Adherence to diet recommendations and associated factors among type 2 diabetic patients at Mulago National Referral Hospital

Abstract

Type 2 Diabetes Mellitus (T2DM) is increasingly prevalent in Uganda, especially in urban centers like Kampala. Despite routine dietary counseling at tertiary hospitals such as Mulago National Referral Hospital, adherence to dietary recommendations remains low, contributing to poor glycemic control and complications. Since diet is central to diabetes management, it is vital to understand adherence levels and influencing factors to improve outcomes. To assess adherence levels to dietary recommendations among T2DM patients at Mulago Hospital and identify associated factors. A cross-sectional study was conducted with 379 adult T2DM patients attending outpatient care at Mulago. Data were collected using interviewer-administered tools, including the Perceived Dietary Adherence Questionnaire (PDAQ). Adherence was categorized as low (<30), moderate (30–45), and high (46–63). Descriptive statistics summarized participant data, and Chi- square tests assessed associations with adherence (significance at p<0.05). Among participants, 72% had low dietary adherence, 27% moderate, and only 1% high. Significant associations (p<0.05) were observed between adherence and variables such as age, sex, marital status, education, residence, employment, and chronic illness. Better adherence was more common in older adults (≥60 years: 40.7%), females (38.1%), widowed (45.5%), tertiary- educated, rural dwellers (40.9%), unemployed/retired, and those without chronic illness. Logistic regression did not show statistically significant odds (CIs included 1.0), but trends supported chi- square findings. Notably, females had 46% higher odds of adherence (OR=1.46, 95%CI: 0.83–2.58), and those without chronic illness had 2.3 times the odds (OR=2.27, 95%CI: 0.57–9.02). Barriers to adherence included poor nutritional knowledge and low self-control. Dietary adherence among T2DM patients at Mulago is generally low and influenced by demographic, comorbid, and behavioral factors. Strengthening nutrition education, improving access to diabetes-friendly foods, and incorporating behavioral support into care are crucial strategies to enhance adherence.