- The Effects of Teaching Methods on the Dietary Compliance and Hemoglobin A1c Level in Patients with Diabetes Mellitus.
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Sung Oh Chung, O Keum Song, Jae Min Ko, Jun Hwan Wi, Tae Hoon Lee, Ju Hyup Yum, Dae Kyoung Cho, Jin Hee Son, Hong Woo Nam, Hyung Joon Yoo, Young Nam Lee, Sung Gon Kim, Hyun Kyung Moon, Eul Sang Kim
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Korean Diabetes J. 2000;24(5):560-573. Published online January 1, 2001
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 Abstract
- BACKGROUND
Diet control plays an important role in diabetic management, but it is often hard for diabetic patients to follow the dietary control program. Poor dietary compliance leads to metabolic derangements in patients with diabetes and it may derive mainly from defects in dietary education program rather than from patients themselves. Therefore, we performed a randomized prospective study to compare the effects of three different teaching methods for diet control. METHODS: Forty eight diabetic patients with poor glycemic control (mean HbA1c 11.4+/-1.5%) were enrolled during hospitalization and allocated at random to three different teaching methods i.e. Conventional diet sheet instruction (Group 1), Food recording on every meal (Group 2), and Meal time demonstration (Group 3). For evaluation, knowledge about DM diet and barriers to diet control were assessed by a questionnaire. Consistency in carbohydrate intake (Coefficient of variation) and serial HbA1C measurements were used for the estimation of dietary compliance and glycemic control respectively. RESULTS: During five months' follow-up period, there was no remarkable improvement in knowledge about diabetic diet control, dietary compliance and glycemic control in Group 1 patients. But both dietary compliance and glycemic control improved in Group 2 and 3 patients during follow-up period. In Group 2 CV (Coefficient of Variation ) fell from 36.4+/-15.2% to 27.7+/-17.3% and in Group 3 from 32.1+/-9.6% to 23.2+/-10.5% (p<0.05). In Group 2 HbA1c fell from 12+/-2.2% to 8.3 +/-2.0% and in Group 3 from 11.5+/-2.0% to 7.5+/-1.9% (p<0.01). The change of HbA1c level showed an appreciable correlation with dietary compliance (r= 0.75). Among the perceived barriers to dietary practice in patients of Group 2 and Group 3, extrinsic factors related to knowledge lowered during the intervention (p<0.05). Even though Group 3 patients had good dietary compliance, they still felt that intrinsic factors related to motive and attitude were the major barriers at the end of the study (p<0.05). CONCLUSION: We found that meal time demonstration teaching method may improve dietary compliance and glycemic control compared with the conven tional diet sheet instruction method.
- Perceived barriers to Dietary Practice Adherence Among Persons with Diabetes.
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O Keum Song, Hong Woo Nam, Do Ho Moon, Kyung Ho Lim, Hyun Kyung Moon, Eul Sang Kim
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Korean Diabetes J. 1998;22(3):381-391. Published online January 1, 2001
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Abstract
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- BACKGROUND
Diet therapy is viewed as a cornerstone of diabetes care and emphasized to all the type of diabetes. The diet has been identified by many patients as one of the most difficult part of managing their diabetes. They may have several factors to influence adherence to a dict. The purpose of this study was to identify dietary practice adherence and perceived barriers(intrinsic and extrinsic factors) among the persons with diabetes at Diabetes Clinic in Nationwide.. METHODS: The survey questionnaire was mailed to 852 persons with diabetes member via diabetes educators of 156 hospitals, clinics and 24 health centers. Questionnaire divided into 3 part;(1)background information (2)meal regularity and food intake as a dietary practice adherence (3)40 items with motive/ attitude as a intrinsic factor and knowledge, resources/authority as a extrinsic factor was rated by the thoughts and feelings associated with barriers to dietary practice adherence. 432 questionnaires were returned. The response rate was 51%. RESULTS: Meal regularty was more satisfactory than food intake. Deficit of meal regularity was reasonable spacing between meal and snack' due to "grazing", "weak will", "hunger feeling". Deficit of food Intake was protein food in 3 meal a day' 43% less recommendation due to I wouldnt disturb anyone so I used to eat something available", fear of hyperglycemia, bother to prepare food. Conclusions: The respondents to this questionnaire were members of Diabetes Clinics. They perceived that motive/attitude(intrinsic factors) was as the major barriers while authority/resources(extrinsic factors) was as a minor barriers to the dietary practice adherence. Tliese results suggest that dietary strategies may need to be developed cognitive-behavioral aspect and problem-solving skills for alteration in 'Real-life' diabetic situation to dietary practice adherence.
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KDA
