Adherence of patients with type 2 diabetes mellitus with the SEMDSA lifestyle guidelines
English: Over the last decade, the global burden of disease and mortality has shifted from infectious diseases to chronic diseases. Type 2 diabetes mellitus (T2DM) is considered to be the fastest growing chronic disease in the world. T2DM is a progressive disease that is associated with a high degree of morbidity and premature mortality in many countries, including South Africa. The global rise in overweight and obesity is considered to be the main reason that the prevalence of T2DM is increasing at such an alarming rate. T2DM is largely preventable. Multi-sectoral, population-based strategies and approaches are, however, needed to address the modifiable risk factors involved in the development of T2DM. Evidence-based nutrition principals and recommendations are continuously summarised by the Society for Endocrinology, Metabolism and Diabetes in South Africa (SEMDSA) into guidelines for the management of T2DM. In the present study, a cross-sectional study design was applied in a convenient sample (n=50) to determine the adherence of patients with T2DM with the SEMDSA lifestyle guidelines. Participants were over 18 years old and being treated for T2DM at a private physician’s practice in Bloemfontein. The study was approved by the Health Sciences Research Ethics Committee of the University of the Free State and all participants signed written informed consent. Three questionnaires were completed by the researcher in a structured interview with each participant. A Food Frequency Questionnaire (FFQ) was used to obtain information about dietary intake to determine both macronutrient and micronutrient intake. Physical activity intensity and duration was calculated using the Global Physical Activity Questionnaire (GPAQ), developed by the WHO. Information related to travel to and from work/ other places, activity at work and recreational activities as well as sedentary behaviour was obtained. Information related to socio-demographics (age, gender, language, marital status and level of education) and smoking and alcohol intake were collected using a questionnaire developed by the researcher (based on the SEMDSA guidelines). Anthropometric measurements were taken by the researcher according to standardised techniques, to determine BMI, waist circumference and waist-height ratio. The median age of participants was 57.9 years and the median time since T2DM diagnosis was seven years. The majority of participants were married (74%). About half spoke Afrikaans at home (52%) and worked full-time (54%). Gender was fairly equally distributed. The majority of participants were overweight (22%) or obese (66%). Most (90%) had a waist circumference above the high-risk cut point, while 92% had a high risk waist-height ratio above 0.5. The SEMDSA guidelines recommend that carbohydrates should make up 45-60% of total energy intake, total fat should be restricted to < 35% of total energy and of this, < 7% should come from saturated fat. It is recommended that sodium should be restricted to < 2 300 mg daily and that two portions of oily fish should be consumed each week to meet the recommended omega 3 fatty acid intake. Information related to dietary intake indicated that the SEMDSA lifestyle guidelines were poorly adhered to. Most participants followed a diet that was low in carbohydrates, high in fat (especially saturated fat) and low in omega 3 fatty acids. Sodium intake was high. Sedentary behaviour and lack of physical activity were common in the majority of participants, with 84% not meeting the guideline for aerobic exercise and 92% not meeting the guideline for resistance training. Ten percent of the participants were current smokers and of the men that regularly consumed alcohol, two thirds (66.67%) fell into the ‘high’ consumption (> 2 units daily) category. In conclusion, the adherence of participants to the SEMDSA guidelines was poor, thus increasing their risk of long term complications and poor glycaemic control. Complying with the SEMDSA guidelines can assist in maintaining a healthy weight, consuming a healthy diet and performing regular exercise. Further research related to the barriers that prevent patients from following the guidelines is warranted, in order to motivate practical, cost-effective and relevant interventions. researcher according to standardised techniques, to determine BMI, waist circumference and waist-height ratio. The median age of participants was 57.9 years and the median time since T2DM diagnosis was seven years. The majority of participants were married (74%). About half spoke Afrikaans at home (52%) and worked full-time (54%). Gender was fairly equally distributed. The majority of participants were overweight (22%) or obese (66%). Most (90%) had a waist circumference above the high-risk cut point, while 92% had a high risk waist-height ratio above 0.5. The SEMDSA guidelines recommend that carbohydrates should make up 45-60% of total energy intake, total fat should be restricted to < 35% of total energy and of this, < 7% should come from saturated fat. It is recommended that sodium should be restricted to < 2 300 mg daily and that two portions of oily fish should be consumed each week to meet the recommended omega 3 fatty acid intake. Information related to dietary intake indicated that the SEMDSA lifestyle guidelines were poorly adhered to. Most participants followed a diet that was low in carbohydrates, high in fat (especially saturated fat) and low in omega 3 fatty acids. Sodium intake was high. Sedentary behaviour and lack of physical activity were common in the majority of participants, with 84% not meeting the guideline for aerobic exercise and 92% not meeting the guideline for resistance training. Ten percent of the participants were current smokers and of the men that regularly consumed alcohol, two thirds (66.67%) fell into the ‘high’ consumption (> 2 units daily) category. In conclusion, the adherence of participants to the SEMDSA guidelines was poor, thus increasing their risk of long term complications and poor glycaemic control. Complying with the SEMDSA guidelines can assist in maintaining a healthy weight, consuming a healthy diet and performing regular exercise. Further research related to the barriers that prevent patients from following the guidelines is warranted, in order to motivate practical, cost-effective and relevant interventions.
Afrikaans: Oor die afgelope dekade, het die wêreldwye siekteprofiel en mortaliteit verander van infektiewe siektes na chroniese siektes. Tipe 2 diabetes mellitus (T2DM) word beskou as die chroniese siekte wat die vinnigste toeneem. T2DM is ‘n progressiewe siekte wat in baie lande, insluitend Suid-Afrika, met ‘n hoë vlak van morbiditeit en premature mortaliteit, verband hou. The wêreldwye toename in oormassa en vetsug word beskou as die hoofrede waarom T2DM so toeneem. T2DM is grootliks voorkombaar. Multi-sektorale, populasie-gebaseerde strategieë word egter benodig om die modifiseerbare risikofaktore wat met T2DM verband hou, aan te spreek. Wetenskaplik bewysde voedingbeginsels en aanbevelings word voortdurend deur die Society for Endocrinology, Metabolism and Diabetes in South Africa (SEMDSA) in riglyne vir die hantering van T2DM opgesom. In die huidige studie is ‘n dwarssnit studieontwerp op ‘n geriefssteekproef (n=50) toegepas, om die deelnemers met T2DM se nakoming van die SEMDSA-leefstylriglyne te bepaal. Deelnemers was ouer as 18 jaar en was almal pasiënte by die praktyk van ‘n privaatinternis in Bloemfontein. Die studie is goedgekeur deur die Gesondheidwetenskappe Etiekkomitee van die Universiteit van die Vrystaat, en alle deelnemers het ingeligte toestemming geteken. Drie vraelyste is deur die navorser in ‘n gestruktureerde onderhoud met elke deelnemer voltooi. ‘n Voedselfrekwensievraelys is gebruik om inligting oor dieetinname in terme van makro- en mikrovoedingstofinname in te samel. Die intensiteit en duur van fisiese aktiwiteit is bepaal deur van die Global Physical Activity Questionnaire (GPAQ), wat deur die Wȇreldgesundorganisasie ontwikkel is, gebruik te maak. Inligting oor vervoer, aktiwiteite by die werk, ontspanning, sowel as sittende aktiwiteite is ingesamel. Inligting oor sosiodemografiese faktore (ouderdom, geslag, taal, huwelikstatus en vlak van onderwys), en rook- en drankgebruik is deur middel van ‘n vraelys wat self deur die navorser, gebaseer op die SEMDSA-riglyne, ontwikkel is, ingesamel. Antropometriese metings is deur die navorser volgens gestandardiseerde tegnieke geneem om liggaamsmassaindeks (LMI), middelomtrek en middel-lengte-verhouding te bepaal. Die mediaanouderdom van deelnemers was 57.9 jaar en die mediaan tydperk vandat T2DM gediagnoseer is, was sewe jaar. Die meerderheid van deelnemers was getroud (74%). Ongeveer helfte het Afrikaans as huistaal gepraat (52%) en het voltyds gewerk (54%). Gelyke getalle mans en vrouens is ingesluit. Die meerderheid deelnemers was oormassa (22%) of vetsugtig (66%). Die meeste (90%) het ‘n middelomtrek bo die hoë-risiko afsnypunt gehad, terwyl 92% ‘n middel-lengte verhouding bo 0.5 gehad het. Die SEMDSA riglyne beveel aan dat koolhidrate 45-60% van totale energieinname behoort uit te maak, en dat totale vet tot < 35% van totale energie inname beperk behoort te word, waarvan < 7% versadigde vette behoort in te sluit. Daar word aanbeveel dat daaglikse natrium tot < 2 300 mg per dag beperk word, en dat twee porsies vetterige vis elke week ingeneem word om aan omega-3-vetsuurbehoeftes te voldoen. Inligting oor dieetinname het gewys dat die SEMDSA leefstylriglyne baie swak nagekom is. Die meeste deelnemers het ‘n dieet laag in koolhidrate, hoog in vet (veral versadigde vet) en laag in omega-3-vetsure gevolg. Natriuminname was hoog. In die meerderheid deelnemers was sittende gedrag en ‘n gebrek aan fisiese aktiwiteit algemeen, met 84% wat nie die riglyn vir aerobiese oefening, en 92% vir weerstandsoefening, nagekom het nie. Tien persent van die deelnemers het huidiglik gerook en van die mans wat gereeld alkohol ingeneem het, het twee derdes (66.67%) in die ‘hoë” inname kategorie (> 2 eenhede per dag) geval. In samevatting, was die deelnemers se nakoming van die SEMDSA-riglyne swak, wat hul risiko vir langtermykomplikasies en swak glikemiese beheer verhoog. Nakoming van die SEMDSA riglyne kan help om ‘n gesonde massa te handhaaf, om ‘n gesonde dieet in te neem en gereelde oefening te doen. Verdere navorsing om die hindernisse wat voorkom dat pasiënte die riglyne volg te identifiseer, met die doel om meer praktiese, koste-effektiewe en relevante intervensies te motiveer, word aanbeveel.
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