Effect of a Nutrition Education Programme on the Management of Metabolic Syndrome by Patients with Type 2 Diabetes Mellitus Attending Care at Thika Level 5 Hospital, Kenya

Abstract

Type 2 Diabetes Mellitus (T2DM) is a chronic disorder of global public health concern. Presence of the metabolic syndrome (MetS), a complex clinical disorder characterized by known risk factors, including insulin resistance, obesity, atherogenic dyslipidemia and hypertension, worsens T2DM further. The prevalence of T2DM in Kenya is estimated at 2.2%. Non-adherence to lifestyle modification as well as low knowledge levels of management of T2DM may further worsen the situation. This study aims to test the effectiveness of a nutrition education programme on MetS, knowledge level of management of T2DM, adherence to lifestyle modification (diet and physical activity) and health care cost incurred by T2DM patients. The study was a randomized control clinical trial with one control group (C; n=51) and two intervention groups (i) nutrition education with peer to peer support (NEP; n=51) and (ii) Nutrition education alone (NE; n=51. Analysis of Co-variance and regression were used in the analysis six months’ post intervention. At baseline, the overall mean age of participants was 56 years. The prevalence of MetS at baseline was 86.3% as per WHO criteria and 88.2 as per Harmonized criteria. The prevalence of poor glycemic control, as indicated by glycated hemoglobin (HbA1c > 7%) was 77.8%. The MetS prevalence significantly reduced among the NEP (90% to 52%) and NE groups (86% to 69%), while it worsened in C (88% to 91%) post intervention. Changes in the anthropometric and metabolic indicators mirrored the changes in food intake patterns and physical activity, where the greatest improvements occurred in the NEP group, followed by the NE, with the control group having the least improvements. An adherence rate of below 15% in diet adherence and below 50 % in physical activity level was reported at baseline. Changes in mean dietary adherence score were significant post intervention with NEP registering highest improvement (+32.37%) followed by NE (+19.92%) while the least improvement was observed in the C group (+9.99%). Knowledge score improved significantly (p<0.01) post intervention in the NEP; +42.45% at the end of the intervention, +40.00% at 1month post intervention, +34.53% at 3 months post intervention and +36.68% at 6 months post intervention. The corresponding improvement in the NE was +38.34% at the end of the intervention, +35.37% 1-month post intervention; +31.12% 3 months’ post intervention and +33.10% 6 months’ post intervention. The current study showed that participants spent an average of Kenya Shillings 4821 per month on care for the management of T2DM. Changes in health care cost incurred by the participants six months’ post intervention was not significant. In conclusion, nutrition education in T2DM patients significantly reduced the prevalence of MetS and MetS risk factors, and improved adherence to lifestyle intervention and knowledge level. Peer to peer support in the intervention had a significantly better impact on the outcomes (knowledge score MetS, MetS indicator, adherence to diet and physical activity). There was no significant change in health care cost incurred by the participants due to the intervention in all the groups. Since nutrition education with and without peer to peer support showed positive outcomes, there is need for its adoption by policy makers in management of T2DM.