Adherence to Dietary Regimens in Diabetes Mellitus Patients

The adherence and barriers to dietary regimens for patients with diabetes mellitus were studied in 128 patients who had participated in a 2-week diabetes education program. They were interviewed every month after discharge from hospital. The high risk situations (HRS) preventing them from maintaning dietary regimens were estimated by modified Marlatt's model of relapse. About 38% of lapses that occurred in all encounters involving giving in to temptation were associated with environmental determinants in the presence of substance cues, which is the highest risk situation. The lapse rate of patients who had come across the HRS was 29.3% at their first visit one month after the discharge. But at their second visit in month 2 the lapse rate was 54.9%, which was significantly higher than that at their first visit. The relapse rate was significantly increased from 11.8% at the second visit to 27.6% at the third visit. The mean HbA1C value was 9.0% before education. The lowest value was 6.4% 3 months after education. The HbA1C value gradually increased during the following 3 months. These results suggest that the HRS coping strategy should be designed around the discharge to maintain adherence to the regimen and good metabolic control.