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Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator.

ABSTRACT: Background:Adherence by diabetic patients to dietary recommendations is important for effective therapy. Considering patients' expectations in case of diet is significant in this regard. The aim of this paper was to analyze the relationship between selected independent variables (eg, regular blood glucose testing) and patients' adherence to dietary recommendations, bearing in mind that the degree of disease acceptance might play a mediation role. Subjects and methods:A cross-sectional study was conducted in 91 patients treated for type 2 diabetes mellitus in a public medical facility. Paper-and-pencil interviewing was administered ahead of the planned visit with a diabetes specialist. Two measures were applied in the study: the Acceptance and Action Diabetes Questionnaire and the Patient Diet Adherence in Diabetes Scale. Additionally, data related to sociodemographic characteristics, lifestyle-related factors, and the course of the disease (management, incidence of complications, and dietician's supervision) were also collected. The regression method was used in the analysis, and Cohen's methodology was used to estimate partial mediation. Significance of the mediation effect was assessed by the Goodman test. P-values of <0.05 were considered statistically significant. Results:Patients' non-adherence to dietary recommendations was related to a low level of disease acceptance (standardized regression coefficient =-0.266; P=0.010). Moreover, failure to perform regular blood glucose testing was associated with a lack of disease acceptance (standardized regression coefficient =-0.455; P=0.000). However, the lack of regular blood glucose testing and low level of acceptance had only partially negative impacts on adherence to dietary recommendations (Goodman mediation test, Z=1.939; P=0.054). This dependence was not seen in patients treated with diet and concomitant oral medicines and/or insulin therapy. Conclusion:Effective dietary education should include activities promoting a more positive attitude toward the disease. This may be obtained by individual counseling, respecting the patient's needs, and focus on regular blood glucose testing.

SUBMITTER: Jaworski M

PROVIDER: S-EPMC5790092 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectiveTo assess the effect of educational dietary intervention offered in the child's first year of life, as well as teenage mothers and grandmothers in carrying out the dietary recommendations at four to seven years.MethodsRandomized clinical trial initiated in 2006, in Porto Alegre, RS, involving 323 teenage mothers and grandmothers who cohabited. The intervention consisted of six counseling sessions on breastfeeding and healthy complementary feeding. The first session occurred in the maternity ward and the other ones in the households of mothers at seven, 15, 30, 60, and 120 days of the child's life. The information about the child's diet were obtained on a monthly basis in the first six months, every two months in the second half-year, and at four to seven years, using a food frequency questionnaire. To assess the adequacy of food consumption to the recommendations from the Ministry of Health, we elaborated a score system that would reflect the compliance with the Ten Steps for Healthy Toddlers from 2 to 10 Years. The average scores of intervention and control groups were compared using the t-test.ResultsLow adherence to recommendations on child nutrition was found in the study population, with no difference in implementation the steps between the groups. The score on the compliance with the steps was similar in both groups (9.6 [SD = 1.63] and 9.3 [SD = 1.60] in the intervention and control groups, respectively) and no influence of the cohabitation with the grandmother was found.ConclusionsEducational dietary intervention in the first four months of the child's life for teenage mothers and grandmothers had no effect on the compliance with the recommendations at four to seven years of the child's life.ObjetivoAvaliar o efeito de intervenção alimentar educativa oferecida, no primeiro ano de vida da criança, a mães adolescentes e avós maternas, no cumprimento das recomendações alimentares aos quatro a sete anos.MétodosEnsaio clínico randomizado iniciado em 2006, em Porto Alegre, RS, envolvendo 323 mães adolescentes e avós maternas, quando em coabitação. A intervenção consistiu em seis sessões de aconselhamento sobre aleitamento materno e alimentação complementar saudável. A primeira sessão ocorreu na maternidade e as demais, nos domicílios das mães aos sete, 15, 30, 60 e 120 dias de vida da criança. As informações sobre alimentação da criança foram obtidas mensalmente nos primeiros seis meses de vida, a cada dois meses no segundo semestre, e aos quatro a sete anos, por meio de questionário de frequência alimentar. Para avaliar a adequação do consumo alimentar às recomendações do Ministério da Saúde, elaborou-se um sistema de escore que refletisse o cumprimento dos Dez Passos Para Uma Alimentação Saudável Para Crianças de 2 a 10 Anos. As médias dos escores dos grupos intervenção e controle foram comparadas por meio do teste t.ResultadosHouve baixa adesão às recomendações sobre alimentação infantil na população estudada, sem diferença no cumprimento dos passos entre os grupos. O escore relativo ao cumprimento dos passos foi semelhante nos dois grupos (9,6 [DP = 1,63] e 9,3 [DP = 1,60] nos grupos intervenção e controle, respectivamente) e não houve influência da coabitação com a avó materna.ConclusõesIntervenção alimentar educativa nos primeiros quatro meses de vida da criança para mães adolescentes e avós maternas não teve efeito no cumprimento das recomendações alimentares aos quatro a sete anos de vida.

Project description:BackgroundMexicans' adherence to food group's dietary recommendations is low and an inaccurate self-perception of dietary quality might perpetuate this low adherence. Our aim was to compare the intake and the adherence to the dietary recommendations for several food groups, subgroups, and to an overall Mexican Diet Quality Index (MxDQI), among those that perceived their diet as healthy vs. those that did not.MethodsWe analyzed data from 989 subjects 20-59 y old from the nationally representative Mexican National Health and Nutrition Survey 2016. Dietary intake was collected with one 24-h recall and a repeated recall in 82 subjects. Self-perception of dietary quality was evaluated with the following question "Do you consider that your diet is healthy? (yes/no)". We used the National Cancer Institute method to estimate the usual intake. We compared the mean intake adjusted by sociodemographic variables and the percentage of adherence according to the self-perception of dietary quality among the whole sample and in sociodemographic subpopulations.ResultsSixty percent perceived their diet as healthy, and their adherence to recommendations was low [20% for fruits and vegetables, < 8% for legumes, seafood and SSBs, and ~ 50% for processed meats and high in saturated fat and/or added sugar (HSFAS) products]. The mean number of recommendations they met was 2.8 (out of 7) vs. 2.6 among the rest of the population (p > 0.05), and the MxDQI score was 40 vs. 37 (out of 100 points). The only food groups and subgroups with a statistically significant difference between those that perceived their diet as healthy vs. unhealthy were fruits [38 g/d (95% CI 3, 73)], fruit juices [27 g/d (95% CI 2, 52)], industrialized SSBs [- 35 kcal/d (- 70, - 1)] and salty snacks [- 40 kcal/d (- 79, - 1)]. Other differences were small or inconsistent across subgroups of the population.ConclusionsThose that perceived their diet as healthy only had a slightly healthier diet than the rest of the population, moreover, their adherence to recommendations was very low. Hence, it is necessary to improve their nutrition knowledge.

Project description:BackgroundGestational diabetes mellitus (GDM) is a common complication of pregnancy associated with serious adverse outcomes for mothers and their offspring. Achieving glycaemic targets is the mainstream in the treatment of GDM in order to improve pregnancy outcomes. As GDM is usually diagnosed in the third trimester of pregnancy, the time frame for the intervention is very narrow. Women need to get new knowledge and change their diet very quickly. Usually, these patients require additional frequent visits to healthcare professionals. Recommender systems based on artificial intelligence could partially substitute healthcare professionals in the process of educating and controlling women with GDM, thus reducing the burden on the women and healthcare systems. We have developed a mobile-based personalized recommendation system DiaCompanion I with data-driven real time personal recommendations focused primarily on postprandial glycaemic response prediction. The study aims to clarify the effect of using DiaCompanion I on glycaemic levels and pregnancy outcomes in women with GDM.MethodsWomen with GDM are randomized to 2 treatment groups: utilizing and not utilizing DiaCompanion I. The app provides women in the intervention group the resulting data-driven prognosis of 1-hour postprandial glucose level every time they input their meal data. Based on the predicted glucose level, they can adjust their current meal so that the predicted glucose level falls within the recommended range below 7 mmol/L. The app also provides reminders and recommendations on diet and lifestyle to the participants of the intervention group. All the participants are required to perform 6 blood glucose measurements a day. Capillary glucose values are retrieved from the glucose meter and if not available, from the woman's diary. Additionally, data on glycaemic levels during the study and consumption of major macro- and micronutrients will be collected using the mobile app with electronic report forms in the intervention group. Women from the control group receive standard care without the mobile app. All participants are prescribed with insulin therapy if needed and modifications in their lifestyle. A total of 216 women will be recruited. The primary outcome is the percentage of postprandial capillary glucose values above target (>7.0 mmol/L). Secondary outcomes include the percentage of patients requiring insulin therapy during pregnancy, maternal and neonatal outcomes, glycaemic control using glycated hemoglobin (HbA1c), continuous glucose monitoring data and other blood glucose metrics, the number of patient visits to endocrinologists and acceptance/satisfaction of the two strategies assessed using a questionnaire.DiscussionWe believe that the approach including DiaCompanion I will be more effective in patients with GDM for improving glycaemic levels and pregnancy outcomes. We also expect that the use of the app will help reduce the number of clinic visits.Trial registration numberClinicalTrials.gov, Identifier NCT05179798.

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Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator.

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