Nutritional structure and associated factors in type 2 diabetic patients

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Background: The actual structure of nutrition and associated factors in the Russian type 2 diabetic patients have not been systematically evaluated.

Aim: To assess type 2 patients' perceptions of the diet recommendations given by their doctors, how do they deflect in the actual nutrition structure depending on demographic, medical and social factors.

Materials and methods: 297  out- and in-patients with type 2 diabetes mellitus were consecutively recruited into this cross-sectional study (mean age ± standart deviation, 61.0 ± 10.1 years, with duration of diabetes from 1 to 35  years). 21% of the patients were treated with the diet only, 53%, with oral hypoglycemic agents (OHA), 26%, with insulin or insulin + OHA. In addition to their comprehensive clinical and laboratory assessment, the patients filled in the following questionnaires: 1) to assess their obstacles and barriers with diabetes treatment; 2) to assess the diet recommendations and factors that might influence their choice of foods; 3) to assess the nutritional structure. The data is given as mean ± standard deviation.

Results: Diet was chosen as the most challenging aspect of diabetes treatment by 53% of patients, whereas insulin therapy was found to be most challenging by 12% of them, blood glucose self-monitoring by 10% and OHA treatment by 4%. The patient's diet is influenced most of all by recommendations given by their doctors (66%), with tastes and nutritional habits of the patients ranking second (48%), their well-being ranking 3rd (43%), and food costs ranking 4th (40%) with a small difference with the 3rd. The analysis of patients' understanding of the diet components and evaluation of their actual nutritional structure showed their non-concordance with current evidenced-based approaches to medical nutrition. The patient's nutrition is dominated by exclusion of fast-absorbable carbohydrates and total carbohydrate restriction, as well as by an excessive intake of vegetable oils and unfounded restraint from fried and spicy foods. Total daily caloric intake was reduced only by 37% of the patients. The patients undervalue the necessity of increased fiber intake. The group of very highly consumed foods (≥ 75% of the patients) included vegetable oils (84.0%), soft drinks (82.9%) and dairy products (78.9%). The group of highly consumed foods (50–74% of the patients) included soups (72.6%), meat, fish and poultry (70.5%), grains and cereals (total, 69.9%), vegetables, greenery and beans (68.9%), potatoes (58.9%), and fruits and berries (52.2%). The group of moderately consumed foods (25–49% of the patients) included bread and bakery products (44.5%) and eggs (27.9%), whereas the least consumed (< 25% of the patients) were “diabetic foods” (19.4%), pasta (17.1%), fat sauces and cream (21.4%), butter and lard (15.7%), nuts (14.5%), oils preserves and smoked foods (5.7%), and sweets (4.7%). The most unhealthy diet was typical for male patients, those of relatively young age, with short diabetes duration, with obesity and with lower educational level.

Conclusion: Diet is seen by type 2 diabetic patients as the most burdening treatment element. Nutritional structure of type 2 diabetic patients, including those who have participated in the patient education programs, in many ways is not consistent with the current principles of rational medical nutrition and is determined first of all by recommendations of their doctors that are not always optimal. The use of the questionnaire to assess nutritional structure and regularity allows to evaluate the diet style of a given patient and, based on it, to elaborate corrective measures and individual dietetic recommendations.

About the authors

E. G. Starostina

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.

Elena G. Starostina – MD, PhD, Professor, Chair of Endocrinology, Postgraduate Training Faculty.

61/2 Shchepkina ul., Moscow, 129110, Tel.: +7 (903) 797 84 88

Russian Federation


  1. American Diabetes Association. 4. Lifestyle Management: Standards of Medical Care in Diabetes-2018. Diabetes Care. 2018;41(Suppl 1):S38–50. doi: 10.2337/dc18-S004.
  2. Vetter ML, Amaro A, Volger S. Nutritional management of type 2 diabetes mellitus and obesity and pharmacologic therapies to facilitate weight loss. Postgrad Med. 2014;126(1): 139–52. doi: 10.3810/pgm.2014.01.2734.
  3. Osonoi Y, Mita T, Osonoi T, Saito M, Tamasawa A, Nakayama S, Someya Y, Ishida H, Kanazawa A, Gosho M, Fujitani Y, Watada H. Relationship between dietary patterns and risk factors for cardiovascular disease in patients with type 2 diabetes mellitus: a cross-sectional study. Nutr J. 2016;15:15. doi: 10.1186/s12937016-0132-6.
  4. Mathe N, Pisa PT, Johnson J, Johnson ST. Dietary Patterns in Adults with Type 2 Diabetes Predict Cardiometabolic Risk Factors. Can J Diabetes. 2016;40(4): 296–303. doi: 10.1016/j.jcjd.2015.11.006.
  5. Enomoto M, Yoshii H, Mita T, Sanke H, Yokota A, Yamashiro K, Inagaki N, Gosho M, Ohmura C, Kudo K, Watada H, Onuma T. Relationship between dietary pattern and cognitive function in elderly patients with type 2 diabetes mellitus. J Int Med Res. 2015;43(4): 506–17. doi: 10.1177/0300060515581672.
  6. Dipnall JF, Pasco JA, Meyer D, Berk M, Williams LJ, Dodd S, Jacka FN. The association between dietary patterns, diabetes and depression. J Affect Disord. 2015;174:215–24. doi: 10.1016/j.jad.2014.11.030.
  7. Wheeler ML, Dunbar SA, Jaacks LM, Karmally W, Mayer-Davis EJ, Wylie-Rosett J, Yancy WS Jr. Macronutrients, food groups, and eating patterns in the management of diabetes: a systematic review of the literature, 2010. Diabetes Care. 2012;35(2): 434–45. doi: 10.2337/dc112216.
  8. Franz MJ, Boucher JL, Evert AB. Evidence-based diabetes nutrition therapy recommendations are effective: the key is individualization. Diabetes Metab Syndr Obes. 2014;7:65–72. doi: 10.2147/DMSO.S45140.
  9. Дедов ИИ, Шестакова МВ, Майоров АЮ, Викулова ОК, Галстян ГР, Кураева ТЛ, Петеркова ВА, Смирнова ОМ, Старостина ЕГ, Суркова ЕВ, Сухарева ОЮ, Токмакова АЮ, Шамхалова МШ, Ярек-Мартынова ИР, Бешлиева ДД, Бондаренко ОН, Волеводз НН, Григорян ОР, Есаян РМ, Ибрагимова ЛИ, Калашников ВЮ, Липатов ДВ, Шестакова ЕА. Алгоритмы специализированной медицинской помощи больным сахарным диабетом / под ред. И.И. Дедова, М.В. Шестаковой, А.Ю. Майорова. Вып. 8. Сахарный диабет. 2017;20(Спецвыпуск 1): 1–121. doi: 10.14341/DM20171S8.
  10. Ahola AJ, Groop PH. Barriers to self-management of diabetes. Diabet Med. 2013;30(4): 413–20. doi: 10.1111/dme.12105.
  11. Ponzo V, Rosato R, Tarsia E, Goitre I, De Michieli F, Fadda M, Monge T, Pezzana A, Broglio F, Bo S. Self-reported adherence to diet and preferences towards type of meal plan in patient with type 2 diabetes mellitus. A cross-sectional study. Nutr Metab Cardiovasc Dis. 2017;27(7): 642–50. doi: 10.1016/j.numecd.2017.05.007.
  12. Scott P, Rajan L. Eating habits and reactions to dietary advice among two generations of Caribbean people: a South London study, part 1. Practical Diabetes. 2000;17(6): 183–6. doi: 10.1002/1528-252X(200009)17:6<183::AIDPDI86>3.0.
  13. Larkin AT, Hoffman C, Stevens A, Douglas A, Bloomgarden Z. Determinants of adherence to diabetes treatment. J Diabetes. 2015;7(6): 864–71. doi: 10.1111/1753-0407.12264.
  14. Albargawi M, Snethen J, Al Gannass A, Kelber S. Relationship between person's health beliefs and diabetes self-care management regimen. J Vasc Nurs. 2017;35(4): 187–92. doi: 10.1016/j.jvn.2017.07.002.
  15. Калашникова МФ, Бондарева ИБ, Лиходей НВ. Приверженность лечению при сахарном диабете 2-го типа: определение понятия, современные методы оценки пациентами проводимого лечения. Лечащий врач. 2015;(3): 27–33.
  16. Jaworski M, Panczyk M, Cedro M, Kucharska A. Adherence to dietary recommendations in diabetes mellitus: disease acceptance as a potential mediator. Patient Prefer Adherence. 2018;12:163–74. doi: 10.2147/PPA.S147233.
  17. Breen C, Ryan M, Gibney MJ, O'Shea D. Diabetes-related nutrition knowledge and dietary intake among adults with type 2 diabetes. Br J Nutr. 2015;114(3): 439–47. doi: 10.1017/S0007114515002068.
  18. Старостина ЕГ, Шаврикова ЕП. Разработка опросника «Соблюдение принципов рационального питания» для больных сахарным диабетом 2-го типа и оценка возможности его применения. Альманах клинической медицины. 2016;44(4): 422–9. doi: 10.18786/2072-0505-2016-44-4-422-429.
  19. Батурин АК. Разработка системы оценки и характеристика структуры питания и пищевого статуса населения России: автореф. дис. ... д-ра мед. наук. М., 1998. 47 с.
  20. Мартинчик АН, Батурин АК, Баева ВС, Пятницкая ИН, Пескова ЕВ, Феоктистова АИ, Азизбекян ГА, Бормачева ЕА. Разработка метода исследования фактического питания по анализу частоты потребления пищевых продуктов: создание вопросника и общая оценка достоверности метода. Вопросы питания. 1998;(3): 8–13.
  21. Мартинчик АН, Батурин АК, Баева ВС, Пескова ЕВ. Изучение фактического питания с помощью анализа частоты потребления пищи: создание вопросника и оценка достоверности метода. Профилактика заболеваний и укрепление здоровья. 1998;(5): 14.
  22. Батурин АК, Мартинчик АН, Сафронова АМ. Региональные особенности питания населения России. Вопросы диетологии. 2011;1(2): 17–22.
  23. Батурин АК, Погожева АВ, Кешабянц ЭЭ, Старовойтов МЛ, Кобелькова ИВ, Камбаров АО. Изучение питания, антропометрических показателей и состава тела у коренного и пришлого населения Российской Арктики. Вопросы питания. 2017;86(5): 11–6.
  24. Кобелькова ИВ, Батурин АК. Анализ взаимосвязи образа жизни, рациона питания и антропометрических данных с состоянием здоровья лиц, работающих в условиях особо вредного производства. Вопросы питания. 2013;82(1): 74–8.
  25. Lichtman SW, Pisarska K, Berman ER, Pestone M, Dowling H, Offenbacher E, Weisel H, Heshka S, Matthews DE, Heymsfield SB. Discrepancy between self-reported and actual caloric intake and exercise in obese subjects. N Engl J Med. 1992;327(27): 1893–8. doi: 10.1056/NEJM199212313272701.
  26. Старостина ЕГ, Мошняга ЕН, Володина МН, Малахова ТС. Эпидемиология наиболее частых психических расстройств у больных сахарным диабетом. Альманах клинической медицины. 2014;32:17–23. doi: 10.18786/2072-0505-2014-32-17-23.
  27. Блохина ЛВ, Кондакова НМ, Погожева АВ, Батурин АК. Изучение фактического питания – важное звено в многоуровневой системе диагностики нарушений пищевого статуса у пациентов с ожирением. Вопросы питания. 2009;78(5): 35–40.
  28. Старостина ЕГ, Мошняга ЕН. Уровень знаний эндокринологов и терапевтов о сахарном диабете и его динамика с 2000 по 2005 гг. В: Высокие медицинские технологии в эндокринологии. Материалы V Всероссийского съезда эндокринологов. М.; 2006. c. 752.
  29. Mühlhauser I, Lenz M. Does patient knowledge improve treatment outcome? Z Evid Fortbild Qual Gesundhwes. 2008;102(4): 223–30. German.
  30. Романенко МС, Гавалко ЮВ, Синеок ЛЛ, Сапожников ИВ, Леськив РИ. Связь фактического питания и метаболических факторов риска: возрастные и гендерные особенности. Современная гастроэнтерология. 2016;91(5): 49–60.
  31. Малахова ТС, Старостина ЕГ, Чих ИД, Бобров АЕ. Клинические особенности больных сахарным диабетом 1 типа, употребляющих алкоголь в допустимых и в чрезмерных количествах. В: Сборник тезисов VII Всероссийского диабетологического конгресса «Сахарный диабет в XXI веке – время объединения усилий», 24–28 февраля 2015 г. М.: УП Принт; 2015. с. 294.

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Copyright (c) 2018 Starostina E.G.

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