Pilot Study on Barriers Influencing the Compliance towards Dietary Intake in Diabetic Patients

Introduction-Despite the importance of diet, previous studies suggest that individuals with diabetes may not follow recommended guidelines for diet. Objective-The objectives of this study were to identify the pattern of diet in diabetic patients, and to determine the possible barriers influencing compliance towards diet. Methods-Cross sectional study with the sample of 127 patients who underwent follow up with Diabetic Clinic of Pulau Pinang Hospital. Convenience sampling used and subjects were given a questionnaire consists of questions on dietary habit and barriers to dietary intake compliance related to belief, knowledge, attitude, and environment. The data analyzed using descriptive statistics in SPSS version 12.0. Results-The intake of fried foods, sweet treats and snacks were only about 1-3 times per week, and the intake of fruit and vegetables were mostly everyday in most patients. This showed that the pattern of dietary intake was as recommended. In term of the barriers to comply with dietary intake recommendation, belief and knowledge of dietary intake were not the barriers, as patient had the right belief and knowledge regarding dietary intake. Conclusion-No strong conclusion can be made in regard to the attitude towards dietary intake compliance. The study unable to evaluate whether patients have the right attitude or not that might influence the compliance towards diet. A huge number of patients also stated that the ‘feeling of difficulty’ to control food intake was also a barrier which related to attitude. Environmental factors such as social gathering reported to be a barrier influencing diet compliance in diabetic patients. Keynote barriers, compliance, diet, diabetes INTRODUCTION The number of people for the whole world with diabetes was estimated to be 135 million in year 1995; increasing to 154 million in the year of 2000; and estimated to be 300 million in the year of 2025. The same phenomenon goes in Malaysia, whereby the First National Health and Morbidity Survey (NHMS 1) conducted in 1986 reported a prevalence of diabetes mellitus of 6.3% and this figure increased to 8.2%. by the Second National Health and Morbidity Survey (NHMS 2) that was conducted in 1996. In addition, according to estimation by World Health Organisation (WHO), Malaysia would have a total number of 2.48 million diabetics in 2030 as compared to 0.94 million in 2000. This automatically predicts the 16.4% increment of diabetic prevalence in Malaysia. [1] Hence, in order to cope with the increasing prevalence of diabetes, there are many activities planned and done in primary prevention and health promotion throughout the world, as many evidence supported that there were significant impact on reducing consequences of diabetes in all ages, by these measured. [2] For example, the American Diabetes Association recommend structured programme that emphasized lifestyle changes including reduce fat and energy intake, which in turn will be able to reduce for about 5-7% weight loss, thus reduce the risk of developing diabetes. [4] Besides, three large randomized controlled trials (RCTs) reported the manifestation of the decreasing pattern of diabetes by lifestyle modification. To be specific, the incidence of diabetes was reduced up to 58% in intensive lifestyle intervention for both gender possessed high risk of diabetes, as what shown in the Finnish Diabetes Prevention Study. In that study, subjects were counselled to increase fiber intake, reduce total fat below 30% of total calories, and reduced saturated fat below 10%. [5,8] The Da Qing IGT and Diabetes Study also manifested that the combination of diet plus exercise and diet changes alone were significantly reduced the progression of diabetes in Impaired Glucose Tolerance group. [6,8] The Diabetes Prevention Program Research Group that comprised individual training sessions on a low calorie, low fat diet, aerobic exercise, and behaviour modification also showed corresponding decreased incidence of diabetes, which the greatest results in lifestyle intervention group. [7,8] Moreover, there are many other evidences showing that dietary intake recommendation adherence will lead to decreasing trend of long term disease complications and occurrence of comorbid condition for diet-modifiable diseases. [911] Despite the importance to comply with dietary intake recommendation, National Health Interview Survey found that only 60% of individuals with diabetes complied to ‘a diabetic diet. ’[3] Other investigation reported that dietary change and maintenance are difficult in persons with dietmodifiable chronic disease as most of them do not comply with prescribed recommendations. [12] The same trend of results also happened to many other studies, which manifested that long term compliance with dietary regimens in reducing cardiovascular risk factors is difficult to be practiced. [13-15] Siti Maisharah S.G et al /J. Pharm. Sci. & Res. Vol.3(7), 2011,1315-1321