BackgroundNonadherence to diet and physical activity is a major problem in the management of diabetes mellitus and its complications. This study was undertaken to measure the factors associated with nonadherence to diet and physical activity advice among Nepalese type 2 diabetic patients.MethodsAn analytical cross-sectional study was conducted among type 2 diabetic patients (age, M ± SD, 54.4 ± 11.5 yrs) and interviewed using three days recall method for dietary history and Compendium of Physical Activity for physical activity. Data were analysed by univariate and multivariate statistics.ResultsOut of 385 patients, 87.5% were nonadherent and 12.5% poorly adherent to dietary advice. 42.1% were nonadherent, 36.6% partially adherent while 21.3% good adherent to physical activity. Adherence to dietary advice was higher in males than females (M ± SD, 33 ± 16.7 vs 27 ± 15.5, p = 0.001), those staying nearer to hospital than farther (M ± SD, 32 ± 18.6 vs 28 ± 13.5, p = 0.013), those advice by physician than others (p = 0.001) and from nuclear family than joint and extended (p = 0.001). With increasing age, dietary advice adherence decreased (p = 0.06) and was positively correlated with the knowledge about diabetes mellitus (r = 0.115, p = 0.024). Physical activity adherence was higher in those with positive family history of diabetes than others (M ± SD, 74 ± 24.2 vs 65 ± 23.6, p = 0.001), upper middle socioeconomic class respondents than lower ones (p = 0.047) and from extended family than nuclear or joint ones (p = 0.041). Divorced were more nonadherent to physical activity than married and widowed patients (p = 0.021).ConclusionsDeterminants of nonadherence to dietary advice: Female gender, increasing age, joint or extended family members, farther distance from hospital, poor knowledge about diabetes mellitus and advice by others than physicians. Determinants for nonadherence to physical activity: negative family history of DM, divorced status, lower socioeconomic class.

BackgroundNon-adherence to lifestyle modification among diabetic patients develops the short-term risks and the long-term complications as well as declines the quality of life. This study aimed to find out the association between non-adherence to self-care practices, medication and health related quality of life (HR-QoL) among type 2 diabetic patients.MethodsAt least 1 year diagnosed patients with type 2 diabetes (N = 500), age>25 years were conveniently selected from the Out-Patient Department of Bangladesh Institute of Health Sciences Hospital. Patients’ self-care practices were assessed via interviewer-administered questionnaires using an analytical cross-sectional design. HRQoL was assessed by an adapted and validated Bangla version of the EQ-5D (EuroQol Group, 2009) questionnaire which has five domains- mobility, self-care, usual activities, pain/discomfort and anxiety/depression and two levels on each dimension. EQ-5D responses were further translated into single summery EQ-5D index using UK TTO value set. Patients’ were considered as non-adhered to self-care practices according to the guidelines of Diabetic Association of Bangladesh. Multivariable linear regression was used to assess the association between non-adherence towards self-care practices and HRQoL.ResultsAmong the study patients, 50.2% were females and mean ± SD age was 54.2 (±11.2) years. Non-adherence rate were assessed for: blood glucose monitoring (37%), diet (44.8%), foot care (43.2%), exercise (33.2%) and smoking (37.2%). About 50.4% patients had problem in mobility, 28.2% in self-care, 47.6% in usual activities, 72.8% in pain/discomfort and 73.6% in anxiety/depression. On chi-squared test, significant association was found between non adherence to foot care and problem with mobility, self-care and usual activities (p < 0.05). Significant association was also found between non-adherence to exercise and poor mobility, self- care, usual activities, pain and anxiety (p < 0.05). Non-adherence to diet was associated with poor mobility (p < 0.05). In multivariable linear regression non-adherence to foot care (p = 0.0001), exercise (p = 0.0001), and smoking (p = 0.047) showed significant association with EQ-5D index after adjusting co-variates.ConclusionsIn this study, patients who have a non-adherence rate also have a lower quality of life.

BackgroundLevels of knowledge about diabetes mellitus (DM) among newly diagnosed diabetics in Bangladesh are unknown. This study assessed the relationship between knowledge and practices among newly diagnosed type 2 DM patients.MethodsNewly diagnosed adults with type 2 diabetes (N = 508) were selected from 19 healthcare centers. Patients’ knowledge and self-care practices were assessed via interviewer-administered questionnaires using a cross-sectional design. Knowledge questions were divided into basic and technical sections. Knowledge scores were categorized as poor (mean + 1 SD). Chi square testing and multivariate logistic regression were conducted to examine the relationship between diabetes-related knowledge and self-care practices.ResultsApproximately 16%, 66%, and 18% of respondents had good, average, and poor (GAP) basic knowledge respectively and 10%, 78%, and 12% of respondents had GAP technical knowledge, about DM. About 90% of respondents from both basic and technical GAP did not test their blood glucose regularly; a significant relationship existed between basic knowledge and glucose monitoring. Technical knowledge and foot care were significantly related, though 81% with good technical knowledge and about 70% from average and poor groups did not take care of their feet. Approximately 85%, 71%, and 52% of the GAP technical knowledge groups, consumed betel nuts; a significant relationship existed between technical knowledge and consumption of betel nuts. Around 88%, 92%, and 98% of GAP technical knowledge groups failed to follow dietary advice from a diabetes educator. About 26%, 42%, and 51% of GAP basic and technical sometimes ate meals at a fixed time (p < 0.05). Approximately one-third of respondents in each basic knowledge group and 29%, 32%, and 32% of GAP technical knowledge groups partially followed rules for measuring food before eating. Total basic knowledge (TBK) and business profession were significant independent predictors of good practice. OR for TBK: 1.28 (95% CI: 1.03 to 1.60); OR for business profession 9.05 (95% CI: 1.17 to 70.09).ConclusionsNewly diagnosed type 2 diabetics had similar levels of basic and technical knowledge of DM. Health education and motivation should create positive changes in diabetes-control-related self-care practices.