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Background: А  specific questionnaire is necessary to perform quantitative assessment of compliance to medical nutrition therapy in patients with type 2 diabetes mellitus (DM).

Aim: Тo develop a questionnaire to assess how type 2 diabetic patients adhere with the principles of medical nutrition therapy and to identify factors associated with good dietary compliance.

Materials and methods: We proposed a questionnaire "Dietary adherence test" (DAT) and validated it in 300 inand out-patients with type 2 DM. DAT was validated against the diabetes-related behavior score, diabetes-related knowledge score, and HbA1c level; the internal consistency coefficient (Cronbach's alfa) was also calculated.

Results: Cronbach's alfa for primary raw and standardized data were 0.7444 and 0.7413, respectively, thus meeting the required range of 0.7–0.8. The score on DAT item 1 (the title item) and total score (the sum of scores of item 2 to 10) correlated with the diabetes-related behavior score (r=0.21, р=0.0006 and r=0.34, р<0.0001, respectively). Patients with poor dietary compliance (average DAT score≤2) had a significantly lower score on the subscale "Nutrition" of the diabetes knowledge test, than those with good dietary compliance (average DAT score≥2) (44.9±15.6 vs 60.2±16.2, р<0.0001). Patients who perceived their diet as the most burdensome element of life with diabetes, had lower total DAT score (24.1±4.6) than those who did not see their diet as a problem (25.9±5.1, р=0.001). There was a  significant difference in average DAT score between patients on insulin therapy and patients on oral treatment (2.8±0.6 vs 2.9±0.6, respectively, р=0.019). Patients with poor and good dietary adherence, according to DAT, differed in their duration of diabetes, social status and diabetes-related behavior score. There was a  weak correlation between the DAT score and duration of diabetes (r=0.16, р=0.009), and weak inverse correlation between the DAT score and total serum cholesterol levels (r=-0.16, р=0.01).

Conclusion: The diagnostic characteristics of the proposed questionnaire meet the criteria of face, content and external validity and internal consistency, or reliability. This self-report questionnaire allows to assess the type 2 DM patient's awareness and adherence to medical nutritional therapy, at no additional time expenses of the doctor. No associations between dietary adherence and main parameters of treatment efficacy in type 2 DM were found.

About the authors

E. G. Starostina

Moscow Regional Research and Clinical Institute (MONIKI)

Author for correspondence.

MD, PhD, Professor, Chair of Endocrinology, Postgraduate Training Faculty,

61/2 Shchepkina ul., Moscow, 129110

Russian Federation

E. P. Shavrikova

PSI Company Ltd; Gryphon Business Centre


Head of Department of Biostatistics,

19 Dostoevskogo ul., Saint Petersburg, 191119

Russian Federation


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Copyright (c) 2016 Starostina E.G., Shavrikova E.P.

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