Perception of diet, dietary practices and sources of dietary information among people with type 2 diabetes followed up at a tertiary care outpatient clinic: a qualitative study

Background: Dietary practices and beliefs among people living with diabetes in low-middle-income South-Asian countries are unique. Understanding them is paramount in supporting them to improve their clinical outcomes. This study aimed to understand the perception of diet, dietary practices, and sources of dietary information among Sri Lankan adults with type 2 diabetes.

Methods: Focus group discussions (FGD) were conducted with the participation of adults with type 2 diabetes attending a Medical Clinic at a tertiary care hospital in Sri Lanka. Eligible participants were recruited between June to October 2022 through convenience sampling. FGDs were facilitated by two researchers using a semi-structured discussion guide developed for this study. Abridged transcripts were formulated using the notes and audio recordings. Data were analysed using Braun and Clarke's six-step method for thematic analysis.

Results: Among 38 participants included in five FGDs, the mean age was 59.9 (range: 39-76) years, 27 (71.1%) were females, and mean duration since the diagnosis of diabetes was 9.4 (range: 0-25) years. Five main themes were identified. (1) Diet in diabetes and composition of the meal; participants were aware of the importance of diet in diabetes and understood a healthy meal including the plate concept. (2) Individual components in the diet; many participants used 'sugar' to refer to 'starch' in the food. Participants considered rice superior to wheat flour-based products in diabetes. Finger millet products were believed to lower blood glucose. We observed beliefs on the glycaemic effects of specific varieties of yams, legumes and fruits. Some participants completely avoided sweets and starchy vegetables. (3) Utilisation of food labels; only a few participants referred to food labels. (4) Factors affecting the practice; external factors such as the recent economic crisis, family members' influence, and availability affected their food choices. (5) Sources of information; some felt that ready access to information was limited.

Conclusions: We identified several misconceptions and undue dietary restrictions, minimal utilisation of food labels and information sources, and the impact of several external factors including economic restrictions. Understanding these dynamic patient and social factors would enable culturally acceptable dietary interventions by health professionals to improve patient outcomes.