Perceived dietary adherence and its barriers to dietary recommendations among type 2 diabetes mellitus patients in Mysuru city: a cross-sectional study

Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major public health challenge requiring long-term lifestyle modifications. Dietary adherence is essential for effective disease management, yet many patients struggle to follow recommended dietary practices due to sociocultural, behavioral and economic barriers, especially in low- and middle-income countries. To assess perceived dietary adherence to dietary recommendations among T2DM patients in Mysuru City, identify barriers to adherence and factors associated with it.

Methods: A community-based cross-sectional study was conducted from April to October 2025 among 300 T2DM patients aged ≥18 years, diagnosed for more than 6 months and attending primary health centers in Mysuru. Simple random sampling was employed. Data were collected using a semi-structured questionnaire and the validated Perceived Dietary Adherence Questionnaire (PDAQ). Statistical analysis was performed using SPSS, with p < 0.05 considered significant.

Results: The mean age was 54±9.37 years; 55.1% were male, 91.3% Hindu and 86% from nuclear families. Dietary adherence was poor in 27.8%, moderate in 54.2% and good in 18%. Common barriers influencing adherence included difficulty following dietary recommendations during social or work-related events, lack of dietary education, financial constraints, stress and low motivation. Significant associations were observed between dietary adherence and age, educational status, duration of diabetes, BMI, smoking and alcohol consumption.

Conclusions: Dietary adherence among patients with T2DM remains suboptimal and is strongly influenced by sociocultural and behavioral factors. Comprehensive, culturally appropriate and patient-centered dietary counseling along with behavioral and family support strategies are essential to improve adherence and diabetes-related outcomes.