Nutritional structure and associated factors in type 2 diabetic patients

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 3^rd (43%), and food costs ranking 4^th (40%) with a small difference with the 3^rd. 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.