Systematic review of the barriers and facilitators to dietary modification in people living with type 2 diabetes and pre‐diabetes from South Asian ethnic populations

Abstract

Aims: Lifestyle and dietary modification are effective in the prevention and management of Type 2 diabetes Mellitus (T2DM). However, South Asian (SA) populations living in Western countries have low adherence rates to healthcare advice and experience poor diabetes control and clinical outcomes compared with the general population. This systematic review aimed to summarise the barriers and facilitators of dietary modification within people from South Asian (SA) ethnicity with T2DM or pre-diabetes. Methods: A systematic search of PubMed, Web of Science and Scopus generated 3739 articles, of which seven were included. Qualitative and quantitative data were inputted utilising COVIDENCE. Qualitative data were analysed by thematic analysis. Results: Thematic analysis identified three facilitators: (1) cultural sensitivity, (2) health education and (3) support networks. Barriers include (1) healthcare inequity, (2) cultural insensitivity, (3) social pressures, (4) misconceptions and (5) time constraints. Good access to health care and motivation were the most common facilitators discussed. Misconceptions on T2DM management and cultural insensitivity contributed to the majority of barriers discussed. Conclusions: Culturally tailored interventions could improve adherence to diet modification in people with T2DM from SA ethnicity. Interventions involving the application of social media to challenge intergenerational stigmas and misinformation, distributing culturally appropriate resources and providing diets tailored to the SA palate could help.

Intergenerational differences in healthy eating beliefs among British Pakistanis with type 2 diabetes

“…34 On the other hand, transformative interventions should be culturally appropriate and offer palatespecific advice, retaining tradition, enjoyment, and family identity. 11 A key finding of this study found lay understandings of healthy eating do not generally conform to dietary guidelines, and health interventions. There were many mixed messages given to first and second generations by health professionals, about what is deemed 'healthy'.…”

“…23 There was a lack of awareness about the nutritional components of eating foods which were high in sugar and fat across all generation groups, which meant people struggled to take measures to substitute their diets. 11 Early detection and understanding food and lifestyle are integral to prevent or delay complications and should continue to be a major public health campaign. 24 Similar to other studies in the UK, we found that traditional foods were deemed important in maintaining cultural roots across all generations; participants held beliefs that traditional foods were important to health.…”

“…A systematic review found that there were a lack of health guidelines targeted at ethnically diverse groups. 11 Family members engage, actively promote, develop, and sustain health behaviours. 12 These include, for example, dietary intake, knowledge of health, generational status, culture, socioeconomic factors, and community membership.…”

Postprandial blood glucose and insulin response in healthy adults when lentils replace high glycemic index food ingredients in muffins, chilies and soups

“…As such, promoting the incorporation of lentils into dietary traditional patterns may improve glycemic control amongst persons who may struggle with dietary advice for disease management that promotes the exclusion of many foods in their traditional diet (20). Indeed, competent care, including dietary advice that aligns with cultural practices, is important for self-management and treatment adherence (20,21).…”