This study aimed to assess the association between diabetes diet adherence and glycemic control among Type 2 Diabetes Mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia.Poor glycemic control was found to be linked with poor diabetes diet and medication dherence, low income, lack of dietary education, diabetes related comorbidities and complications.
Diet is one of the most important factors that can modify many aspects of the body physiology including the physiology of pancreas that secretes insulin hormone. Moreover, good dietary adherence is one of the important strategies of life style modification which helps to control the blood glucose level. Hence, failure to adhere to diabetes diet could lead to poor glycemic control.
Accordingly, this study showed that the odds of poor glycemic control were 3.89 times higher among patients with poor diabetes dietary adherence compared with patients with good diabetes dietary adherence. The finding is consistent with other similar studies done in Malaysia[33], Bangladesh [34], Iraq [35], Jordan [36],Kenya[37] and Ethiopia [26, 38, 39]. Nontheless ,a study done in Nekemte referral hospital, western Ethiopia, shows that diabetes dietary adherence is not significantly associated with glycemic control [17].
The odds of poor glycemic control were 3.7 times higher among patients with poor adherence to diabetes medication compared with their counterparts.It is in agreement with result of previous studies done in Singapore, Japan, Democratic republic of Congo, Ghana,and Ethiopia[14, 40–43]. This may be due to the fact that anti-diabets medications influence the pancreas release more insulin. limit the liver’s ability to make and release glucose, block the actions of enzymes that aid in the process of glycolysis ,and improve cell’s sensitivity to insulin.Thus s non-adherence to these medication could result in distortions this functions leading to poor glycemic control.Moreover, adherence to prescribed medication regimen is crucial to reach metabolic control as non-adherence to blood glucose lowering agents results in higher Hba1c value [44]. In contray, a study done in western part Ethiopia showed that medication adherence is not significantly associated with glycemic control [17].
Diabetes dietary education has also influenced the level blood glucose level whereby the odds of poor glycemic control were 4.97 times higher among patients who didn’t receive diabetes dietary education compared with patients who received the education. This result is in accordance with similar previous studies conducted done in Croatia and South Korea [45, 46].This may be due to the reason that patients who didn’t receive dietary education were less likely to have knowledge about the benefit of food management in diabetes control. Additionally, patients who have received dietry education may perceive the fatality of the disease when they fail to adhere to dietary recommendations.
This study also revealed that the odds of poor glycemic control were 3.1 times higher among patients from low economic class compared with their counterparts. This finding is in line with previous studies conducted in some parts of Ethiopia [14, 47]. However, studies done in India and Portugal showed an absence of statistically significance association between level of income and poor glycemic control [48, 49].
Poor glycemic control was 5.1 times more common among patients who had diabetes complications compared with their counterparts.This find is consistent with the studies conducted in England, northern Ireland and Scotland, and some parts of Ethiopia [50–52]. This may be explained by the fact that high blood glucose level induces tissue damage through mitochondrial superoxide production which may lead to cellular damage including capillary endothelial cells in the retina, mesangial cells in the renal glomerulus ,and neurons and Schwann cells in peripheral nerves. These cells are particularly at high risk of damage as they are unable to regulate uptake of glucose during hyperglycemia. Therefore, a prolonged hyperglycemia is associated with metabolic imbalances, accumulation of advanced glycation end products, oxidation stress, and lipid alterations leading to diabetes polyneuropathy and multiple organ damage increasing the risk of diabetis complications and eventual death.
The odds of poor glycemic control were nearly five time higher among patients with superimposed comorbidities compared with their counterparts. Former studies conducted in Italy, Congo, and some parts Ethiopia have reported similar findings[2, 40, 53, 54].This could be attributed to the effect of polypharmacy that patients with diabetes comorbidities may not adhere to their diabtes medication because of loss of appetite secondary to multiple medication intake which collectively results in poor glycemic control. On the other hand, other studies conducted in Netherland, Croatia, and Canada [55–57] didn’t show the relationship between comorbidities and level of HgA1c may be attributed to difference in tools applied to assess comorbidity and an advanced approach in management of comorbidities .