Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator

Mariusz Jaworski,1 Mariusz Panczyk,1 Małgorzata Cedro,2 Alicja Kucharska3 1Division of Teaching and Outcomes of Education, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland; 2Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland; 3Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland Background: Adherence by diabetic patients to dietary recommendations is important for effective therapy. Considering patients’ expectations in case of diet is significant in this regard. The aim of this paper was to analyze the relationship between selected independent variables (eg, regular blood glucose testing) and patients’ adherence to dietary recommendations, bearing in mind that the degree of disease acceptance might play a mediation role.Subjects and methods: A cross-sectional study was conducted in 91 patients treated for type 2 diabetes mellitus in a public medical facility. Paper-and-pencil interviewing was administered ahead of the planned visit with a diabetes specialist. Two measures were applied in the study: the Acceptance and Action Diabetes Questionnaire and the Patient Diet Adherence in Diabetes Scale. Additionally, data related to sociodemographic characteristics, lifestyle-related factors, and the course of the disease (management, incidence of complications, and dietician’s supervision) were also collected. The regression method was used in the analysis, and Cohen’s methodology was used to estimate partial mediation. Significance of the mediation effect was assessed by the Goodman test. P-values of <0.05 were considered statistically significant.Results: Patients’ non-adherence to dietary recommendations was related to a low level of disease acceptance (standardized regression coefficient =−0.266; P=0.010). Moreover, failure to perform regular blood glucose testing was associated with a lack of disease acceptance (standardized regression coefficient =−0.455; P=0.000). However, the lack of regular blood glucose testing and low level of acceptance had only partially negative impacts on adherence to dietary recommendations (Goodman mediation test, Z=1.939; P=0.054). This dependence was not seen in patients treated with diet and concomitant oral medicines and/or insulin therapy.Conclusion: Effective dietary education should include activities promoting a more positive attitude toward the disease. This may be obtained by individual counseling, respecting the patient’s needs, and focus on regular blood glucose testing. Keywords: patient adherence, diabetes mellitus type 2, attitude toward health, glycemic contro