Why Do Diabetics Fail To Adhere To Dietary Regimes?

I am an advanced diabetic educator dedicated in finding solutions as to why diabetic patients fail to follow their diets and exercise regimens. I do recognize socioeconomic status, level of obtained education and depression as reasons that compliance has not been achieve, but measures are being taken to address each of these obstacles.

I am of the opinion that taking the time to assist the patient in building an individualized dietary plan creates "ownership" in the task of managing T2DM. Another component in building the dietary plan is to identify the patient's favorite foods and traditional family recipes, and discuss making minor changes to effect the glycemic load of the dish. The patient is made aware that this diet can be changed as required, and that they are not stuck with eating the same food over and over for the rest of their life. Discussions about appropriate portions of each food group, and acceptable snacks is also discussed. Before the appointment is concluded, the question as to why these dietary restrictions are so important is answered, and the patient is able to repeat this information. Written information including substitute options, easy recipes, and contact information accompany the full dietary plan created by the patient with the assistance of the diabetic educator or nutritionist. Follow-up in 6 weeks intervals.

In tracking 100 patients over the period of a year in the clinic, these dietary changes have produced a gain of dietary compliance of 12%. Weight loss ranging from (13 to 26 pounds), and HbA1c have been decreased in these patients by 9% with HbA1c goals reached in 88%.

LittleGreyCat said:

Given that 80% of overweight/obese people are not diabetic, isn't your focus a little narrow?

Perhaps the inability to stick to a sensible eating regime has nothing to do with being diabetic; it is just that unfortunately 20% of the overweight/obese go on to develop T2 Diabetes.

I know that it isn't that simple, and that insulin imbalances can make it very hard to lose weight whatever the diet and exercise regime, but I would be interested to know if dietary compliance is better, worse, or average between diabetics and non-diabetics.

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Good Day LittleGreyCat,

My dissertation is focused on T2DM and nutrition. However, I must say that there is nothing narrow about the epidemic of obesity and T2DM. This is all interlinked.

Actually the majority of overweight/obese people can be classified as prediabetic as some do fully convert to diabetes, and others go back and forth from prediabetes state to a normal state and then back again to the prediabetes state. The important point is that being overweight is damaging to the metabolism and sets insulin intolerance free to attack every cell type in the body. Some of the latest research identifies fat as causing metabolic conversions in the liver creating insulin resistance which has the tendency to be permanent if not dealt with quickly and aggressively. I have seen many who have been able to reestablish normal labs including HbA1c's that actually convert back to a normal range. There are others that regardless of the weight loss and increase in activity never achieve a normal range again, however do reach an acceptable range where damage and risk factors are minimal.

According to the Harvard Gazette (7 mar 2012), 30% of all obese people already have T2DM. In addition, they state that 85% of all diabetics are overweight. Impossible to talk about diabetes without addressing obesity as well. ( See: http://news.harvard.edu/gazette/story/2012/03/the-big-setup/ ) I have reviewed many articles just based on being overweight, and the compliance failure for both remain well under 50%. One cannot discuss obesity without referring to diabetes these days.

Thank you for your comments.