, change in F (1, 373) = 35.219, p < 0.001. Similarly, the performance of the Stroop task had a significant predictive effect for dietary adherence to some foods, i.e., carbohydrate and fat. Adding the Stroop effect variable to the regression equation resulted in the following values: overall model F (19, 81) = 2.848, p = 0.005, increase in R2 value by 0.060, change in F (1, 81) = 8.137, p = 0.006.

CONCLUSIONS

Inhibitory control was a predictor of dietary adherence in patients with T2DM. Future interventions should investigate whether inhibitory control training results in the improvement of dietary adherence in patients with T2DM.

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.

Self-care adherence and affective disorders in Barbadian adults with type 2 diabetes

Purpose

Diabetes management requires adherence to complicated self-care behaviors. Therefore, the emotional state of the individual living with diabetes, is likely to affect their ability to comply with recommendations. This study explored the relationship of self-care adherence to diabetes distress and depression in Barbadian adults with type 2 diabetes.

Methods

Adults aged 20 to 80 years, with type 2 diabetes, completed self-report questionnaires comprised of a profile section consisting of demographic and clinical characteristics; and standardized questionnaires comprising, The Diabetes Distress Scale (DDS), The Patient Health Questionnaire (PQH-9), and the Summary of Diabetes Self-care Activities Scale (SDSCA). Additionally biological measures (BP and HbA1c) were collected.

Results

For the 509 participants there were no differences in adherence for males (30.8%) and females (69.2%), high diabetes distress and depression were associated with low adherence. General diet was negatively associated with BP and HbA1c; while HbA1c was positively correlated with blood glucose testing.

Conclusion

Self-care non-adherence is more than a behavioral problem; it is a multidimensional phenomenon inclusive of demographic factors, condition or disease factors, psychological and social factors.

Adherence to a healthy dietary pattern is associated with greater anti-oxidant capacity and improved glycemic control in Iraqi patients with Type 2 Diabetes

BACKGROUND: Healthy dietary patterns are typically associated with improved metabolic and cardiovascular health in population-based cohorts. This study aims to investigate whether a healthy dietary score, derived from UK Diabetes and Diet Questionnaire (UKDDQ), is significantly associated with measures of metabolic health and nutritional status in patients with T2DM. METHODS: This cross-sectional study included 85 patients with T2DM (age: 51.7±9.4, BMI: 30.6±5.3) and 20 healthy volunteers (age: 48.4±8.6, BMI: 29.5±5) recruited from the Al-Hassan Diabetes and Endocrinology Specialized Center, Karbala, Iraq. Body weight, height and body mass index (BMI) and resting clinic blood pressure were measured. All participants completed the UKDDQ to assess the quality of the diet. Metabolic and nutritional biomarkers were measured in fasting blood samples. A composite nutritional heathy index score (CNHI-score) based on the sum of z-scores for plasma vitamin A, C and E concentrations was derived. RESULTS: In patients with T2DM the UKDDQ score was associated with lower fasting blood glucose (FBG) (r = –0.33; P <  0.01), hemoglobin A1C (r = –0.49; P <  0.001), total cholesterol (TC) (r = –0.26; P = 0.02) concentrations. In patients with T2DM, the CNHI-score significantly associated with UKDDQ (r = 0.43; P <  0.001). In addition, a higher CNHI-score was associated with FBG (r = –0.61; P <  0.001), HbA1C (r = –0.83; P <  0.001), TC (r = –0.30; P <  0.01) and triglyceride (r = –0.30; P <  0.01) concentrations. CONCLUSIONS: A healthy diet is associated with a higher concentration of anti-oxidant vitamins and better glycemic and lipid profile in healthy subjects and in patients with T2DM.

Low Reported Adherence to the 2019 American Diabetes Association Nutrition Recommendations among Patients with Type 2 Diabetes Mellitus, Indicating the Need for Improved Nutrition Education and Diet Care

Patient adherence to guidelines is important for improved outcomes and prognosis. Nevertheless, many patients with type 2 diabetes mellitus (T2DM) do not comply with the recommendations regarding medication, physical activity, diet or self-care. The present cross-sectional study aimed to assess the level of adherence to the dietary recommendations issued by the American Diabetes Association (ADA) among patients with T2DM in Komotini, Greece. A total of 162 adults with T2DM (64.7 ± 10.6 years old), of which 41.4% were men, were recruited from the Sismanoglio Hospital and participated in the study. The level of adherence to individual recommendations issued by the ADA was assessed using yes/no questions. The overall adherence rate to the guidelines was low (41.2%). According to the multivariable analysis, age and medication therapy were identified as contributors to the compliance rate. No differences were noted in the total compliance rate between patients of different religious denominations (Muslims/Christians). Patients on oral antidiabetic agents (OAA) were more adherent compared with those on insulin therapy. A mere 3.7% of the participants had received nutrition education by a registered dietitian, 9.9% were following an individualized diet plan to improve glycemia, and 3.1% had set specific energy goals to reduce body weight. These findings are indicative of the need for the delivery of improved nutrition education.

Validation of an instrument to measure adherence to type 2 diabetes management

Background Adherence to type 2 diabetes management is defined as the extent to which the behaviour of a person matches the one recommended by health care professionals. Control of this disease depends on adherence to diabetes management, which includes monitoring blood glucose levels, adopting a healthy diet, exercising, taking medication, quitting smoking, and undergoing psychosocial care and periodic check-ups. This can also prevent health complications and reduce medical costs. Objective The objective of this study is to validate a culturally appropriate instrument directed towards the Mexican population that measures a patient's level of adherence to their type 2 diabetes mellitus management. Method The study design was cross-sectional. The instrument was applied individually (face to face researcher-assisted survey) by a member of the team. The study sample included 200 participants, which were attended at an outpatient clinic. To evaluate the psychometric validity of the scale we calculated response frequencies, the discrimination of items for extreme groups, the validity, and the internal reliability. The scale of adherence for complete management in patients with type 2 diabetes includes disease monitoring, complication prevention, and social support using questions and answers based on the Likert scale, corresponding to the 5 stages of the transtheoretical model. Main outcome measure The validity and internal reliability of the instrument to measure adherence to type 2 diabetes management, which proved to be justifiable and reliable with a Cronbach's alpha of 0.92 and a total explained variance of 65.03%. Results The instrument was composed of 29 items and 6 factors: adherence to medical Cronbach's alpha = 0.92 and dietary treatment Cronbach's alpha = 0.88, change in dietary habits Cronbach's alpha = 0.89, adherence to physical activity and exercise Cronbach's alpha = 0.84, social support Cronbach's alpha = 0.79, and prevention of complications Cronbach's alpha = 0.70. The instrument obtained a content validity index (I-CVI) of 0.9. Conclusion The proposed instrument, which includes factors that measure adherence in type 2 diabetes mellitus patient's management, using the transtheoretical model of behaviour change to simultaneously identify patient motivation to change their lifestyle, is valid and reliable.

Medication adherence and self-care behaviours among patients with type 2 diabetes mellitus in Ghana

BACKGROUND

Diabetes often coexists with other medical conditions and is a contributing cause of death in 88% of people who have it. The study aimed at evaluating medication adherence, self-care behaviours and diabetes knowledge among patients with type 2 diabetes mellitus in Ghana.

METHODS

A total of 330 participants were recruited into the study from three public hospitals in the Tamale metropolis. A validated medication adherence questionnaire and the Summary of Diabetes Self-care Activities tool were used to assess medication adherence and self-care activities respectively. Logistic and linear regressions were used to determine factors positively associated with non-adherence to medication and self-care behaviours respectively.

RESULTS

Of the 330 participants whose data were analysed, the mean (SD) age was 57.5 (11.8) years. The majority (84.5%) were adherent to anti-diabetes medication. Participant's age, educational level, and practice of self-care behaviours influenced adherence to anti-diabetes medication. Participants aged 70 years and above were 79% less likely to be non-adherent to medication as compared to those below 50 years [OR = 0.21 (95%CI: 0.06-0.74), p = 0.016]. Participants with senior high school education were 3.7 times more likely to be non-adherent to medication than those with tertiary education [OR = 3.68 (95%CI: 1.01-13.44), p = 0.049]. Participants with tertiary education had an increase in the level of practice of self-management by 1.14 (p = 0.041). A unit increase in knowledge score also increased the level of practice of self-management by 3.02 (p<0.001).

CONCLUSION

The majority of participants were adherent to anti-diabetes medication. Non-adherence to medication was associated with younger age and low level of education. Interventions to improve adherence should target younger and newly diagnosed patients through aggressive counselling to address healthy self-management behaviours.

Defining modifiable barriers to uptake of dietary recommendations in Chinese immigrants with type 2 diabetes: a qualitative study

The objective is to support development of a nutritional intervention for Chinese immigrants with diabetes by defining current deficiencies and identifying modifiable factors and mechanisms of change. Semi-structured interviews conducted with 13 ethnic Chinese with type 2 diabetes identified modifiable problems related to culturally relevant diabetes resources and low cultural acceptability of recommended diets. These factors could be addressed through creation of resources developed in partnership with Chinese-speaking health care professionals and persons with diabetes.

Diabetes and Diet: Purchasing Behavior Change in Response to Health Information

Individuals with obesity and related conditions are often reluctant to change their diet. Evaluating the details of this reluctance is hampered by limited data. I use household scanner data to estimate food purchase response to a diagnosis of diabetes. I use a machine learning approach to infer diagnosis from purchases of diabetes-related products. On average, households show significant, but relatively small, calorie reductions. These reductions are concentrated in unhealthy foods, suggesting they reflect real efforts to improve diet. There is some heterogeneity in calorie changes across households, although this heterogeneity is not well predicted by demographics or baseline diet, despite large correlations between these factors and diagnosis. I suggest a theory of behavior change which may explain the limited overall change and the fact that heterogeneity is not predictable.

Adherence to riluzole in patients with amyotrophic lateral sclerosis: an observational study

OBJECTIVE

Riluzole is the first drug approved to treat amyotrophic lateral sclerosis (ALS). Recently, an oral suspension (OS) of riluzole was made available. Thus, the aim of our study was to evaluate the adherence to 2 formulations of riluzole in patients with ALS.

PATIENTS AND METHODS

We enrolled 45 consecutive patients with ALS. At disease diagnosis, riluzole was prescribed in 2 different formulations depending on the severity of dysphagia (27/45 patients received tablets and 18/45 patients received OS). Side effects (SEs) and treatment adherence were investigated using a clinical questionnaire including the ©Morisky 8-item Medication Adherence Questionnaire.

RESULTS

Gastroenteric complaints were the most frequent SEs (58% in the tablet group and 48% in the OS group), followed by those at the nervous system (29% and 40%, respectively). No serious SEs related to treatment were reported. The rate of adherence to riluzole was independent of the formulation of the drug and consistent with other medications assumed for comorbidities (p=0.004). In the tablet group, low adherence was caused by SEs in 55.6% and by dysphagia in 44.4% of patients. In the OS group, SEs caused low adherence in 75% of patients. Independently of the drug formulation, patients with high or medium adherence to riluzole had a higher progression rate (p=0.002 and p=0.009, respectively) and a shorter time to generalization (TTG; p=0.01), compared to those with low adherence.

CONCLUSION

Gastroenteric symptoms were the most frequent SE related to tablet as well as OS. The rate of adherence was independent of the formulation of riluzole and the number of medications assumed for comorbidities, and it was consistent with the severity of the disease. The low adherence was caused by dysphagia and SEs in the tablet group, whereas it was caused prevalently by SEs in the OS group.

Food sources of sodium, saturated fat, and added sugar in the Physical Activity and Nutrition for Diabetes in Alberta (PANDA) trial

Diabetic patients may find it difficult to achieve recommended nutrient intakes embedded within dietary guidelines. The objective of this analysis was to document total sodium, saturated fat, and added sugar intake as well as the main food sources of these nutrients in Canadian adults with type 2 diabetes before and after an intervention focused on healthy eating. Participants were enrolled in a single-arm dietary intervention trial designed to improve glycemic control and adherence to dietary recommendations. A 4-week menu plan and recipes were provided for participants along with a 6-week educational curriculum. Three repeated 24-h dietary recalls were collected at baseline and 3 months. Food sources of sodium, saturated fat, and added sugar were a secondary outcome derived from the dietary recalls. After 3 months, there was a reduction (p < 0.05) in sodium intake of 561 mg/day, which was mainly due to reduced consumption of processed meats, soups, and condiments. Significantly lower intake of processed meat contributed to -2.9 g/day saturated fat intake (p < 0.1) while added sugar intake declined by 7 g/day (p < 0.1), which was due to lower consumption of baked goods/desserts and chocolate (both p < 0.05). The intervention was beneficial for type 2 diabetes patients in terms of changing dietary habits. However, the majority of the participants still exceeded the dietary guidelines for sodium and saturated fat. In addition to the efforts of individuals and their healthcare providers, strategies to increase the nutritional quality of prepared foods could provide widespread benefits.