Dietary intake and barriers to dietary compliance in black type 2 diabetic patients attending primary health-care services

Abstract

Objective: To determine the dietary intake, practices, knowledge and barriers to dietary compliance of black South African type 2 diabetic patients attending primary health-care services in urban and rural areas. Design: A cross-sectional survey. Dietary intake was assessed by three 24-hour recalls, and knowledge and practices by means of a structured questionnaire (n ¼ 133 men, 155 women). In-depth interviews were then conducted with 25 of the patients to explore their underlying beliefs and feelings with respect to their disease. Trained interviewers measured weight, height and blood pressure. A fasting venous blood sample was collected from each participant in order to evaluate glycaemic control. Setting: An urban area (Sheshego) and rural areas near Pietersburg in the Northern Province of South Africa. Subjects: The sample comprised 59 men and 75 women from urban areas and 74 men and 80 women from rural areas. All were over 40 years of age, diagnosed with type 2 diabetes for at least one year, and attended primary health-care services in the study area over a 3-month period in 1998. Results: Reported dietary results indicate that mean energy intakes were low (,70% of Recommended Dietary Allowance), 8086 -8450 kJ day 21 and 6967-7382 kJ day 21 in men and women, respectively. Urban subjects had higher ðP , 0:05Þ intakes of animal protein and lower ratios of polyunsaturated fat to saturated fat than rural subjects. The energy distribution of macronutrients was in line with the recommendations for a prudent diet, with fat intake less than 30%, saturated fat less than 10% and carbohydrate intake greater than 55% of total energy intake. In most respects, nutrient intakes resembled a traditional African diet, although fibre intake was low in terms of the recommended 3-6 g/1000 kJ. More than 90% of patients ate three meals a day, yet only 32 -47% had a morning snack and 19-27% had a late evening snack. The majority of patients indicated that they followed a special diet, which had been given to them by a doctor or a nurse. Only 3.4-6.1% were treated by diet alone. Poor glycaemic control was found in both urban and rural participants, with more than half of subjects having fasting plasma glucose above 8 mmol l 21 and more than 35% having plasma glycosylated haemoglobin level above 8.6%. High triglyceride levels were found in 24 to 25% of men and in 17 to 18% of women. Obesity (body mass index $30 kg m 22) was prevalent in 15 to 16% of men compared with 35 to 47% of women; elevated blood pressure ($160/95 mmHg) was least prevalent in rural women (25.9%) and most prevalent in urban men (42.4%). Conclusions: The majority of black, type 2 diabetic patients studied showed poor glycaemic control. Additionally, many had dyslipidaemia, were obese and/or had an elevated blood pressure. Quantitative and qualitative findings indicated that these patients frequently received incorrect and inappropriate dietary advice from health educators.

Effect of a nutrition education programme on clinical status and dietary behaviours of adults with type 2 diabetes in a resource-limited setting in South Africa: a randomised controlled trial

“…The intakes were similar to those reported in people with T2DM in South Africa (14) . The non-significant results in vegetable and fruit intake are in agreement with findings from a study by Yannakoulia et al (37) .…”

“…Barriers to selfcare may be particularly apparent for dietary self-care (10) , an area cited as among the most difficult of diabetes selfcare areas (11) . Poor dietary adherence is a recognised problem in people with T2DM (12)(13)(14) . The barriers associated with the problem are also well documented in the literature (12,14,15) , even for individuals in a resource-limited setting in South Africa (14) .…”

“…Poor dietary adherence is a recognised problem in people with T2DM (12)(13)(14) . The barriers associated with the problem are also well documented in the literature (12,14,15) , even for individuals in a resource-limited setting in South Africa (14) . Therefore, people from resource-limited settings who are living with diabetes are an important target group for interventions -particularly dietary interventions.…”

Needs and preferences for nutrition education of type 2 diabetic adults in a resource-limited setting in South Africa

“…Knowledge deficits and misconceptions about the causes, metabolic consequences, complications and the relationship between diet and disease were common. This finding confirms previous reports regarding patient knowledge of the disease and its treatment (Holmstrom & Rosenqvist 2005;Badruddin et al 2002;Nthangeni et al 2001). The inaccuracy and deficiency in knowledge may be due to lack of specific and comprehensive education, as indicated by the patients, and poor understanding related to low literacy levels.…”

“…The problem with food portion control was cited in a study in a similar context (Nthangeni et al 2001). Notable too is that most of the problems observed in the patients' reported dietary practices are similar to those reported by the health professionals.…”