Factors associated with diet barriers in patients with poorly controlled type 2 diabetes

Li Cheng,1 Doris Yin-ping Leung,1 Janet Wing-hung Sit,1 Xiao-mei Li,2 Yu-ning Wu,3 Miao-yan Yang,4 Cui-xia Gao,5 Rong Hui6 1The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Ma Liu Shui, Shatin, New Territories, Hong Kong; 2The Department of Nursing, Faculty of Medicine, The Xi’an Jiaotong University, 3The Department of Endocrinology, The Ninth Affiliated Hospital of Xi’an Jiaotong University, 4The Department of Endocrinology, The Second Affiliated Hospital of Xi’an Jiaotong University, 5The Department of Endocrinology, The First Affiliated Hospital of Xi’an Jiaotong University, 6The Department of Endocrinology, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China Background: The study was conducted to investigate the diet barriers perceived by patients with poorly controlled type 2 diabetes and examine the associations between diet barriers and sociodemographic characteristics, medical condition, and patient-centered variables. Methods: Secondary subgroup analyses were conducted based on the responses of 246 adults with poorly controlled type 2 diabetes from a multicenter, cross-sectional study. Diet barriers were captured by the Diet Barriers subscale of the Personal Diabetes Questionnaire. Participants also completed validated measures of diet knowledge, empowerment level, and appraisal of diabetes. Multiple regression techniques were used for model building, with a hierarchical block design to determine the separate contribution of sociodemographic characteristics, medical condition, and patient-centered variables to diet barriers. Results: Diet barriers were moderately evident (2.23±0.86) among Chinese patients with poorly controlled type 2 diabetes. The feeling of deprivation as a result of complying with a diet was the most recognized diet barrier (3.24±1.98), followed by “eating away from home” (2.79±1.82). Significantly higher levels of diet barriers were observed among those with lower levels of diet knowledge (β=-0.282, P<0.001) and empowerment (β=-0.190, P=0.015), and more negative appraisal (β=0.225, P=0.003). Conclusion: Culturally tailored, patient-centered intervention programs that acknowledge individuals’ preferences and allow for flexibility in diet management should be launched. Interventions programs that could enhance diet knowledge, promote positive appraisal, and improve empowerment level might effectively address diet barriers perceived by patients with poorly controlled type 2 diabetes. Keywords: diabetes, diet barriers, knowledge, appraisal, empowermen