Background
Abundant literature supports the beneficial effects of diet and exercise recommendations for
improving and maintaining glycaemic levels of people with type 2 diabetes mellitus. Patient
adherence to therapeutic lifestyle measures is notoriously difficult to initiate and sustain;
however, reason for non-adherence amongst diabetes population is very complex and multifaceted
in nature.
Objectives
To determine rates of non-adherence and reasons/barriers for not adhering to diet and exercise
recommendations amongst type 2 diabetes mellitus patients attending Extension II clinic in
Gaborone, Botswana.
Summary of methods
Design: descriptive cross-sectional study using self administered questionnaire
Setting: Extension II clinic, a public family practice in Gaborone, Botswana.
Study population: Consenting adults diagnosed with type 2 diabetes mellitus, aged 30 years or
older, diagnosed 2 or more years and on clinic care.
Sample selection: Convenience sampling method was used to select 35 subjects per month, over
a period of three successive months and a total of 105 participants were recruited into the study,
made up of 44 men and 61 women.
Results
104 correctly filled questionnaires were included in the data analysis, of which, 59% were
female. Estimated rates of non-adherence to diet and exercise were 37.4%; 95% CI, 27.7 –
46.3% and 52%; 95% CI, 42.4 – 61.6% respectively. The main perceived reasons for nonadherence
to diet were granting self-permission (36.5%), lack of information (33.3%), eating out
(31.7%), financial constraints (28.8%) and poor self control (26.9%); while the main perceived
reasons for non-adherence to exercise were lack of information (65.7%), exercise as potentially
exacerbating illness (57.6%), lack of exercise partner (24.0%), specific locations away from
home (18.0%), and winter weather (15.4%). The overall reasons for not adhering to diet and
exercise include lack of moral and emotional supports from the spouse (54.1%), family members
(44.8%), and friends (58.7%). 95% and 67.3% of the participants had reported that diet and
exercise respectively could improved and maintained their diabetic control.
Conclusion
Non-adherence to diet and exercise recommendations amongst type 2 diabetes patients is far
more prevalent and no particular single reason could be attributed to poor adherence to either
diet or exercise recommendations, rather a combination of many factors.