Non-adherence to lifestyle modification and its determinants among Bangladeshi type 2 diabetic patients
METHODS: Under an analytical cross-sectional design 374 type 2 diabetic patients (age >20 years), diagnosed for at least 1 year, were purposively selected from different health care centers operated by the Diabetic Association of Bangladesh (DAB). Data were collected by a pre-tested, interviewer-administered questionnaire. Three-point scale (yes, no, sometimes) were used to assess patient adherence to lifestyle measures (diet and exercise). Patients were considered compliant if patients had adhered to a recommended dietary chart, maintain specific time of food intake and followed advised quantity and quality of food. Exercise were considered adhered if they did exercise >30 min/day. Self management was assessed by self monitoring of blood glucose, foot care and smoking practice. Anthropometric measurements were done by using appropriate tools and all biochemical data were collected from record book.
RESULTS: Of the respondents 58% were females. The mean±SD age was 51 (±11.3) years, about 35% were aged between 40- 59 years, 46% had completed high school with mean monthly income US$ 398 (±375) and 75% lived in urban areas. Mean BMI was 25.7(±3.6) Kg/m2 and about 69% were overweight or obese according to Asian BMI cut-off value. Mean fasting serum glucose was 8.4(±3.4) mmol/l and about 58% patients’ HbA1c level was >7%. About 60% patients attended diabetes education class at least once followed by 24% never attended. Non-adherence rate of diet was 88% and exercise was 25% -overall 89% (95% CI 87.4-91.0) had non-adhered to both diet and exercise. About 32% patients non-adhered to self blood glucose monitoring, 70% to foot care and 6% had smoking habits. The main barriers to adherence to blood glucose monitoring was that they did not believe it is useful (65%) and barriers to do exercise were always being busy (44%) and coexisting diseases (9%). Association was found between non-adherence of diet and residence and nonattendance to diabetes education classes (p<0.05). Age, gender and nonattendance to diabetes education classes were associated with non-adherence to exercise (p<0.05). Binary logistic regression suggests that level of education (p=0.03) and nonattendance to diabetes education classes (p=0.05) are correlates of non-adherence of diet, and gender (p=0.04), family history of diabetes (p=0.04) and age (p=0.04) are correlates to non-adherence to exercise.
CONCLUSIONS: Although majority of the patients do not follow dietary and foot care recommendations, the adherence to exercise and blood glucose monitoring is comparatively high. Diabetes education and sociodemographic factors need to be considered to improve adherence to lifestyle modification and self care.