Prevalence of dietary adherence and associated factors among adolescents with Type 1 Diabetes mellitus attending St. Francis Hospital Nsambya and Ugand Martyrs Hospital Lubaga Diabetes Clinics

Abstract

Introduction: Type 1 diabetes mellitus (T1D) is a chronic condition requiring lifelong management, including strict adherence to dietary recommendations. Despite the critical role of diet in managing T1D and preventing complications, many adolescents with T1D struggle with dietary adherence. This poor adherence among adolescents compromises effective diabetes management and increases the risk of complications. Understanding the factors that influence adherence is crucial to developing effective dietary interventions and behavioral strategies that can improve adherence and health outcomes in this population. Aim of the study: This study determined the prevalence of adherence to dietary recommendations among adolescents with Type 1 Diabetes and explored the factors influencing adherence among adolescents with T1D in St. Francis hospital Nsambya and Uganda Martyr’s hospital Lubaga. Method: A facility-based convergent parallel mixed methods study was conducted. Quantitative data were collected from 103 adolescents aged 10-19 years through structured questionnaires and 24-hour dietary recall. The major dependent variable was dietary adherence, while independent variables included factors such as demographic characteristics, family support, nutrition counseling attendance, knowledge about nutrition for T1D adolescents, Qualitative data were obtained via 15 In-depth interviews with adolescents and 7 key informant interviews with healthcare providers. Quantitative analysis involved descriptive statistics and a modified Poisson model using STATA v14, while qualitative data were analyzed thematically with Atlas.Ti software. Results: Overall dietary adherence among adolescents with Type 1 diabetes across the four macronutrients was at 17.5%, with specific adherence rates of 29.1% for protein, 15.5% for carbohydrates, 33% for fiber, and 79.6% for fat intake. Religion was significantly associated with adherence (PR = 2.93, 95% CI:1.15–7.47 p = 0.025). Higher adherence was observed among adolescents who regularly attended nutrition counseling attendance (19.7%) and having fathers as primary caregivers (31.3%). Qualitative findings highlighted barriers to adherence, including peer influence, school challenges, frequent hunger, and financial constraints. Conclusion: The study revealed that only 17.5% of adolescents with Type 1 Diabetes Mellitus adhered to dietary recommendations according to the ISPAD (International Society for Pediatric and Adolescent Diabetes) criteria across the four macronutrient groups. Key barriers included developmental challenges, difficulties within the school environment, frequent hunger, and financial constraints. Religion, social support, and consistent nutritional education emerged as important factors influencing adherence. Strengthening continuous nutrition education and counseling at the diabetic clinics, as highlighted by health workers, may improve adherence rates. Targeted interventions focusing on enhancing nutrition knowledge, providing emotional and involving caregivers are recommended to improve dietary adherence among adolescents with T1D.