Abstract
This study aims to identify the modifiable barriers encountered by type 2 diabetic patients in Nepal to achieving their recommended dietary and exercise advice. A cross-sectional study was conducted among 197 type 2 diabetic patients, attending a diabetic clinic. Binary logistic regression models were used to identify perceived barriers. About 41% and 46% of the participants were noncompliant to diet and exercise advice, respectively; only 35.5% the participants were compliant to both. Perceived social acceptability (OR = 0.14; 95% CI: 0.03–0.58) and reminder to action (OR = 2.77; 95% CI: 1.38–5.53) were associated with noncompliance to diet. Most of the barriers to diet were related to taste, feast and festivals, lack of knowledge, and availability of healthy options. Self-efficacy (OR = 0.09; 95% CI: 0.02–0.34) and social acceptability (OR = 0.12; 95% CI: 0.04–0.34) were significant predictors of noncompliance to exercise. The supportive role of children and spouse and the opposing role of friends and relatives were important for compliance to both. A misconception on diabetes severity, effectiveness of healthy lifestyle, and exercise timing was prevalent among the study participants. Addressing the modifiable barriers identified in this study is essential for successful diabetes management in Nepal.
Highlights
In Nepal, type 2 diabetes mellitus (T2DM) is the third most common noncommunicable disease among hospitalized patients [1], with an estimated prevalence of 6.3%–25.9% [1,2,3] among the general population
A cross-sectional study was conducted in March–May, 2016, among T2DM patients at the outpatient department (OPD) of the Diabetes, Thyroid & Endocrinology Care Centre (DTECC) in Kupondole, Nepal
The supportive role of children and spouses and the opposing role of friends and relatives were important for compliance to both
Summary
In Nepal, type 2 diabetes mellitus (T2DM) is the third most common noncommunicable disease among hospitalized patients [1], with an estimated prevalence of 6.3%–25.9% [1,2,3] among the general population. Unhealthy diet and physical inactivity are important modifiable risk factors for T2DM [4]. Adoption of a healthier lifestyle is a key factor in prevention [4] and management [5] of T2DM. Effective lifestyle interventions that include healthy diet and exercise can reduce diabetes incidence up to 55% [6] and have shown to be more efficient than antidiabetic medicines [7]. Diet combined with physical exercise has been identified as the most effective preventative strategy in reducing the incidence of diabetes [8]. Despite their importance, the practice of both is relatively low among Nepalese diabetic patients. None of the patients was adherent (87.5% nonadherence and 12.5% poor adherence) to dietary advice, and only 21% were adherent to exercise [9]
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