Knowledge, Attitudes, and Behaviors Toward Proper Nutrition and Lifestyles in Kosovar’s Diabetic Patients

A. Ukëhaxhaj, B. Sutaj, H. Terziqi, A. Vrella, F. Hoxha

 
For citation: Ukëhaxhaj A, Sutaj B, Terziqi H, Vrella A, Hoxha F. Knowledge, Attitudes, and Behaviors Toward Proper Nutrition and Lifestyles in Kosovar’s Diabetic Patients. International Journal of Biomedicine. 2024;14(1):110-117. doi:10.21103/ Article14(1)_OA17
 
Originally published March 1, 2024

Abstract: 

Background: The aim of our study was to assess the knowledge and attitudes about type 2 diabetes (T2D) in Kosovars patients, as well as self-efficacy toward eating behavior, and determine the impact of diabetes on patients' daily work and lifestyle practices.
Methods and Results: This analytical cross-sectional survey was performed among 400 T2D patients (203 males and 197 females) to assess their knowledge, attitude, and practice regarding diabetic diet and eating habits. It was conducted from February to May 2023 in Kosovo's rural and urban areas. Knowledge, attitudes, and eating behavior were assessed using the self-administered 28-item sets related to glycemic control, physical activity, risk of complications, foot care, and food and nutrition. The largest proportion (42.3%) was made up of the patients over 60 years of age; 41.5% were 40-60 years of age, and only 16.3% were 30-40 years old. Most of the patients were males (50.8%); more than 87% were married. Interviewed participants did not have enough knowledge about the consumption of foods with more fruits, beverages, and sweets. Generally, participants had poor knowledge about the impact of DM on health. Most diabetics in Kosovo still have suboptimal diet practices, choosing to base their main meals around carbohydrates containing food with a high glycemic index, such as white bread and potatoes most of the time. In our case, 38.8% of participants never exercised during the week because they did not know the importance of exercise to treat their disease. In our study, we found no association between the level of diabetes-related knowledge and age, gender, or the years since the patient was diagnosed. A worrying fact for Kosovar patients is that there are no diabetes counseling centers in the regions where they live.
Conclusion: There is a need to increase awareness of the complications of diabetes and consequently improve nutrition knowledge, attitudes, and practices. The benefits of early detection of T2D through screening in the general population are needed in Kosovo.

Keywords: 
knowledge • type 2 diabetes • eating habits • Kosovo adults
References: 
  1. Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care. 2004 May;27(5):1047-53. doi: 10.2337/diacare.27.5.1047. PMID: 15111519.
  2. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011 Dec;94(3):311-21. doi: 10.1016/j.diabres.2011.10.029. Epub 2011 Nov 12. PMID: 22079683.
  3. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010 Jan;87(1):4-14. doi: 10.1016/j.diabres.2009.10.007. 
  4. PAHO. Diabetes. Available from: https://www.paho.org/en/topics/diabetes
  5.  International Diabetes Federation. IDF diabetes atlas. 6th edition. IDF; Brussels: 2013.
  6. Fang M, Wang D, Coresh J, Selvin E. Undiagnosed Diabetes in U.S. Adults: Prevalence and Trends. Diabetes Care. 2022 Sep 1;45(9):1994-2002. doi: 10.2337/dc22-0242. PMID: 35817030; PMCID: PMC9472490.
  7. AJPH Global News. Am J Public Health. 2018 Oct;108(10):1270. doi: 10.2105/AJPH.2018.304665. 
  8. IDF Diabetes Atlas. Diabetes around the world in 2021. Available from: https://diabetesatlas.org/
  9. Altobelli E, Angeletti PM, Profeta VF, Petrocelli R. Lifestyle Risk Factors for Type 2 Diabetes Mellitus and National Diabetes Care Systems in European Countries. Nutrients. 2020 Sep 13;12(9):2806. doi: 10.3390/nu12092806. PMID: 32933175; PMCID: PMC7551066.
  10. Funnell MM, Anderson RM. MSJAMA: the problem with compliance in diabetes. JAMA. 2000 Oct 4;284(13):1709. PMID: 11015809.
  11. Goyal R, Singhal M, Jialal I. Type 2 Diabetes. 2023 Jun 23. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan–. PMID: 30020625.
  12. WHO. Diabetes 5 April 2023, Available from: https://www.who.int/news-room/fact-sheets/detail/diabetes
  13. International Diabetes Federation: About WDD, 2018. Available from: https://www.blockscientific.com/world-diabetes-day-2018-focus-on-the-rol...
  14. Karatzi K, Manios Y. The Role of Lifestyle, Eating Habits and Social Environment in the Prevention and Treatment of Type 2 Diabetes and Hypertension. Nutrients. 2021 Apr 25;13(5):1460. doi: 10.3390/nu13051460. PMID: 33922994; PMCID: PMC8146863.
  15. Hansaram, Sinha AP, Chongloi N, Sahoo B, Ara M, Savita, Madanlalsaini. A cross-Sectional Study to Assess the Knowledge of the Diabetes patients regarding Diabetic Diet. Indian Journal of Nutrition. 2022; 9(1):250.
  16. Al-Maskari F, El-Sadig M, Al-Kaabi JM, Afandi B, Nagelkerke N, Yeatts KB. Knowledge, attitude and practices of diabetic patients in the United Arab Emirates. PLoS One. 2013;8(1):e52857. doi: 10.1371/journal.pone.0052857. Epub 2013 Jan 14. PMID: 23341913; PMCID: PMC3544806.
  17. Hamilton K, Stanton-Fay SH, Chadwick PM, Lorencatto F, de Zoysa N, Gianfrancesco C, Taylor C, Coates E, Breckenridge JP, Cooke D, Heller SR, Michie S; DAFNEplus study group. Sustained type 1 diabetes self-management: Specifying the behaviours involved and their influences. Diabet Med. 2021 May;38(5):e14430. doi: 10.1111/dme.14430. Epub 2020 Dec 8. PMID: 33073393; PMCID: PMC8247296.
  18. Due-Christensen M, Joensen LE, Sarre S, Romanczuk E, Wad JL, Forde R, Robert G, Willaing I, Forbes A. A co-design study to develop supportive interventions to improve psychological and social adaptation among adults with new-onset type 1 diabetes in Denmark and the UK. BMJ Open. 2021 Nov 2;11(11):e051430. doi: 10.1136/bmjopen-2021-051430. PMID: 34728449; PMCID: PMC8565545.
  19. Turner A, LaMonica HM, Moroney C, O'Leary F, Naismith SL, Flood VM. Knowledge, Attitudes, and Behaviours Concerning the Mediterranean Diet Among Older Adults in Australia. J Community Health. 2023 Dec;48(6):951-962. doi: 10.1007/s10900-023-01237-1. Epub 2023 Jun 8. PMID: 37289354; PMCID: PMC10248335.
  20. Basker J, Mammen JA, Sreethu PT, Mahesh NM, Williams F, Chandrashekara P. Assessment of diabetic knowledge and medication adherence in type 2 diabetes patients. Indo American Journal of Pharmaceutical Research.2016;6(2):4479-4491.
  21. Islam FM, Chakrabarti R, Dirani M, Islam MT, Ormsby G, Wahab M, Critchley C, Finger RP. Knowledge, attitudes and practice of diabetes in rural Bangladesh: the Bangladesh Population based Diabetes and Eye Study (BPDES). PLoS One. 2014 Oct 14;9(10):e110368. doi: 10.1371/journal.pone.0110368. PMID: 25313643; PMCID: PMC4196995.
  22. Shah VN, Kamdar PK, Shah N. Assessing the knowledge, attitudes and practice of type 2 diabetes among patients of Saurashtra region, Gujarat. Int J Diabetes Dev Ctries. 2009 Jul;29(3):118-22. doi: 10.4103/0973-3930.54288. PMID: 20165648; PMCID: PMC2822215.
  23. Kant R, Thapliyal V. Knowledge attitude and practice of type 2 diabetic patients in a tertiary care teaching hospital in India. Integr Food Nutr. Metab.2015;2(1):131-135.
  24. Mohamed BA, Almajwal AM, Saeed AA, Bani IA. Dietary practices among patients with type 2 diabetes in Riyadh, Saudi Arabia. J Food Agric Environ.2013;11(2):110114.
  25. Vieira ER, Cavalcanti FADC, Civitella F, Hollifield M, Caceres S, Carreno J, Gaillard T, Huffman FG, Mora JC, Queiroga MR. Effects of Exercise and Diet on Body Composition and Physical Function in Older Hispanics with Type 2 Diabetes. Int J Environ Res Public Health. 2021 Jul 29;18(15):8019. doi: 10.3390/ijerph18158019. PMID: 34360312; PMCID: PMC8345658.
  26. Mohan D, Raj D, Shanthirani CS, Datta M, Unwin NC, Kapur A, Mohan V. Awareness and knowledge of diabetes in Chennai--the Chennai Urban Rural Epidemiology Study [CURES-9]. J Assoc Physicians India. 2005 Apr;53:283-7. PMID: 15987011.
  27. Sari A. Knowledge and Self - Efficacy towards Eating Behaviors by people living with diabetes mellitus.The  4th International Virtual Conference on Nursing, KnE Life Science. 2021: 288-298. doi:10.18502/kls.v6i1.8617, 2021.
  28. Sami W, Ansari T, Butt NS, Hamid MRA. Effect of diet on type 2 diabetes mellitus: A review. Int J Health Sci (Qassim). 2017 Apr-Jun;11(2):65-71. PMID: 28539866; PMCID: PMC5426415.
  29. Francia P, Gulisano M, Anichini R, Seghieri G. Diabetic foot and exercise therapy: step by step the role of rigid posture and biomechanics treatment. Curr Diabetes Rev. 2014 Mar;10(2):86-99. doi: 10.2174/1573399810666140507112536. PMID: 24807636; PMCID: PMC5750747.
  30. Bassuk SS, Manson JE. Epidemiological evidence for the role of physical activity in reducing risk of type 2 diabetes and cardiovascular disease. J Appl Physiol (1985). 2005 Sep;99(3):1193-204. doi: 10.1152/japplphysiol.00160.2005. PMID: 16103522.
  31. Primanda Y, Kritpracha C, Thaniwattananon P. Dietary Behaviors among Patients with Type 2 Diabetes Mellitus in Yogyakarta, Indonesia. Nurse Media Journal of Nursing. 2011;1(2):211-223.
  32. Bukhsh A, Khan TM, Sarfraz Nawaz M, Sajjad Ahmed H, Chan KG, Goh BH. Association of diabetes knowledge with glycemic control and self-care practices among Pakistani people with type 2 diabetes mellitus. Diabetes Metab Syndr Obes. 2019 Aug 14;12:1409-1417. doi: 10.2147/DMSO.S209711. PMID: 31616171; PMCID: PMC6698595.
  33. Ariani Y, Sitorus R, Gayatri D. Motivasi dan Efikasi Diri Pasien Diabetes Melitus Tipe 2 Dalam Asuhan Keperawatan. Journal Keperawatan Indonesia. 2012;15(1):29-38.
  34. Assy N, Nasser G, Kamayse I, Nseir W, Beniashvili Z, Djibre A, Grosovski M. Soft drink consumption linked with fatty liver in the absence of traditional risk factors. Can J Gastroenterol. 2008 Oct;22(10):811-6. doi: 10.1155/2008/810961. PMID: 18925303; PMCID: PMC2661299.
  35. Nseir W, Nassar F, Assy N. Soft drinks consumption and nonalcoholic fatty liver disease. World J Gastroenterol. 2010 Jun 7;16(21):2579-88. doi: 10.3748/wjg.v16.i21.2579. PMID: 20518077; PMCID: PMC2880768.
  36. Amin TT, Al-Sultan AI, Ali A. Overweight and Obesity and their Association with Dietary Habits, and Sociodemographic Characteristics Among Male Primary School Children in Al-Hassa, Kingdom of Saudi Arabia. Indian J Community Med. 2008 Jul;33(3):172-81. doi: 10.4103/0970-0218.42058. PMID: 19876479; PMCID: PMC2763675.
  37. Panagiotakos DB, Tzima N, Pitsavos C, Chrysohoou C, Papakonstantinou E, Zampelas A, Stefanadis C. The relationship between dietary habits, blood glucose and insulin levels among people without cardiovascular disease and type 2 diabetes; the ATTICA study. Rev Diabet Stud. 2005 Winter;2(4):208-15. doi: 10.1900/RDS.2005.2.208. Epub 2006 Feb 10. PMID: 17491696; PMCID: PMC1783563.
  38. Bano A, Afzal M, Sarwar H, et al. Dietary knowledge, Attitude and Practices of Diabetes Patients at Services Hospital Lahore. International Journal of Applied Sciences and Biotechnology. 2017;5(2):227-36.
  39. Purifine Ake-Tano SO, Ekou FK, Konan YE, Tetchi EO, Kpebo DO, Sable SP, Aka F, Dagnan NS. Pratiques alimentaires des diabétiques de type 2 suivis au Centre Antidiabétique d’Abidjan [Dietary habits among type 2 diabetic patients attending the Abidjan Diabetes Centre]. Sante Publique. 2017 Jul 10;29(3):423-430. PMID: 28737363. [Article in French].
  40. Bani IA. Prevalence, knowledge, attitude and practices of diabetes mellitus among Jazan population, Kingdom of Saudi Arabia (KSA). Int J Diabetes Mellitus 2015; 5:115.

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Received November 11, 2023.
Accepted January 8, 2024.
©2024 International Medical Research and Development Corporation.