Dietary adherence amongst adults with type 2 diabetes mellitus : a South African urban population perspective

Abstract

Non-communicable diseases are on the increase and expected to be the most common cause of death by the year 2030. Non-communicable diseases and in particular type 2 diabetes mellitus (T2DM) can be managed effectively to prevent or delay the onset of microvascular and macrovascular complications and improve morbidity and mortality outcomes. T2DM can be managed effectively with improved lifestyle behaviours including heathier food choices, physical activity, and destressing techniques together, in some cases, with pharmaceutical treatment. However, the prevalence of non-adherence to recommended behaviour changes is high. Understanding factors that motivate and challenge the patient with T2DM (T2DM) to change lifestyle will help health professionals design interventions that are sustainably adhered to. The association between dietary adherence and glucose control and metabolic risk was assessed, and factors associated with non-adherence to dietary recommendations were identified. A structured questionnaire and focus group discussions (FGDs) were used to collect data. Data was analysed using SPSS21 and recordings from FGDs were themed. Ninety-one patients with T2DM attending two private diabetes clinics in Gauteng, South Africa were targeted to answer the structured questionnaire in a short interview. Of these participants, 37 also participated in the FGDs. A quantitative analysis of diabetes-related biochemical markers was undertaken. The biomarkers included glycated haemoglobin (HbA1c), lipid profile, and microalbuminuria (MAU), as well as an assessment of dietary quality which was used to identify a dietary adherence score. A qualitative analysis of factors influencing dietary adherence was done. In this study combined low and intermediate adherence to dietary recommendations was 77%. No significant association was found between dietary adherence and the various variables. Glucose control was also suboptimal. Only 32% of the group achieved a recommended HbA1c of less than 7%. This is similar to other South African studies. The main challenges to adherence included difficulty in breaking habits and resisting temptation, challenges in eating out, and feeling the dietary guidelines are too restrictive. The main motivators to adhering to dietary guidelines included the desire to attain and maintain good health and prevent the disease worsening, seeing positive results when actively doing what is recommended, having a good support system, and being persistent in making lifestyle changes so that eating well becomes a habit. These factors that were found to influence non-adherence are similar to those found in other studies. Non-adherence to dietary recommendations in over two thirds of the target population is of concern since non-adherence to recommended behavioural changes could have detrimental effects on the progression of the disease and also increases the requirements for pharmaceutical interventions at an added cost to the health industry. Adherence to recommended medication is also questionable but a separate issue. Health professionals should utilise this information to understand how to better assist a patient to adhere to diet