The worldwide prevalence of type 2 diabetes is skyrocketing alarmingly to epidemic proportions. According to King, Aubert and Herman (1998), in the year 2000 there were 150 million people with type 2 diabetes worldwide, and this number is expected to double by 2025. This explosive increase in type 2 diabetes prevalence is also associated with a significant increase in morbidity and mortality. (Dankner, Abdul-Ghani, Gerber, Chetit, Wainstein and Raz, 2007). This global increase in diabetes will occur because of population ageing and growth, and because of increasing trends towards obesity, unhealthy diets and sedentary lifestyles. Worldwide, according to the WHO Diabetes Action Now booklet (2004), there are 3.2 million deaths attributable to diabetes every year. This means 8,700 deaths every day and six deaths every minute. A study of the Irish Diabetes Prevalence Working Group (Balanda, Fahy, Jordan and McArdle, 2006) using the Diabetes Population Prevalence (PBS) Model estimates that 129,052 persons in the Republic of Ireland have adult type 2 diabetes. This corresponds to 4.3% of the population. Nutritional intervention is an integral part of diabetes care however patients find it difficult to comply with dietary regimes. Yannakoulia, (2006) identifies poor understanding of diet-disease associations, misinformation and lack of social support as some of the barriers to dietary adherence in type 2 diabetes. Using a combination of the search terms “type 2 diabetes mellitus”, “adherence” and “diet” an electronic subject search was conducted utilising the databases CINAHL, ScienceDirect and PubMed. Limits applied to the search were journals from 2000-2010, peer reviewed, research articles and English language. A further search adding the keywords “family” “support” and “diet” uncovered a wealth of results. Six key articles emerged, which were reviewed under the themes (i) lack of dietary knowledge and education and (ii) family and social support. Qualitative research was the main approach to this area of research.
1.2 Lack of dietary knowledge and education
Lifestyle modifications, primarily through diet and physical activity are essential for type 2 diabetes control and prevention of complications. Knowledge is a key tool for diabetic patients to understand this disease however it is also a huge barrier to behavioural change. (Albarran, Ballesteros, Morales and Ortega, 2005). In a qualitative study undertaken by Nagelkerk, Reick and Meengs (2006) of the perceived barriers to and effective strategies for self-management of adults with type 2 diabetes, the sample population (n=26) of participants from an initial group (n=160) took part in 3 interviews. Results showed that the highest ranked barrier to self-management was lack of knowledge and understanding of a specific diet plan; 48-75% of respondents reported inconsistent adherence to dietary recommendations. A similar outcome was identified by Clarke (2009) with 50% of participants reporting dietary non-adherence. These patients desired one-on-one education and classes with specific information on their disease. This is of major importance as nutritional intervention is an integral part of diabetes management and can optimise metabolic control. An individualised approach according to each patient’s characteristics may be effective for patients struggling with dietary adherence. In a study of registered dietitians, Williamson, Hunt, Pope and Tolman (2000), aiming to identify factors contributing to dietary adherence similarly noted that 59% of participants surveyed (n=75) cited lack of knowledge as being their patients’ most significant barrier to dietary compliance. Like Nagelkerk et al (2006), they also emphasized the importance of individualised dietary counselling. A further study was conducted by Savoca and Miller (2001) examining the beliefs and perspectives about dietary requirements and self-management...