Factors Associated with Consumption of Diabetic Diet among Type 2 Diabetic Subjects from Ahmedabad, Western India

Article excerpt

INTRODUCTION

Type 2 diabetes mellitus (T2DM) is a chronic disease associated with high morbidity and mortality worldwide (1), and India is no exception (2, 3). Currently, India is facing a three-fold rise in the prevalence of diabetes in urban as well as in rural area (4). Subjects with T2DM are at high risk of developing micro-vascular and macro-vascular complications; hence, the need for preventive action is widely acknowledged (5). The fundamentals of diabetes control largely depend upon drug therapy and lifestyle measures (increased physical activity and restriction of energy intake/diabetic diet) (6). Improved glycaemic control may reduce the development and progression of diabetic complications to some extent (7). Wealth of information is available on improving glycaemic control and decrease glycosylated haemoglobin (HbA1c) up to 2% through diet control (8-10). Coupled with this, appropriate dietary practices play a vital role in treating diabetes mellitus and, to some extent, prevent the complications of diabetes by improving risk factor profile. Strong body of evidence suggests that role of specific dietary factors remain uncertain; however, obesity and high intake of fat are associated with increased risk of diabetes (11-14).

Despite the importance of diet in the management of T2DM, diabetic subjects are often unaware of the importance in ensuring glycaemic control (15). On the other hand, lack of dietary compliance is a major limiting factor in achieving glycaemic control in T2DM. Studies revealed that generally patients fail to adhere to dietary recommendations (16, 17). Hence, the present study aimed at providing the profile of the factors associated with consumption of diabetic diet among T2DM subjects from western India as an impetus for further exploration of the sociocultural and subject-related factors affecting the outcomes of T2DM care that, in turn, will lead to redefine the diabetes control and prevention strategies in this region.

MATERIALS AND METHODS

Study setting

A hospital-based cross-sectional study was conducted during July 2010-November 2010 in Ahmedabad district of Gujarat state, India. Ahmedabad is the commercial hub of the Gujarat state with an approximate population of six million.

Study population

The study population comprised diabetic subjects. We required them to be at least 40 years of age, have been diagnosed with T2DM for at least one year before enrollment for the study and, above all, it was a prerequisite for subjects to attend the Department of Diabetology, All India Institute of Diabetes and Research and Yash Diabetes Specialities Centre (Swasthya Hospital) during the study period.

Sample-size and sampling method

A sample-size of 405 was obtained by using parameter estimation method with 5% precision around the point estimate (an expected diabetic diet consumption level of 50%) with 95% confidence level. The calculated minimum sample-size was inflated by 5% to account for anticipated non-response from subjects.

On an average, there are at least 40 known diabetes cases reporting to OPD, and the monthly load of known diabetics will be around 900-1,000. Hence, during the study period of five months, the cases will be around 4,500-5,000. The study subjects were selected through systematic random sampling strategy for 4,000 study subjects (on conservative side) who reported to the OPD. Selection of the first case was done from within the first 10 subjects (in our case, it was number 6), followed by adding 10 to the number till the required sample-size of 405 was achieved.

Procedure for data collection

After recruitment of the subjects based on selection criteria and obtaining informed consent, the details of the study methodology were explained to them; a detailed history, including data on age, sex, education, occupation, smoking status, alcohol consumption, diabetic diet, method of cooking, and source of advice regarding diet, were recorded on a close-ended proforma. …