Dietary Knowledge, Attitudes, Practices and their Association with Demographic Factors in Type 2 Diabetes Patients
Abstract
The study aimed to assess dietary Knowledge, Attitude, And Practice (KAP) among Type 2 Diabetes Mellitus patients at Hospital Pakar USM (HPUSM), and their associations with demographic characteristics. The study used a cross-sectional design with a convenience sampling method, and the analysis included responses from 118 participants. Their dietary KAP and demographic characteristics were assessed using an adapted and translated questionnaire based on the ADA Diabetes Self-Management Assessment Research Tool (D-SMART) and the University of Michigan Diabetes Research and Training Centre’s KAP questionnaire. The questionnaire was translated and pilot-tested among 10% of the study population to ensure clarity and understanding. Minor adjustments were made based on participant feedback. The mean age of the 118 participants was 58.0±13.3 years, with 40.7% men and 59.3% women. The vast majority of participants possessed favourable attitudes (91.5%), good dietary knowledge (84.7%), and good practice (72.9%). Specifically, the mean scores for dietary knowledge, attitude, and practice were 41.8±9.39, 5.4±1.06, and 5.3±1.6, respectively. Bivariate analyses indicated significant associations between education level and knowledge (p=0.007) and attitude (p=0.009) but not practice (p=0.942). Multivariate Analysis of Variance (MANOVA) demonstrated a significant multivariate association between education level and the combined KAP scores, Pillai’s Trace=0.182, p=0.001. The remaining demographic variables were not significantly associated with the combined KAP scores in the multivariate model (p>0.05).The results of the study indicate that, despite the fact that the majority of participants had favourable dietary knowledge, attitudes, and practices, education level significantly influenced knowledge and attitude scores. This underscores the importance of providing ongoing and targeted dietary education, particularly for individuals with lower educational attainment, to facilitate more effective dietary management among those with Type 2 Diabetes Mellitus (T2DM).
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References
Adam H MI, Elmosaad YM, Ahmed AEE, Khan A, Mahmud I. 2021. Dietary knowledge, attitude, and practice among type 2 diabetes mellitus patients in Sudan: A hospital-based cross-sectional study. Afr Health Sci 21(1):32–40. https://doi.org/10.4314/ahs.v21i1.6
American Diabetes Association. 2020. 5. Lifestyle management: Standards of medical care in diabetes—2020. Diabetes Care 43(Suppl 1):S48–S65. https://doi.org/10.2337/dc20-S005
American Diabetes Association. 2022. 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes—2022. Diabetes Care 45(Suppl 1): S17–S38. https://doi.org/10.2337/dc22-S002
Amsah N, Md Isa Z, Kassim Z. 2022. Poor glycaemic control and its associated factors among type 2 diabetes mellitus patients in southern part of Peninsular Malaysia: a registry-based study. Open Access Maced J Med Sci 10(B):422–427. https://doi.org/10.3889/oamjms.2022.8696
Ansari T, Sami W, Alsubaie N, Althaqib AA, Alenezi AA, Almutairy AN, Alshamrani, MA, Alanazi MA, Almutairi MA. 2019. Assessment of knowledge, attitude, and practice of dietary pattern in patients with type 2 diabetes mellitus: A locality-based perspective study. Int J Med Dev Ctries 3(7):581–585. https://doi.org/10.24911/ijmdc.51-1547743129
Azizi MS, Vanoh D, Yudin ZM. 2022. Health literacy: How is it related to body mass index of patients with diabetes mellitus? J Gizi Pangan 17(3):195–204. https://doi.org/10.25182/jgp.2022.17.3.195-204
Bano A, Afzal M, Sarwar H, Bano A, Afzal M, Sarwar H, Waqas A, Kousar S, Gulzar S. 2017. Dietary knowledge, attitude and practices of diabetes patients at Services Hospital Lahore. Int J Appl Sci Biotechnol 5(2):227–236. https://doi.org/10.3126/ijasbt.v5i2.17625
[DOSM] Department of Statistics Malaysia. 2020. Household income and basic amenities survey report 2019. Department of Statistics Malaysia. https://www.dosm.gov.my [Accessed 24 April 2025].
Habib F, Durrani AM. 2018. Effect of age and socio-economic status on compliance among type 2 diabetic patients. Curr Res Diabetes Obes J 7(3):3–7. https://doi.org/10.19080/crdoj.2018.07.555714
Han CY, Chan CGB, Lim SL, Zheng X, Woon ZW, Chan YT, Bhaskaran K, Tan KF, Mangaikarasu K, Chong MFF. 2020. Diabetes-related nutrition knowledge and dietary adherence in patients with Type 2 diabetes mellitus: A mixed-methods exploratory study. Proc Singapore Healthc 29(2):81–90. https://doi.org/10.1177/2010105820901742
Hu X, Zhang R, Wang Y, Lin S, Guo X,Yang D, Cai M, Gao L. 2021. Dietary Knowledge, Attitude and Practice (KAP) among the family members of patients with Type 2 Diabetes Mellitus (T2DM) and its influence on the KAP of T2DM patients. Diabetes Metab Syndr Obes 14:205–213. https://doi.org/10.2147/DMSO.S290639
Jing T, Zhang S, Bai M, Chen Z, Gao S, Li S, Zhang J. 2023. Effect of dietary approaches on glycemic control in patients with type 2 diabetes: A systematic review with network meta-analysis of randomized trials. Nutr 15(14):3156. https://doi.org/10.3390/nu15143156
Johannesen CO, Dale HF, Jensen C, Lied GA. 2020. Effects of plant-based diets on outcomes related to glucose metabolism: A systematic review. Diabetes Metab Syndr Obes 13:2811–2822. https://doi.org/10.2147/DMSO.S265982
Jusoh Z, Tohid H, Omar K, Muhammad NA, Ahmad S. 2018. Clinical and sociodemographic predictors of the quality of life among patients with type 2 diabetes mellitus on the East Coast of Peninsular Malaysia. Malays J Med Sci 25(1):84–95. https://doi.org/10.21315/mjms2018.25.1.10
Kim J, Hur MH. 2021. The effects of dietary education interventions on individuals with type 2 diabetes: A systematic review and meta-analysis. Int J Environ Res Public Health 18(16):8439. https://doi.org/10.3390/ijerph18168439
[MOH] Ministry of Health Malaysia. 2020. Management of type 2 diabetes mellitus (6th ed.). Clinical Practice Guidelines. https://www.moh.gov.my/moh/resources/Penerbitan/CPG/Endocrine/CPG_T2DM_6th_Edition_2020_13042021.pdf [Accessed 24 April 2025].
Ntaate C. 2015. Dietary practices and self-management of type 2 diabetes: The role of knowledge and attitudes. J Diabetes Res 2015:36–42. https://doi.org/10.1155/2015/289130
Olatona FA, Airede CA, Aderibigbe SA, Osibogun A. 2019. Nutritional knowledge, dietary habits and nutritional status of diabetic patients attending teaching hospitals in Lagos, Nigeria. J Community Med Prim Health Care 31(2):90–103.
Patel M, Patel IM, Patel YM, Rathi SK. 2012. Factors associated with consumption of diabetic diet among type 2 diabetic subjects from Ahmedabad, Western India. J Health Popul Nutr 30(4):447–455. https://doi.org/10.3329/jhpn.v30i4.13328
Patel R, Sina RE, Keyes D. 2024. Lifestyle modification for diabetes and heart disease prevention. In Continuing Education Activity (Chapter 1). National Center for Biotechnology Information. Treasure Island (USA): StatPearls Publishing.
Ponzo V, Rosato R, Tarsia E, et al. 2017. Self-reported adherence to diet and preferences towards type of meal plan in patients with type 2 diabetes mellitus: A cross-sectional study. Nutr Metab Cardiovasc Dis 27(7):642–650. https://doi.org/10.1016/j.numecd.2017.05.007
Sami W, Alabdulwahhab KM, Ab Hamid MR, Alasbali, TA, Alwadani, FA, Ahmad MS. 2020. Dietary attitude of adults with type 2 diabetes mellitus in the Kingdom of Saudi Arabia: A cross-sectional study. Medicina (Kaunas) 56(2):91. https://doi.org/10.3390/medicina56020091
Tan JYH, Ng CJ. 2023. Prevalence and burden of diabetes mellitus-related symptoms in patients with type 2 diabetes mellitus: A cross-sectional study. Plos One 18(12):e0289402.
[WHO] World Health Organization. 2021. The top 10 causes of death. https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death [Accessed 24 April 2025].
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