A Study on Factors Affecting the Adherence of Medical Nutrition Therapy Amongst Patients with Type 2 Diabetes Mellitus Attending Outpatient Clinics of Teaching Hospital Jaffna, Sri Lanka

Background: Diabetes care includes lifestyle modification which includes Medical Nutritional Therapy (MNT). Diabetes nutrition therapy can result in cost saving and improved outcomes such as HbA1C reduction. Despite understanding the importance of diabetic MNT adherence, implementation is difficult due to various reasons.
Objective: To study the factors affecting the adherence of diabetic MNT among patients with type 2 diabetes mellitus attending outpatient clinics of Teaching Hospital Jaffna.
Methods: This descriptive hospital based cross sectional study was conducted in outpatient medical clinics of Teaching Hospital Jaffna for a period of six months from April 2020 to September 2020.All registered type 2 Diabetes Mellitus patients, who visited for their monthly diabetes follow-up were included in this study. Knowledge on diabetes MNT was assessed using a 5-component questionnaire and adherence with MNT was assessed using a single question. Median score 13 was used categorize the knowledge score on diabetic MNT into adequate knowledge (13 and above) and inadequate knowledge (<13) for statistical analysis which was done by using SPSS version 26.
Results: Out of 351 patients with diabetes 51.3% were females and mean age of participants was 59.42+_13.08. Mean duration of diabetes in years among participants was 7.41+-5.26. Majority of participants (65.5%; CI: 60.4-70.4) showed poor adherence with recommended diabetic MNT and 53.0% of the patients reported they consume more than half (portion) starchy food type plate in their daily meal. Our analysis showed knowledge regarding diabetes MNT significantly in influenced adherence with diabetic MNT recommendations (Chi square-25.61; P<0.001) and 31.3% (CI: 26.6-36.3) participants found to have inadequate knowledge in the assessment. Further 28.5% of them believed that fat and oils can be consumed liberally and only 35.9% identified correct type of food plate for a patient with diabetes. Individual knowledge, cravings, social priorities, understanding the portion size, cost of some foods were noted as perceived barriers among participants for recommended diabetic MNT adherence.
Conclusion: The adherence of diabetic MNT was poor among participants and knowledge of participants regarding diabetic MNT significantly influences adherence of MNT. In addition, majority of them reported their daily food plate consists with major portion of starch (Type 1, Type 3 and Type 4). Furthermore, this research has explored several sociocultural unique aspects affecting adherence to diabetes MNT, as such through structured educational interventions by including these factors, health care providers could improve the adherence of diabetic MNT.