Factors Affecting Medical Nutritional Therapy among Type 2 Diabetes Patients at Kenyatta National Hospital, Nairobi, Kenya

Abstract

The prevalence of Diabetes Mellitus has been rising in Kenya, and successful management of the condition is a challenge. Evidence from randomized controlled trials, observational studies and meta-analyses has shown that nutrition intervention for patients with Diabetes Mellitus improves metabolic outcomes, such as blood glucose and hbA1C. The aim of this study was to provide an insight into the factors affecting Medical Nutrition Therapy (MNT) among the Type 2 Diabetes patients as perceived by the patients and professional healthcare providers. This was a descriptive cross-sectional study where data from patients was collected using questionnaire administered by two trained research assistants as well as through schedule interviews with key informants. The study was carried out at Kenyatta National Hospital Diabetes Clinic where 422 Type 2 Diabetes patients, who had been attending the clinic more than 3 months were recruited into the study. This was done through systematic sampling. Overall non-adherence to recommended Medical Nutritional Therapy (MNT) was 35.8% and was significantly associated with Primary level of education (AOR=3.44; 95% CI: 1.35 – 8.82; p=0.010), Secondary level of education (AOR=3.48; 95% CI: 1.40 – 8.66; p=0.007), and Tertiary level of education (AOR=6.97; 95% CI: 2.69 – 18.05; p<0.001). Getting to the diabetes clinic by other means other than walking (AOR=3.49; 95% CI: 1.56 – 7.80; p=0.002), irregular visits (when sick) (AOR=3.65; 95% CI: 1.73 – 7.71; p=0.001) were significantly associated with non-adherence to recommended Medical Nutrition Therapy. Non-adherence to recommended Medical Nutritional Therapy (MNT) was also significantly associated with agreement to the fact that ‘duration of time taken determines how serious the client takes the treatment’ (AOR=1.75; 95% CI: 1.09 – 2.82; p=0.020) and regular eating of food that is not prepared according to recommended diet (MNT) (OR=3.78; 95% CI: 1.29 – 11.08; p=0.016). The levels of non-adherence according to this study were high at 35.8%. Reasons for nonadherence were having a formal education, irregular visits to the diabetic clinic, eating food that was not prepared according recommended MNT while away from home, overstaying at the diabetes clinic and not having enough staff.