ArticleAACE endocrinology and diabetes
Dietary Adherence and Associated Factors Among Adults With Diabetes in Debre Markos, Ethiopia 2024/2025: A Mixed-Methods Study.
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Abstract
Background/Objective: Adherence to recommended dietary practices is essential for optimal glycemic control, yet the determinants of dietary adherence in low-resource settings remain insufficiently understood. This study assessed the magnitude and factors associated with dietary adherence among adults with diabetes attending Debre Markos Comprehensive Specialized Hospital. Methods: A convergent mixed-methods design was used. Quantitative data were collected through interviewer-administered questionnaires on 470 patients with diabetes analyzed using binary logistic regression. Three focus group discussions, each containing 8 patients with diabetes, and 3 in-depth interviews (2 Orthodox religious leaders and a Muslim leader) were conducted for the qualitative part. Coding, categorizing, and theme development were done for the qualitative data analysis. Result: The magnitude of poor adherence to a dietary recommendation was 72.3%. The significant factors contributing to poor adherence included not receiving a diet manual (adjusted odds ratio [AOR] = 3.667:95% CI, 1.833, 7.336), lack of access to the recommended diet (AOR = 5.124:95% CI, 2.724, 9.639), absence of family support (AOR = 2.543:95% CI, 1.126, 5.743), fasting on designated fasting days (AOR = 4.850:95% CI, 2.899, 8.115), and having a low monthly income (AOR = 8:95% CI, 2.272, 29.686). Conclusion: Dietary adherence among adults with diabetes is limited by multidimensional barriers. Improving adherence requires culturally sensitive education materials, written diet manuals, family-centered counseling, and structured collaboration with religious leaders to develop safe fasting alternatives. Policies that enhance access to affordable, diabetes-appropriate foods are also essential to support sustainable dietary practices and improve metabolic outcomes.
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