Dietary Practice and its Association with Glycemic Control among Individuals with Type 2 Diabetes Mellitus in Ethiopia: A Multi-Center Cross-Sectional Study

Abstract

Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder that needs a comprehensive management plan. The integral role of nutrition therapy in diabetes management is getting special attention in guidelines though the practice is in a primitive stage, especially in resource limited settings where lifestyle modifications have a large role in the overburdened healthcare system. Understanding the current dietary practice and its effect on disease control in settings where a tertiary level care is provided is a critical step in providing targeted intervention. Therefore, the aim of the study was to assess dietary practice and its association with level of glycemic control among individuals with T2DM who were on follow-up at two large tertiary hospitals in Ethiopia. Methods: A hospital based cross-sectional study was conducted from January to March 2023 among 314 systematically selected individuals with T2DM who were on follow-up at diabetes clinics of St. Paul's Hospital Millennium Medical College and Tikur Anbessa Specialized Hospital. Data was collected using a pre-tested structured questionnaire and summarized using frequency and median (interquartile range). To examine the association of dietary practice with level of glycemic control, a binary logistic regression model was run at 5% level of significance where Adjusted Odds Ratio (AOR) and 95% CI for AOR were used to interpret the results. Results: From the 314 participants, 146 (46.5%) patients had adequate knowledge regarding the recommended dietary practices and only 42 (13.4%) of the individuals practiced a healthy diet. A total of 107 (34.1%, 95% CI=29.0%-39.2%) had optimal glycemic control. Poor dietary practice (AOR=7.93, 95% CI=2.63-23.89, p<0.001), obesity (AOR=2.74, 95% CI=1.05-7.18%, p=0.04), and taking combination oral anti-diabetic drugs (AOR=6.22, 95% CI=3.05-12.69, p<0.001) were significantly associated with suboptimal glycemic control. Conclusions: Dietary knowledge and practice among individuals with T2DM were very low, as is the level of glycemic control, which are similar to studies conducted years back, indicating a lack of improvement in the desired behavior over time. Poor dietary practice in turn was associated with suboptimal glycemic control. It is important to target interventions that enhance the understanding and application of dietary practice in these individuals.