Factors affecting adherence to nutrition therapy by type 11 diabetics attending mulago hospital diabetic clinic, uganda.

Abstract

The prevalence of type II diabetes is on the increase due to dietary changes, reduction in physical activity and increasing obesity. The prevalence of type II diabetes in Uganda is 8.1% and it is estimated that the prevalence of diabetes is to triple within the nest 25 years. Although, nutrition therapy is the major intervention in the management of type II diabetes, it has not been adequately emphasised by most diabetes. This study was carried out to establish the factors that affect adherence to nutrition therapy in the management of type II diabetes in mulago hospital diabetes clinic. A Cross sectional study of 132 diabetics attending the diabetic clinic at mulago hospital was conducted. All patients aged 25 years and older were purposively recruited for the study, excluding pregnant women and those on insulin treatment. A Food frequency questionnaire was administered to capture the frequency at which the clients consumed various foods. A glucometer was used to measure the blood glucose levels and the body mass index (BMI) of the subjects was computed using anthropometrical methods. Focus group discussions were held among health service providers in the hospital, to establish the level of nutrition knowledge offered to the diabetic patients. Nutrient intake data was computed using Nutri-survey. All data was cleaned, edited and bivariate and multivariate analyses done using SPSS (version 12). Statistical differences were tested at p<_0.05. The majority (72.7%) of the patients reported to have a family history of type II diabetes and hypertension which is one of the predisposing factors to type II diabetes. Patients who reported that they had received nutrition education were found to practice the right choice of foods required by patients of type II diabetes (p=0.001). Patients that reported eating the recommended foods were also those that had knowledge of these foods (p=0.001). The practice of recommended nutrition therapy for 62.9% of the diabetic patients was low. Patients with low levels of nutrition knowledge were also more likely to be at risk of becoming overweight or obese (BMI >_25) than those with high levels of nutrition knowledge. Blood glucose levels increased with fewer numbers of meals and wrong choice of food (p<0.05). Linear regression identified nutrition education (p=0.015), knowledge of recommended foods (p=0.000), recommended number of meals (p=0.000) and whether the patients made their own food choices or not (p=0.007) to be the factors affecting adherence to nutrition therapy. Findings of this study revealed that nutrition knowledge and adherence to nutrition therapy are the factors that resulted in the high levels of blood glucose levels with the mean being 240+_107mg/dl. Adherence to nutrition therapy (appropriate diet and increased physical activity and a consequent reduction of weight) therefore, plays a crucial role in the control of glycemia, which is the ultimate goal. Health workers should therefore, work together with nutritionists to ensure maximum nutrition education, which in turn improves nutrition knowledge an important factor in enhancing adherence to nutrition therapy.