Barriers and facilitators in meal planning strategies for glycemic control in individuals with type 1 diabetes in Beijing, China
Creators: name: Lyu, Jennifer
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2017

description: Type-1 diabetes (T1D) incidence in China is one of the lowest among the world but is steadily increasing each year. Without proper matching of insulin injections with dietary intake, patients with T1D face challenges with maintaining healthy blood glucose levels. Currently, there is very limited research that has focused on the nutrition aspect of T1D self-management among patients in China. This study aims to further investigate the nutrition aspect of T1D management in China by exploring how nutrition knowledge may be influencing adherence to meal planning and carbohydrate counting among T1D patients in China. The study also aims to investigate other potential barriers that may influence adherence to meal planning and carbohydrate counting. Two online nutrition surveys were developed through Qualtrics Survey Software: one survey was targeted towards patients with T1D (n=82) and one survey was targeted towards health care providers (n=11) from Peking University People’s Hospital in Beijing, China. The mean age of patient participants was 26.0 ±7.2 years. Approximately 74.4% of patient participants were female. Majority of patient participants were also underweight/healthy weight (BMI < 23.0), from urban residence, and have at least a college level of education. Overall, patient participants scored higher on nutrition knowledge questions related to nutrition labels (70.6±20.2) versus questions regarding healthy foods and diet (non-label) questions (60.9±17.1). Only 35.4% of patient participants reported counting carbohydrates ‘Every day.’ The study also found the most common major barrier reported by patients was the desire to eat more food than what their doctor recommended. Other common barriers included wanting to read food labels, but not being able to because many of the foods consumed by patients do not have labels and because labels were hard for patients to understand. The sample of providers were all female and included 9 physicians, 1 nurse, and 1 dietitian. Descriptive statistics showed 81.8% of providers believing meal plans were too stringent for patients and 72.7% agreeing that meal plans were not practical because they included foods the patient did not normally consume. Overall, the study found no significant associations between nutrition knowledge and adherence to meal planning and carbohydrate counting. The study also did not find any significant associations between total number of barriers perceived and adherence to meal planning and carbohydrate counting. This suggests a more flexible insulin regimen is needed in China to allow for more flexible dietary patterns, as opposed to a fixed insulin regimen that is currently being utilized by majority of T1D patients in China. Cost and accessibility of healthy foods were also not perceived to be significant barriers to meal planning and T1D management by both patients and health care providers. Given the small sample size of this study, more research is needed in the future to test these associations between nutrition knowledge and adherence to meal planning and carbohydrate counting, as well as total number of barriers perceived and adherence to meal planning and carbohydrate counting.