Barriers to following dietary recommendations in Type 2 diabetes

被引:120
作者
Vijan, S
Stuart, NS
Fitzgerald, JT
Ronis, DL
Hayward, RA
Slater, S
Hofer, TP
机构
[1] Vet Affairs Ctr Practice Managment & Outcomes Res, Ann Arbor, MI USA
[2] Univ Michigan, Sch Nursing, Ann Arbor, MI 48109 USA
[3] Univ Michigan, Dept Gen Internal Med, Ann Arbor, MI 48109 USA
[4] Univ Michigan, Dept Med Educ, Ann Arbor, MI 48109 USA
关键词
diabetes; dietary adherence; barriers; patient preferences; guidelines;
D O I
10.1111/j.1464-5491.2004.01342.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To evaluate barriers to following dietary recommendations in patients with Type 2 diabetes. Methods We conducted focus groups and surveys in urban and suburban VA and academic medical centres. For the written survey, a self-administered questionnaire was mailed to a random sample of 446 patients with diabetes. For the focus groups, six groups of patients with diabetes (three urban, three suburban) were conducted, with 6-12 participants in each group. The focus groups explored barriers across various types of diabetes self-management; we extracted all comments relevant to barriers that limited patients' ability to follow a recommended diet. Results The written survey measured the burden of diabetes therapies (on a seven-point rating scale). Moderate diet was seen as a greater burden than oral agents (median 1 vs. 0, P = 0.001), but less of a burden than insulin (median 1 vs. 4, P < 0.001). A strict diet aimed at weight loss was rated as being similarly burdensome to insulin (median 4 vs. 4, P = NS). Despite this, self-reported adherence was much higher for both pills and insulin than it was for a moderate diet. In the focus groups, the most commonly identified barrier was the cost (14/14 reviews), followed by small portion sizes (13/14 reviews), support and family issues (13/14 reviews), and quality of life and lifestyle issues (12/14 reviews). Patients in the urban site, who were predominantly African-American, noted greater difficulties communicating with their provider about diet and social circumstances, and also that the rigid schedule of a diabetes diet was problematic. Conclusions Barriers to adherence to dietary therapies are numerous, but some, such as cost, and in the urban setting, communication with providers, are potentially remediable. Interventions aimed at improving patients' ability to modify their diet need to specifically address these areas. Furthermore, treatment guidelines need to consider patients' preferences and barriers when setting goals for treatment.
引用
收藏
页码:32 / 38
页数:7
相关论文
共 25 条
[21]  
Ray NF, 1998, DIABETES CARE, V21, P296
[22]   Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33) [J].
Turner, RC ;
Holman, RR ;
Cull, CA ;
Stratton, IM ;
Matthews, DR ;
Frighi, V ;
Manley, SE ;
Neil, A ;
McElroy, K ;
Wright, D ;
Kohner, E ;
Fox, C ;
Hadden, D ;
Mehta, Z ;
Smith, A ;
Nugent, Z ;
Peto, R ;
Adlel, AI ;
Mann, JI ;
Bassett, PA ;
Oakes, SF ;
Dornan, TL ;
Aldington, S ;
Lipinski, H ;
Collum, R ;
Harrison, K ;
MacIntyre, C ;
Skinner, S ;
Mortemore, A ;
Nelson, D ;
Cockley, S ;
Levien, S ;
Bodsworth, L ;
Willox, R ;
Biggs, T ;
Dove, S ;
Beattie, E ;
Gradwell, M ;
Staples, S ;
Lam, R ;
Taylor, F ;
Leung, L ;
Carter, RD ;
Brownlee, SM ;
Fisher, KE ;
Islam, K ;
Jelfs, R ;
Williams, PA ;
Williams, FA ;
Sutton, PJ .
LANCET, 1998, 352 (9131) :837-853
[23]   Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus - Putting evidence into practice [J].
Vijan, S ;
Stevens, DL ;
Herman, WH ;
Funnell, MM ;
Standiford, CJ .
JOURNAL OF GENERAL INTERNAL MEDICINE, 1997, 12 (09) :567-580
[24]   A NURSE-COORDINATED INTERVENTION FOR PRIMARY-CARE PATIENTS WITH NON-INSULIN-DEPENDENT DIABETES-MELLITUS - IMPACT ON GLYCEMIC CONTROL AND HEALTH-RELATED QUALIFY OF LIFE [J].
WEINBERER, M ;
KIRKMAN, S ;
SAMSA, GP ;
SHORTLIFFE, EA ;
LANDSMAN, PB ;
COWPER, PA ;
SIMEL, DL ;
FEUSSNER, JR .
JOURNAL OF GENERAL INTERNAL MEDICINE, 1995, 10 (02) :59-66
[25]   United kingdom prospective diabetes study 24: A 6-year, randomized, controlled trial comparing sulfonylurea, insulin, and metformin therapy in patients with newly diagnosed type 2 diabetes that could not be controlled with diet therapy [J].
Wright, A ;
Cull, C ;
Holman, R ;
Turner, R ;
Murchison, L ;
Wright, AD ;
Oakley, N ;
Kohner, E ;
Hayes, R ;
Scarpello, J ;
Hadden, D ;
Spathis, AG ;
Yudkin, J ;
Greenwood, R ;
Borthwick, L ;
Day, J ;
Newton, R ;
Fox, C ;
Paisey, R ;
Roland, J ;
Humphriss, D ;
Peacock, I ;
Boulton, A ;
Dornan, T ;
Burden, F ;
Tooke, J .
ANNALS OF INTERNAL MEDICINE, 1998, 128 (03) :165-175