{"paper_id":"42ba74fd-79ad-4e8c-87b7-5f262cf2de64","body_text":"Association between adherence to diabetes diet and glycemic control among type 2 diabetes mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia: a health facility based unmatched case-control study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between adherence to diabetes diet and glycemic control among type 2 diabetes mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia: a health facility based unmatched case-control study. Mahlet Eyob, Gudina Egata, Yakob Desalegn, Abdurezak Ahmed This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4659131/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background Suboptimal adherence to diabetes diet can drive the occurrence of diabetes complications. However, the association between adherence to diabetes diet and glycemic control was limited to non-analytical surveys and fasting blood sugar determinationin in low-income countries. This study was aimed to assess the association between adherence to diabetes diet and glycemic control among adult type 2 DM patients on follow-up in selected hospitals, Addis Ababa, Ethiopia. Methods Hospital-based unmactched case-control study was conducted among 156 diabetes patients ( 104 controls and 52 cases ) from May to September 2022. Data were collected using pretested structured questionnaire .Blood sugar level was tested using HgA1c test. Cases were patients with HgA1c < 7% while controls had HgA1c ≥ 7%. Descriptive statistics was used to describe all relevant data. Binary logistic regression analysis was done to assess the association between glycemic control and adherence to diabetes diet and other predictors. Adjusted odds ratios alongside 95% confidence intervals (CIs) were estimated to measure the strength of association between response and explanatory variables at p-value less than 0.05. Results A total of 156 type 2 diabetes patients were enrolled in this study. The mean (± SD) age of respondents was 52.65(± 9.94) and 51.04 (± 10.84) years among cases and controls respectively. In multivariable analysis, poor adherence to diabetes diet [(adjusted odds ratio(AOR) = 3.89,95%CI:(1.58,9.54)] and diabetes medication [(AOR = 3.74,95% CI:(1.42,9.85)], lack of dietary education [(AOR = 4.97,95% CI:(1.56,15.87)], patient’s income level of ≤ 2500 Ethiopian birr (ETB) [(AOR = 3.17,95%CI:(1.24,8.07)], presence of diabetes comorbidities [(AOR = 4.78,95%CI:(1.37,16.71)] and diabetes complications [(AOR = 5.11,95%CI:( (1.60,15.87)] were significant determinants of poor glycemic control. Conclusion Poor dietary and medication -adherence ,lack of dietary education, low economic status, presence of comorbidities ,and diabetes complications were determinants of poor glycemic control. Thus, health care providers should design appropriate interventions in line with modifiable determinants of poor glycemic control. Diabetes mellitus diabetes dietary adherence Ethiopia glycemic control HgA1c Figures Figure 1 Background Diabetes mellitus (DM) is a chronic, metabolic disorder characterized by elevated levels of blood glucose which leads overtime to serious damage to the heart, blood vessels, eyes, kidneys and nerves [ 1 ].Type 2 diabetes mellitus (T2DM) is a heterogeneous group of disorders characterized by disorder of insulin secretion and insulin action, increased glucose production either of which may be predominant features and it accounts for 90% of DM patients [ 2 ]. Glycemic control is the way of managing the blood glucose level of DM patients at optimum level [ 3 ]. Glycemic control is the major factor that determines the complication and death from diabetes [ 4 ]. The global estimate of poor glycemic control ranges from 50.1–91.8% [ 5 – 11 ].The magnitude of poor glycemic control among T2DM patients in Ethiopia ranges from 50–80% [ 12 – 18 ]. Poor glycemic control is a major public health problem among patients with T2DM [ 19 ].The World Health Organization (WHO) reported that high blood glucose level due to diabetes is the third highest risk factor for premature mortality after high blood pressure and tobacco use [ 20 ]. Poor glycemic control is associated with a reduction in life expectancy of approximately 0.22 years per patient [ 21 ]. It is highly correlated with diabetes complications[ 22 ]. The WHO defines adherence to diabetes medication as ”the extent to which patients take medications as prescribed by their health care providers, following a diet and executing a life style changes which correspond with agreed recommendations from a health care providers”[ 23 ]. Dietary adherence ,on the other hand, refers to commitment to healthy dietary recommendations that are mutually planned by the health care providers and the patients to promote health and prevent DM related complications[ 13 ].Improvement of dietary practice alone can reduce HgA1c by absolute 1 to 2% [ 24 ]. Based on the previous studies in Ethiopia the level of dietary adherence is generally low [ 15 , 25 , 26 ]. Available prior studies were cross-sectional studies and those studies assess glycemic control only by using fasting blood glucose (FBG) whereas this study used case control study design and it used golden standard measure of glycemic status, HgA1c, to assess glycemic control.This study intends to elucidate the association between diabetic diet adherence and glycemic control status which will help in the prevention and management of poor glycemic control. Methods Study setting and period The study was conducted at the out-patient diabetes clinics of Tekur Annbessa specialized hospital and St. Paul’s Millennium Hospital, Addis-Ababa, Ethiopia. Tekur Annbessa Hospital receives approximately 400,000 patients referred from across Ethiopia annually. The diabetes clinic is the largest referral for DM in the country and there are more than 500,000 patients are treated as outpatient and inpatient every year during the study period [ 27 ]. The St. Paul’s Hospital Millennium medical college is the second largest hospital in Ethiopia, built by the Emperor Haile Selassie in 1961 with the help of the German Evangelical Church. The hospital was established to serve the economically under privileged population, providing services free of charge to about 75% of its patients including diabetes patient. In 2007, the hospital became a medical college and its core services include the provision of medical care, teaching and research [ 28 ].This study was carried out from March-September,2022. Study design and population Facility based un-matched case-control study was conducted. The source population was all T2DM patients who were on follow up treatment in selected Hospitals of Addis Ababa during data collection period. The study population was all consecutively selected T2DM patients who were on follow up treatment at Tikur Annbessa and Saint Paul Hospitals and who fulfilled the inclusion criteria during the data collection period. Eligibility Criteria Cases and controls were defined based on their glycemic control status. Accordingly, cases were recruited from randomly selected T2DM patients who had poor glycemic control (HgA1c ≥ 7%) while controls were recruited from randomly selected T2DM patients who had good glycemic control (HgA1c < 7%). All T2DM patients aged 18 years and above who were attending follow up during data collection period were included in the study while both cases and controls with T2DM who were critically ill or unconscious, with communication difficulty and were not able to respond to the interview were excluded from the study Sampling size determination The sample size was calculated by considering the following assumptions for unmatched case control study in Epi info version 7.2.6.0 software using the following assumptions: 95% Confidence level (probability of committing α error) to be 1.96 ,90% power (probability of rejecting a true difference), control to case ratio of 2:1, and proportion of main exposure variable (persistent proteinuria among controls to be 14.4% with its adjusted odds ratio of 3.96 from previous studies [ 29 ] yielding the largest sample size of 153 ( 102 controls and 51 cases ). However, we included two additional controls and one case at spot during data collection and analyzed data from 156 (104 controls and 52 cases ).Although, we considered the exposure variables such as adherence to diabetes diet and medication, physical exercise and comorbidities to estimate the sample size, they yielded less sample size for this study. Sampling procedure All eligible patients with T2DM attending the diabetes clinics during the working hours of the clinics were candidates for the study.The average estimated monthly patient flow in St.Paul Millennium Hospital diabetes clinic was 800 where follow up service is given for 5 days per week. On the other hand, the average estimated weekly patient flow in Tekur Anbessa SpecializedHospital diabetes clinic ranges between 800–1000 where follow up service is given for only 2 days per week. The sample size was proportionally allocated to both health facilities based on their patient load and freaquency of services.The samples were selected at random using a sampling frame prepared from the patients’ registry available in the facilities during the study period until the sample size was satisfied for cases and controls. Both cases and controls were subject to an exit interview at the end of their routine follow –up services in diabetes clinics. Measurements The data were collected by trained nurses working in the diabetes outpatient clinics department using pretested structured questionnaire through face to face interview and record review. The questionnaire was prepared orginally in English and then translated to Amharic for data collection purpose and then re-translated back to English for consistency of the information. Height was measured to the nearest 0.1cm with respondents standing on a hard surface against a wall, using a square and tape measure to the wall. Weight was also measured to the nearest 100gm using a calibrated instrument. Blood samples were collected from all participants for Hga1c lab test. Three ml of venous blood was collected in EDTA tube and then the samples were inverted for 8–10 times after collection and reinverted just prior to use. The samples were checked for the presence of hemolysis, lipemic icteric and clotted sample to ensure the data quality. The determination of HbA1c was made by a turbidimetric-immune inhibition method using the fully automated Beckman Coulter DXC 700AU clinical chemistry analyzer.The technique has been certified by the NGSP from the patients’ vein for HgA1c test. The outcome variable of interst in this study is glycemic control status.However, diet adherence, medication adherence, age, income, diabetes comorbidities, dietary education, following dietary recommendation, and diabetes complications were considered as the explanatory variables. Poor glycemic control refers to HgA1c measurement < 7% and fasting blood sugar( FBS) measurement > 130mg/dl while HgA1c measurement ≥ 7% and FBS 70-130mg/dl indicates good glycemic control[ 30 ]. For this particular study we used HgA1c measurement.Diabetes diet is a healthy eating plan which consists of fruits, vegetables, whole grains and that’s naturally rich in nutrients and low in fat and calories [ 2 ].Diabetes diet adherence implies a person having a good diabetes diet adherence if he/she consumed a healthy diet for at least 4 days in the week where as a person considered to have poor diabetes diet adherence if he/she consumed a healthy diet < 4 days in the week [ 26 ]. Poor medication adherence is refers to patients who did not adhere to their medications based on MMAS-8 score which is less than 6 while patients are considered adherent to their medication when the MMAS-8 score is greater or equal to 6 [ 31 ].Physical exercise adherence was understood as adhering to physical exercise for 30 minute or 150 min/week or more of moderate intensity physical activity whereas non-adherence to physical exercise was if the patient exercises for less than 30 minute or less regular exercise per day or less than 150 min/week or less of moderate intensity physical activity [ 32 ]. Data quality control Data collectors and supervisors were trained on the objectives of the study and how to maintain privacy of the study participants. The questionnaire was pretested before the actual task of data collection and all necessary modification was made based on the findings of the pretest. questionnaires were checked for completeness,consistency,and missed information on daily basis by the data supervisor and and amendements were made to finalize the final version of the tool for data collection. Moreover, the laboratory procedures were done following standard operating procedure (SOPs) to determine FBS and HgA1c. Statistical Methods Data were double entered on to EpiData software version 4.0.2 and exported to SPSS version 25 statistical packages for analysis. The data were also explored to check outliers, missing data and all important assumptions.Descriptives statiscs was used to describe independent variables in relation to the outcome variable. Bivariable binary logistic regression analyses were performed to select candidate variables for multivariable analysis. All variables with a p-value < 0.25 during bivariable analyses were entered into multivariable logistic regression model to control for all possible confounders and identify predictors of glycemic control among Type 2 DM adult patients.Model fitness and multicollinearity were checked using Hosmer and Lemshow test and variance inflation factor (VIF) indicating the adequacy of model and absence of multicollinearity between independent variables respectively .Odds ratio alongside 95% confidence intervals (CIs) were estimated to measure the strength of the association between variables of interest. Level of statistical significance was declared at a p-value of less than 0.05. Results Socio-demographic characterstics of the study participants A total of 156 type 2 diabetes mellitus patients ( 104 controls and 52 cases ) were participated in the study .The mean (± SD) age of the respondents was 52.65(± 9.94) years among cases and 51.04(± 10.81) years among controls respectively. Of 156 participants, 30(57.7%) of cases and 55(52.9%) controls were females while 22(42.3%) of cases and 49(47.1%) of controls were males respectively.The majority of patients 30(57.7%) of cases and 78(75.5%) of controls were urban residents. Nearly, 37% of cases and 94%) of controls were married. About (42.3% of cases were unable to read and write whereas nealy 37% of controls attended college/university and above education (Table 1 ). Table 1 Socio-demographic characteristics adult diabetic out patients in TASH and St. Paul’s millennium hospital, Addis Ababa, Ethiopia,2022. Variables Category Cases (n/%) Controls(n/%) Total N/%) Age (in years ) < 50 17(32.7%) 54(51.9%) 71(45%) ≥ 50 35(67.3%) 50(48.1%) 85(55%) Sex Male 22(42.3%) 49(47.1%) 71(45.5%) Female 30(57.7%) 55(52.9%) 85(54.5%) Residence Rural 22(42.3%) 26(25%) 48(30.8%) Urban 30(57.7%) 78(75%) 108(69%) Marital status Single 3(5.8%) 4(3.8%) 7(4.5%) Married 19(36.5%) 98(94.2%) 117(75%) Divorced 17(32.7%) 0(%) 17(10.9%) Widowed 13(25%) 2(1.9%) 15(9.6%) Occupational status House wife 13(25%) 35(33.7%) 48(30.8%) Civil servant 10(19.2%) 34(32.7%) 44(28.2%) Farmer 9(17.3%) 14(13.5%) 23(14.7%) Merchant 5(9.6%) 15(14.4%) 20(12.7%) Daily laborer 11(21.2%) 1(1%) 12(7.7%) Pensioner 4(7.7%) 3(2.9%) 7(4.5%) Student 0(0%) 2(1.9%) 2(1.3%) Educational status Unable to read and write 22(42.3%) 3(2.9%) 25(16%) Primary level(1–8) 16(30.7%) 24(23.1%) 45(28.8%) Secondarylevel(9–12) 8(15.4%) 33(31.7%) 41(26.3%) College/university and above 4(7.7%) 38(36.5%) 42(26.9%) Technical 2(3.8%) 6(5.8%) 8(5.1%) Living arrangment Living alone 27(51.9%) 7(6.7%) 34(21.7%) Living with partner 19(36.5%) 90(86.5%) 109(70%) Living with parent/s 3(5.8%) 5(4.8%) 9(5.12%) Living with children 3(5.8%) 2(1.9%) 5(3%) Income(in Ethiopian birr < 2500 25(48.1%) 75(72.1%) 52(33%) ≥ 2500 27(51.9%) 29(27.9%) 104(67%) Payment Out of pocket 22(42.3%) 24(23.1%) 46(30%) Medical insurance 30(57.7%) 80(76.9%) 110(70%) Clinical related profile Among 156 study participants, the majority of cases 57.7% and 54.8% of controls were ≥ 10 years and < 10 years since diagnosis respectively. Nearly eighty one (80.8%) of controls and 69.2% of cases had family history of diabetes mellitus respectively. Nearly eighty nine percent (88.5%)of cases and slightly more than half (52.9%) of controls suffered from diabetes related comorbidities. With regard to their nutritional status 26.9%and 57.7% of cases and 88.5% and 16.3% of controls were overweight and obese respectively. Dyslipidemia is common among 65.4% of cases and 37.5% of controls while hypertension is common among 78.8% of cases and 50% of controls respectively .Most of the study participants (80.8%) of cases and less than half (41.3%) of controls suffered from diabetic complications.The most common diabetic complication in this study was diabetic retinopathy, which affected 59.6% of cases and 21.2% of controls. The 2nd most common diabetic complication was peripheral neuropathy affecting 51.9% of cases and 11.5% of controls. Nearly three fouthe (73.1%) of cases and 88.5% of controls received dietary education from health care providers at every follow up visit (Table 2 ). Table 2 Clinical and patient related characteristics of T2DM patients at TASH and St. Poulos millennium hospital, Addis Ababa,2022. Variables Category Cases n(%) Controls n(%) Total N(%) Duration since diagnosis < 10 22(42.3%) 57(54.8%) 79(50.6%) ≥10 30(57.7%) 47(45.2%) 77(49.4%) Family history Yes 36(69.2%) 84(80.8%) 120(77%) No 16(30.8%) 20(19.2%) 36(23%) Self-management of blood glucose Yes 13(25%) 75(72.1%) 88(56.4%) No 39(75%) 29(27.9%) 68(43.6%) Comorbidities Yes 39(75%) 40(38%) 79(51%) No 13(25%) 64(62%) 77(49%) Obesity Yes 30(57.7%) 17(16.3%) 47(30%) No 22(42.3%) 87(83.7%) 109(70%) Dyslipidemia Yes 34(65.4%) 39(37.5%) 73(46.8%) No 18(34.6%) 65(62.5%) 83(53.2%) Hypertension Yes 41(78.8%) 52(50%) 93(59.6%) No 11(21.2%) 52(50%) 63(40.4%) Diabetic complications Yes 42(80.8%) 43(41.3%) 85(54.5%) No 10(19.2%) 61(58.7%) 71(45.5%) Types of complications Retinopathy Yes 31(59.6%) 22(21.2%) 53(34%) No 21(40.4%) 82(78.8%) 103(66%) Cardiovascular Yes 17(32.7%) 14(13.5%) 31(19.9%) No 35(67.3%) 90(86.5%) 125(80.1%) Peripheral neuropathy Yes 27(51.9%) 12(11.5%) 39(25%) No 25(48.1%) 92(88.5%) 117(75%) Nephropathy Yes 11(21.2%) 5(4.8%) 16(10.3%) No 41(78.8%) 99(95.2%) 140(89.7%) Diabetic education Yes 38(73.1%) 92(88.5%) 130(83.3%) No 14(26.9%) 12(11.5%) 26(16.7%) Follow diet recommendation Yes 39(75%) 94(90.4%) 133(85%) No 13(25%) 10(9.6%) 23(15%) Perceived dietary adherence scores of T2DM patients Less than half (42.3%) of cases and nearly three fourth of (73.1% of controls followed a healthful eating plan for more than 4 days within a week. Almost equal proportion of cases (61.5%) and controls (62.5%) adhered to consumption of fruit and vegetables with in the last 7 days prior to the survey. Intake of carbohydrate containing foods with a low glycemic index such as dried beans, lentils, barley, pasta, low fat dairy carbohydrates was 50% among cases and 80.8% among controls respectively. Nearly thirty three percent (32.7%) of cases and 64.4% of controls reported a good adherence to intake of foods with a low glycemic index such as dried beans, lentils, barley, pasta, low fat dairy, and carbohydrates in the the last seven days prior to the survey respectively. On the otherhand, consumption of foods high in fats such as high fat dairy products, fatty meal, fried foods, and deep fried foods was poorly adhered to among cases, 71.2%, compared with controls(38.5%) (Table 3 ). Table 3 Proportion of perceived dietary adherence status among T2DM patients in TASH and St. Paul’s millennium hospital, Addis Ababa,2022. Questions Cases n(%) Controls n(%) Total N(%) On how many of the last seven days have you followed a healthful eating plan? Good adherence Poor adherence 22(42.3%) 30(57.7%) 76(73.1%) 28(26.9%) 98(62.8%) 58(37.2%) On how many of the last seven days did you eat the number of fruit and vegetables? Good adherence Poor adherence 32(61.5%) 20(38.5%) 65(62.5%) 39(37.5%) 97(62%) 59(38%) On how many of the last seven days did you eat, carbohydrate containing foods with a low glycemic index? (e.g., dried beans, lentils, barley, pasta, low fat dairy carbohydrates) Good adherence Poor adherence 26(50%) 26(50%) 84(80.8%) 20(19.2%) 110(75%) 46(25%) On how many of the last seven days did you eat foods high in sugar such as rice, potatoes, etc.? Good adherence Poor adherence 17(32.7%) 35(67.3%) 67(64.4%) 37(35.6%) 84(54%) 72(46%) On how many of the last seven days did you eat food low in sugar such as oatmeal, high fiber cereals and whole grains? Good adherence Poor adherence 29(55.7%) 23(44.3%) 78(75%) 26(25%) 107(69%) 49(35%) On how many of the last seven days did you space carbohydrate throughout the day? Good adherence Poor adherence 24(46%) 28(54%) 63(60.6%) 41(39.4%) 87(55.8%) 69(44.2%) On how many of the last seven days did you eat fish or other foods rich in omega-3 fat? Good adherence Poor adherence 9(17.3%) 43(82.7%) 40(19.2%) 64(61.5%) 49(31%) 107(69%) On how many of last seven days did you eat foods that contained or prepared with canola, walnut, olive, or flux oils? Good adherence Poor adherence 18(35%) 34(65%) 80(77%) 24(23%) 98(63%) 58(37%) On how many of the last seven days did you eat foods high in fats such as high fat dairy products, fatty meal, fried foods, deep fried foods? Good adherence Poor adherence 15(28.8%) 37(71.2%) 64(61.5%) 40(38.5%) 79(51%) 77(49%) Overall adherence Good diet adherence Poor diet adherence 18(34.6%) 34(65.4%) 67(64%) 37(36%) 85(54%) 71(46%) Medication adherence score of T2DM patients Among study participants ,42% of cases and 24% of controls reported that they sometimes forget to take their medication. Similarly, 36.5% of cases and 27.9% of controls forgot to take their medication when they travel or leave home. In contrary ,80.8% of cases and 84.6% of controls never experience difficulty remembering their medication. Moreover, 9.6%) of cases and 6 .7% of controls experience difficulty remembering their medication once in a while, 5% of cases and 3.8% of controls experience difficulty remembering their medication sometimes ,and nearly equal proportion, 4% of cases and 4.8% of controls experience difficulty remembering their medication usually. On the otherhand, 32.7% of cases and 22% of controls cut back or stopped their medication without telling their doctor. Overall, 37% of cases and 61% of controls were adherent to their medication (Table 4 ). Table 4 Medication adherence scores of T2DM patients in TASH and St. Paul’s millennium hospital, Addis Ababa, 2022. Questions/Items Cases n(%) Controls n(%) Total N(%) Do you sometimes forget to take your medication? Yes No 22(42%) 30(58%) 25(24%) 79(76%) 47(30%) 109(70%) People sometimes miss taking their medications for reasons other than forgetting. Over the past 2 weeks, were there days when you did not take your medication? Yes No 27(52%) 25(48%) 32(30.8%) 72(69.2%) 59(38%) 97(62%) Have you ever cut back or stopped taking your medication without telling your doctor because you felt worse when you took it? Yes No 17(32.7%) 35(67.3%) 23(22%) 81(78%) 40(26%) 116(74%) When you travel or leave home, do you sometimes forget to bring your medication? Yes No 19(36.5%) 33(63.5%) 29(27.9%) 75(72.1%) 48(31%) 108(69%) Did you take all your medication yesterday? Yes No 5(9.6%) 47(90.4%) 5(4.8%) 99(95.2%) 10(6.4%) 146(93.5%) When you feel like your symptoms are under control, do you sometimes stop taking your medication? Yes No 15(28.8%) 37(71.2%) 25(24%) 79(76%) 40(26%) 116(74%) Taking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your treatment plan? Yes No 22(42%) 30(5.8%) 34(33%) 70(67%) 56(36%) 100(64%) How often do you have difficulty remembering to take all your medication? Never/Rarely Once in a while Sometimes Usually 42(80.8%) 5(9.6%) 3(5%) 2(4%) 88(84.6%) 7(6.7%) 4(3.8%) 5(4.8%) 130(83%) 12(7.7%) 7(4.4%) 7(4.4%) Adherence to the recommended medication Yes No 19(37%) 33(63%) 63(61%) 41(39%) 82(53%) 74(47%) Physical exercise adherence Of all 156 study participants ,35% cases and 68% controls practiced physical exercise. The most practiced exercise was brisk walking among both cases and controls. Less number of cases (17%) and more number of controls (42%) adhered to physical exercise‘s recommendations (Table 5 ). Table 5 Distribution of adherence to physical exercise among T2DM patients in TASH and St. Paul’s millennium hospital, Addis Ababa, 2022. Questions Cases n(%) Controls n(%) Total N(%) Do you practice physical exercise? Yes No 18(35%) 34(65%) 71(68%) 33(32%) 89(57%) 67(43%) What type of exercise did you perform? Brisk walking Running Climbing stairs Cycling Swimming Other aerobic activities 7(38%) 6(33%) 3(16%) 0(0%) 2(11%) 0(0%) 31(44%) 14(20%) 9(13%) 9(13%) 5(7%) 4(5%) 36(23%) 22(14%) 11(7%) 9 (5%) 7(4%) 4(3%) Duration of exercise < 30 min/day > 30min/day 14(60%) 9(39%) 27(44.2%) 44(72.1%) 41(44%) 53(56%) Number of days you exercise per week < 5 days > 5 days 9(50%) 9(50%) 27(44.2%) 44(72.1%) 36(40%) 53(60%) Overall adherence to the recommended exercise Yes No 9(17%) 43 (83%) 44(42%) 60 (58%) 53(34%) 103(66%) Association between adherence to diabetes diet and glycemic control Among the study participants, 11.5% of cases and 41.6% of controls had good diabetes dietary adherence (Fig. 1). Chi-square test was used to examine the association between glycemic control and diabetes dietary adherence. Accordingly, there is a significant association at 5% significance level between glycemic control and adherence to diabetes diet among respondents (x2 = 10.827, df = 1, P = 0.001). Figure 1 : Association between adherence to diabetes dietry and glycemic control among T2DM patients in TASH and S.t Paul’s hospitals,2022. Predictors of poor glycemic control among T2DM patients In multivariable logistic regression, after controlling for the possible effects of confounders, poor adherence to diabetes diet [(AOR = 3.89,95%CI:(1.58,9.54)], not receiving dietary education [(AOR = 4.97,95% CI:(1.56,15.87)], poor adherence diabetes medication [(AOR = 3.74,95% CI:(1.42,9.85)], patient’s income level of ≤ 2500 Ethiopian birr (ETB) [(AOR = 3.17,95%CI:(1.24,8.07)], presence of diabetes comorbidities [(AOR = 4.78,95% CI:(1.37,16.71)] and diabetes complications [(AOR = 5.11,95% CI:( (1.60,15.87)] were significantly associated with poor glycemic control ascertaining the association between adherence to diabetes dietand glycemic control (Table 6 ). Table 6 Results of multivariable binary logistic regression on determinants of glycemic controls in T2DM patients in St. Paul’s and TASH, Addis Ababa,2022. Variables Category Cases n(%) Controls n(%) COR(95%CI) AOR (95%CI) Diabetes diet adherence Good 18(34.6%) 67(64.4%) 1 1 Poor 34(65.4%) 37(35.6%) 3.42(1.70,6.87) 3.90(1.58,9.54*) Diabetes medication adherence Good 19(37%) 63(61%) 1 1 Poor 33(63%) 41(39%) 2.6(1.31–5.31) 3.74(1.42, 9.85*) Age 18–50 18(34.6%) 53(51%) 1 1 ≥ 50 34(65.4%) 51(49%) 2.2(1.10–4.45) 2.12(0.84–5.29) Income (ETB) < 2500 25(48.1%) 75(72.1%) 2.8(1.39–5.58) 3.10(1.24, 8.07*) ≥ 2500 27(51.9%) 29(27.9%) 1 1 Diabetes comorbidities Yes 39(75%) 40(38%) 4.8(1.87–12.24) 4.78(1.37–16.71*) No 13(25%) 64(62%) 1 1 Dietary education Yes 38(73.1%) 92(88.5%) 1 1 No 14(26.9%) 12(11.5%) 2.82(1.19–6.66) 4.97(1.56–15.87*) Follow dietary Recommendation Yes 39(75%) 94(90.4% 1 1 No 13(25%) 10(9.6%) 5.4(1.19–15.34) 1.70(0.44–6.63) Diabetes complications Yes 42(80.4%) 43(41.3%) 5.95(2.69–13.16) 5.10(1.60-16.26*) No 10(19.2%) 61(58.7%) 1 1 Disscusion This study aimed to assess the association between diabetes diet adherence and glycemic control among Type 2 Diabetes Mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia.Poor glycemic control was found to be linked with poor diabetes diet and medication dherence, low income, lack of dietary education, diabetes related comorbidities and complications. Diet is one of the most important factors that can modify many aspects of the body physiology including the physiology of pancreas that secretes insulin hormone. Moreover, good dietary adherence is one of the important strategies of life style modification which helps to control the blood glucose level. Hence, failure to adhere to diabetes diet could lead to poor glycemic control. Accordingly, this study showed that the odds of poor glycemic control were 3.89 times higher among patients with poor diabetes dietary adherence compared with patients with good diabetes dietary adherence. The finding is consistent with other similar studies done in Malaysia[ 33 ], Bangladesh [ 34 ], Iraq [ 35 ], Jordan [ 36 ] , Kenya[ 37 ] and Ethiopia [ 26 , 38 , 39 ]. Nontheless ,a study done in Nekemte referral hospital, western Ethiopia, shows that diabetes dietary adherence is not significantly associated with glycemic control [ 17 ]. The odds of poor glycemic control were 3.7 times higher among patients with poor adherence to diabetes medication compared with their counterparts.It is in agreement with result of previous studies done in Singapore, Japan, Democratic republic of Congo, Ghana,and Ethiopia[ 14 , 40 – 43 ]. This may be due to the fact that anti-diabets medications influence the pancreas release more insulin. limit the liver’s ability to make and release glucose, block the actions of enzymes that aid in the process of glycolysis ,and improve cell’s sensitivity to insulin.Thus s non-adherence to these medication could result in distortions this functions leading to poor glycemic control.Moreover, adherence to prescribed medication regimen is crucial to reach metabolic control as non-adherence to blood glucose lowering agents results in higher Hba1c value [ 44 ]. In contray, a study done in western part Ethiopia showed that medication adherence is not significantly associated with glycemic control [ 17 ]. Diabetes dietary education has also influenced the level blood glucose level whereby the odds of poor glycemic control were 4.97 times higher among patients who didn’t receive diabetes dietary education compared with patients who received the education. This result is in accordance with similar previous studies conducted done in Croatia and South Korea [ 45 , 46 ].This may be due to the reason that patients who didn’t receive dietary education were less likely to have knowledge about the benefit of food management in diabetes control. Additionally, patients who have received dietry education may perceive the fatality of the disease when they fail to adhere to dietary recommendations. This study also revealed that the odds of poor glycemic control were 3.1 times higher among patients from low economic class compared with their counterparts. This finding is in line with previous studies conducted in some parts of Ethiopia [ 14 , 47 ]. However, studies done in India and Portugal showed an absence of statistically significance association between level of income and poor glycemic control [ 48 , 49 ]. Poor glycemic control was 5.1 times more common among patients who had diabetes complications compared with their counterparts.This find is consistent with the studies conducted in England, northern Ireland and Scotland, and some parts of Ethiopia [ 50 – 52 ]. This may be explained by the fact that high blood glucose level induces tissue damage through mitochondrial superoxide production which may lead to cellular damage including capillary endothelial cells in the retina, mesangial cells in the renal glomerulus ,and neurons and Schwann cells in peripheral nerves. These cells are particularly at high risk of damage as they are unable to regulate uptake of glucose during hyperglycemia. Therefore, a prolonged hyperglycemia is associated with metabolic imbalances, accumulation of advanced glycation end products, oxidation stress, and lipid alterations leading to diabetes polyneuropathy and multiple organ damage increasing the risk of diabetis complications and eventual death. The odds of poor glycemic control were nearly five time higher among patients with superimposed comorbidities compared with their counterparts. Former studies conducted in Italy, Congo, and some parts Ethiopia have reported similar findings[ 2 , 40 , 53 , 54 ].This could be attributed to the effect of polypharmacy that patients with diabetes comorbidities may not adhere to their diabtes medication because of loss of appetite secondary to multiple medication intake which collectively results in poor glycemic control. On the other hand, other studies conducted in Netherland, Croatia, and Canada [ 55 – 57 ] didn’t show the relationship between comorbidities and level of HgA1c may be attributed to difference in tools applied to assess comorbidity and an advanced approach in management of comorbidities . Conclusion In this study, poor adherence to diabetes diet was associated with poor glycemic control. Moreover, lack of education on diabetes diet, poor adherence to diabetes medication, diabetes related comorbidities and complications, land ow economical status were determinants of poor glycemic control.More efforts need to be made in strengthening and disseminating health education programs for diabetes patients at each follow up visit while emphasizing on the importance of achieving dietary and medication adherence.Health care providers should design appropriate interventions including better management of medication and dietary adherence to minimize diabetes comorbidities and complications toachieve the diabetes management goal through good glycemic control. Although, non-adherence to physical exercise was not significantly associated with glycemic control patients need to be advised to exercise regularly. Abbreviations ADA: American Diabetes Association, BMI: Body Mass Index, CFG: Canadian Food Guide, CVD: Cardio Vascular Disease, CA: cases ,CON: controls , DALYs : Disability Adjusted Life Years, DM: Diabetes Mellitus, FBS: Fasting Blood Sugar, FMOHE: Federal Ministry of Health Ethiopia, HgA1c: HemoglobinA1c, IDF: International Diabetes Federation, NCD: Non- Communicable Disease, PDAQ: Perceived Dietary Adherence Questionnaire , SDG: Sustainable Development Goal, T2DM: Type 2 Diabetes Mellitus Declarations Ethics approval and consent to participate The study was approved by ethical review committee of School of Public Health (SPH-Rec) , College of Health Sciences, Addis Ababa University with the approval identification (ID) number of 96/SPH-Rec ; dated 15 /March/2022. The procedure and purpose of this study was explained to the department of diabetes clinic to get support letter. This study involves human participants and was conducted in accordance with the Declaration of Helsinki. Patients were asked their oral and written consent to confirm their willingness to participate in the study after discussing the purpose,benefit ,risks,and confidentiality of the provided informations was maintained and the anonymity of the participants was kept by using codes to indicate participants’ card and and collected specimen by using codes instead of using the participants’ name. Consent for publication : Not applicable Availability of data and materials: Data are available upon reasonable request Competing interests: None declared. Funding: None Authors' contributions ME: was responsible the conception of the study including designing, collecting and analyzing interpreting the data , and drafting the manuscript.:GE: supervised the research work and critically reviewed the study at the design stage stage and data analysis and finalized the manuscript write up.YD: supervised the research work and contributed to study at the design stage and during data analysis , AA: supported the designing of the study , supervised the research work including laboratory data collection process and reviewed the manuscript. Acknowledgements The authors express their deepest gratitude to Addis Ababa University for its whole rounded support during the research work.Additionally,our gratitude goes to Black lion specialized hospital,S.t.Paul millennium hospital ,data collectors and study participants for their willingness and cooperation during the data collection time References World health organization.Reducing the burden of non-communicable disease through strengthening prevention and control of diabetes. 2021. Global Diabetes Compact. https://apps.who.int/gb/ebwha/pdf_files/WHA74/A74_ACONF5-en.pdf . American Diabetes Association. Standards of medical care in diabete. Diabetes Care. 2016;39(Suppl 1):S1–109. World health organization. Prevention of DM.Report of a WHO study group. 1994. Report No.: 844. https://books.google.com.et/books/about/Prevention_of_Diabetes_Mellitus.html?id=g3MoAQAAMAAJ&redir_esc=y.Date accessed: 08/Jan./2024. Koro CE, Bowlin SJ, Bourgeois N, et al. 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Initiative Implementing a Balanced Scorecard at St. Paul’s Hospital Addis Ababa, Ethiopia Case Study. https://ministerial-leadership.org/sites/default/files/resources_and_tools/St%20Pauls%20Case%20Study%20FINAL.pdf.Date accessed: 2024 Jan 7. Legese GL, Asres G, Alemu S, Yesuf T, Tesfaye YA, Amare T. Determinants of poor glycemic control among type 2 diabetes mellitus patients at University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia:Unmatched case-control study. Front Endocrinol 9;14:1087437. 10.3389/fendo.2023.1087437 . American Diabetic Association. Standards of Medical Care in Diabetes—2015: Summary of Revisions. Diabetes Care. 2015;38(Supplement1):S4–4. Youssef RM. Moubarak II. Patterns and determinants of treatment complications among hypertensive patients. East Mediterr Health J. 2002;8:579–92. Akumiah PO, Samuel OA, Azumah Nayembil D, et al. Barriers to adherence to diet and exercise recommendation amongst type 2 diabetes mellitus patients. J Health Med Nurs. 2017;39:48–53. Tan, et al. Dietary Compliance and its Association with Glycemic Control among Poorly Controlled Type 2 Diabetic Outpatients in Hospital Universiti Saints Malaysia. Malays J Nutr. 2011;17(3):287–99. Afroz et al. Glycemic Control for People with Type 2 Diabetes Mellitus in Bangladesh - An urgent need for optimization of management plan. Springer Nat [Internet]. 2019;9(10,248). https://doi.org/10.1038/s41598-019-46766-9 . Amir Jafarian-amirkhizi et al., Adherence of Patients with Diabetes to a Lifestyle Advice and Management Plan in Basra, Southern Iraq. J Diabetes Med Disord. 2018;17:165–72. Khattab M, Khader YS, Al-Khawaldeh A, Ajlouni K. Factors associated with poor glycemic control among patients with poor 9lycemic control among patients with type2 diabetes. J Diabetes Complicat. 2010;24(2):84–9. Muthoni WN, Factors Affecting Glycemic Control Among Type Ii Diabetics Attending Machakos Level Five Outpatient Clinic. Univ Nairobi. MpH thesis January 31,2018. http://erepository.uonbi.ac.ke/bitstream/handle/11295/106136/Wanjohi%20Milka_Factors%20Affecting%20Glycemic%20Control%20Among%20Type%20Ii%20Diabetics%20Attending%20Machakos%20Level%20Five%20Outpatient%20Clinic.pdf?sequence=1&isAllowed=y.Date accessed: 08/Jan./2024. Alemu T, Tadesse T, Amogne G. Glycemic control and its determinants among patients with type 2 diabetes mellitus at Menelik II Referral Hospital, Ethiopia. SAGE Open Med. 2021;9:1–8. Fseha B. Glycemic Control and its associated factors in Tye 2 Diabetic Patients in Suhul Hospital.North west Tigray,Ethiopia. J Diabetes Metab. 2017;8(3):1–6. 10.4172/2155-6156.100072 . Cedrick LM, Fina Lubaki J-P, Francois LB, Gboyega OA, Philippe LN. Prevalence and determinants of poor glycaemic control amongst patients with diabetes followed at Vanga Evangelical Hospital, Democratic Republic of the Congo. Afr J Prim Health Care Fam Med 13(1):1–6. Tominaga Y, Aomori T, Hayakawa T, Morisky DE, Takahashi K, Mochizuki M. Relationship between medication adherence and glycemic control in Japanese patients with type 2 diabetes. Pharm - Int J Pharm Sci. 2018;73(10):609–12. Lin L-K, Sun Y, Heng BH, et al. Medication adherence and glycemic control among newly diagnosed diabetes patients. BMJ Open Diab Res Care. 2017;5(1):1–25. Yeboah JO, Lokpo SY. Medication Adherence and its Association with Glycaemic Control, Blood Pressure Control, Glycosuria and Proteinuria Among People Living With Diabetes (PLWD) in the Ho Municipality, Ghana. Open Public Health J. 2018;11:552–61. Owiredu , WKBAJohnson BB, Orish VN, Botchway F, Ussher FA, et al. Al-Qazaz HK, Sulaiman SA, Hassali MA, et al. Diabetes knowledge, medication adherence and glycemic control among patients with type 2 diabetes. Int J Clin Pharm. 2011;33:1028–35. Gvozdanovic Z, Farcic N, Placento H, et al. Diet education as sucess factor of glycemia regulation in Diabetes patients.A prospective study. Int JEnvironment Res Public Health. 2019;16(20):4003. 10.3390/ijerph16204003 . Yang SH, Chung HK,Lee SM. Effects of Activity- Based personalized Nutrition Education on Dietary behaviours and blood parameters in middle aged and older type 2 Diabetes Korean outpatients.Clin Nutr Res. Clin Nutr Res. 2016;5(4):237–48. Yosef T, Nureye D, Tekalign E. Poor glycemic control and its contributing factors Among Type 2 Diabetes patients at Adama Hospital.Medical college in East Ethiopia. Dove Press. 2021;2021(14):3273–80. Sasi TVD, Kodali S, Burra M, Muppala KC, Gutta BS. Self care activities diabetic distress and other factors which affected glycemic control in teritiary care teaching hospital in South India. J Clin Diagn Reasearch. 2013;7(5):857–60. Lima RF, et al. Factors associated with glycemic control among people with diabetes at the family health strategy in pernambuco. J Sch Nurs USP. 2016;50(6):937–44. Sttraton IM, Adler AI, Neil HAW, et al. Association of glycamia with macrovascular and microvascular complication of type 2 diabetes (UKPDS 35), Prospective Observational study.BMJ. BMJ. 2000;321(7258):405–12. Fasil A, Biadgo B, Abebe M. Glycemic control and diabetes complications among diabetes mellitus patients attending at University of Gondar Hospital, Northwest Ethiopia. Diabetes Metab Syndr Obes Internet. 2018;12:75–83. Oluma A, Abadiga M, Mosisa G, Etafa W. Magnitude and predictors of poor glycemic control among patients with diabetes attending public hospitals of western Ethiopia. PLoS ONE. 2021;16(2):e0247634. 10.1371/journal.pone.0247634 . Bereda G, Bereda G. The Incidence and Predictors of Poor Glycemic Control among Adults with Type 2 Diabetes Mellitus in Ambulatory Clinic of Mettu Karl Referral Hospital, South Western, Ethiopia: A Prospective Cross Sectional Study. Int Arch Endocrinol Clin Res. 2021;7(1):1–22. Mamo Y, Bekele F, Nigussie T. Determinants of poor glycemic control among adult patients with type 2 diabetes mellitus in Jimma University Medical Center, Jimma zone, south west Ethiopia: a case control study. BMC Endocr Disord. 2019;19(1):1–34. Luijks H, Biermans M, Bor H, van Weel C, Lagro-Janssen T, de Grauw W, et al. The effect of comorbidity on glycemic control and systolic blood pressure in type 2 diabetes: a cohort study with 5 year follow-up in primary care. PLoS ONE. 2015;10(10):1–18. Bralić Lang V, Bergman MB. Prevalence of comorbidity in primary care patients with type 2 diabetes and its association with elevated HbA1c: a cross-sectional study in Croatia. Scand J Prim Health Care. 2016;34:66–72. Hudon C, Fortin M, Dubois M-F, Almirall J. .Comorbidity and glycemia control among patients with type 2 diabetes in primary care. Diabetes Metab Syndr Obes. 2008;1:33–7. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-4659131\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":329463380,\"identity\":\"3159385e-3050-41af-a9cc-b48c7fab6bd3\",\"order_by\":0,\"name\":\"Mahlet Eyob\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Addis Ababa University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Mahlet\",\"middleName\":\"\",\"lastName\":\"Eyob\",\"suffix\":\"\"},{\"id\":329463382,\"identity\":\"efc175b0-a2ac-43ed-8098-199533a035fb\",\"order_by\":1,\"name\":\"Gudina Egata\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA7UlEQVRIiWNgGAWjYHACgwNw5gcGhgRStDAzMM4gVgsDTAszDzFa5COSNx4uqGGQk3c/f/CzbZtdHj97A+OHjzm4tRjeSCs4POMYg7HhmWRm6dy25GLJngPMkjO34dEyI8fgMA8bQ+LGhmQGoBbmxA03EtiYeQlq+cdQv7H/MfNvy7Z6wlrkJYBaeNsYEuQlktmkGdsOE9ZiwPOs4DBvH4PhBonHZpY9544nzuw52IzXL/LtyZs/83xjkJfvT3x840dZdWI/e/PBDx/x2XIATP2HMBjZQBzGBtzqQbY0oDD+4FU8CkbBKBgFIxQAACw5U04qnQX7AAAAAElFTkSuQmCC\",\"orcid\":\"\",\"institution\":\"Addis Ababa University\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Gudina\",\"middleName\":\"\",\"lastName\":\"Egata\",\"suffix\":\"\"},{\"id\":329463384,\"identity\":\"f4c9b7cd-a04d-4835-9fee-f33bf73d0d0a\",\"order_by\":2,\"name\":\"Yakob Desalegn\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Addis Ababa University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Yakob\",\"middleName\":\"\",\"lastName\":\"Desalegn\",\"suffix\":\"\"},{\"id\":329463386,\"identity\":\"42d75e83-f7ea-4ea1-9f81-12176ac5330a\",\"order_by\":3,\"name\":\"Abdurezak Ahmed\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Addis Ababa University\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Abdurezak\",\"middleName\":\"\",\"lastName\":\"Ahmed\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2024-06-29 11:40:22\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-4659131/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-4659131/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":61180901,\"identity\":\"8b20b8cd-0d14-4284-8bc4-cc6d79fe946d\",\"added_by\":\"auto\",\"created_at\":\"2024-07-26 16:44:54\",\"extension\":\"jpg\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":104609,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eAssociation between \\u0026nbsp;adherence to diabetes dietry and glycemic control among T2DM patients in TASH and S.t Paul’s hospitals,2022.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.jpg\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4659131/v1/79c9e19bb228a3aa60f8e2f0.jpg\"},{\"id\":83489538,\"identity\":\"be46c1c2-aadf-4d26-a12f-998c28d3c23b\",\"added_by\":\"auto\",\"created_at\":\"2025-05-27 09:32:17\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":1363851,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-4659131/v1/b3e4fcf8-510d-4b5d-8352-94b50ec149eb.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Association between adherence to diabetes diet and glycemic control among type 2 diabetes mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia: a health facility based unmatched case-control study.\",\"fulltext\":[{\"header\":\"Background\",\"content\":\"\\u003cp\\u003eDiabetes mellitus (DM) is a chronic, metabolic disorder characterized by elevated levels of blood glucose which leads overtime to serious damage to the heart, blood vessels, eyes, kidneys and nerves [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e].Type 2 diabetes mellitus (T2DM) is a heterogeneous group of disorders characterized by disorder of insulin secretion and insulin action, increased glucose production either of which may be predominant features and it accounts for 90% of DM patients [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eGlycemic control is the way of managing the blood glucose level of DM patients at optimum level [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e]. Glycemic control is the major factor that determines the complication and death from diabetes [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. The global estimate of poor glycemic control ranges from 50.1\\u0026ndash;91.8% [\\u003cspan additionalcitationids=\\\"CR6 CR7 CR8 CR9 CR10\\\" citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].The magnitude of poor glycemic control among T2DM patients in Ethiopia ranges from 50\\u0026ndash;80% [\\u003cspan additionalcitationids=\\\"CR13 CR14 CR15 CR16 CR17\\\" citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePoor glycemic control is a major public health problem among patients with T2DM [\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].The World Health Organization (WHO) reported that high blood glucose level due to diabetes is the third highest risk factor for premature mortality after high blood pressure and tobacco use [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e]. Poor glycemic control is associated with a reduction in life expectancy of approximately 0.22 years per patient [\\u003cspan citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e]. It is highly correlated with diabetes complications[\\u003cspan citationid=\\\"CR22\\\" class=\\\"CitationRef\\\"\\u003e22\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe WHO defines adherence to diabetes medication as \\u0026rdquo;the extent to which patients take medications as prescribed by their health care providers, following a diet and executing a life style changes which correspond with agreed recommendations from a health care providers\\u0026rdquo;[\\u003cspan citationid=\\\"CR23\\\" class=\\\"CitationRef\\\"\\u003e23\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDietary adherence ,on the other hand, refers to commitment to healthy dietary recommendations that are mutually planned by the health care providers and the patients to promote health and prevent DM related complications[\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e].Improvement of dietary practice alone can reduce HgA1c by absolute 1 to 2% [\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eBased on the previous studies in Ethiopia the level of dietary adherence is generally low [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e]. Available prior studies were cross-sectional studies and those studies assess glycemic control only by using fasting blood glucose (FBG) whereas this study used case control study design and it used golden standard measure of glycemic status, HgA1c, to assess glycemic control.This study intends to elucidate the association between diabetic diet adherence and glycemic control status which will help in the prevention and management of poor glycemic control.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy setting and period\\u003c/h2\\u003e \\u003cp\\u003eThe study was conducted at the out-patient diabetes clinics of Tekur Annbessa specialized hospital and St. Paul\\u0026rsquo;s Millennium Hospital, Addis-Ababa, Ethiopia. Tekur Annbessa Hospital receives approximately 400,000 patients referred from across Ethiopia annually. The diabetes clinic is the largest referral for DM in the country and there are more than 500,000 patients are treated as outpatient and inpatient every year during the study period [\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e]. The St. Paul\\u0026rsquo;s Hospital Millennium medical college is the second largest hospital in Ethiopia, built by the Emperor Haile Selassie in 1961 with the help of the German Evangelical Church. The hospital was established to serve the economically under privileged population, providing services free of charge to about 75% of its patients including diabetes patient. In 2007, the hospital became a medical college and its core services include the provision of medical care, teaching and research [\\u003cspan citationid=\\\"CR28\\\" class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e].This study was carried out from March-September,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec4\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStudy design and population\\u003c/h2\\u003e \\u003cp\\u003eFacility based un-matched case-control study was conducted. The source population was all T2DM patients who were on follow up treatment in selected Hospitals of Addis Ababa during data collection period. The study population was all consecutively selected T2DM patients who were on follow up treatment at Tikur Annbessa and Saint Paul Hospitals and who fulfilled the inclusion criteria during the data collection period.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec5\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eEligibility Criteria\\u003c/h2\\u003e \\u003cp\\u003eCases and controls were defined based on their glycemic control status. Accordingly, cases were recruited from randomly selected T2DM patients who had poor glycemic control (HgA1c\\u0026thinsp;\\u0026ge;\\u0026thinsp;7%) while controls were recruited from randomly selected T2DM patients who had good glycemic control (HgA1c\\u0026thinsp;\\u0026lt;\\u0026thinsp;7%). All T2DM patients aged 18 years and above who were attending follow up during data collection period were included in the study while both cases and controls with T2DM who were critically ill or unconscious, with communication difficulty and were not able to respond to the interview were excluded from the study\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec6\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSampling size determination\\u003c/h2\\u003e \\u003cp\\u003eThe sample size was calculated by considering the following assumptions for unmatched case control study in Epi info version 7.2.6.0 software using the following assumptions: 95% Confidence level (probability of committing α error) to be 1.96 ,90% power (probability of rejecting a true difference), control to case ratio of 2:1, and proportion of main exposure variable (persistent proteinuria among controls to be 14.4% with its adjusted odds ratio of 3.96 from previous studies [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e] yielding the largest sample size of 153 ( 102 controls and 51 cases ). However, we included two additional controls and one case at spot during data collection and analyzed data from 156 (104 controls and 52 cases ).Although, we considered the exposure variables such as adherence to diabetes diet and medication, physical exercise and comorbidities to estimate the sample size, they yielded less sample size for this study.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec7\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSampling procedure\\u003c/h2\\u003e \\u003cp\\u003eAll eligible patients with T2DM attending the diabetes clinics during the working hours of the clinics were candidates for the study.The average estimated monthly patient flow in St.Paul Millennium Hospital diabetes clinic was 800 where follow up service is given for 5 days per week. On the other hand, the average estimated weekly patient flow in Tekur Anbessa SpecializedHospital diabetes clinic ranges between 800\\u0026ndash;1000 where follow up service is given for only 2 days per week. The sample size was proportionally allocated to both health facilities based on their patient load and freaquency of services.The samples were selected at random using a sampling frame prepared from the patients\\u0026rsquo; registry available in the facilities during the study period until the sample size was satisfied for cases and controls. Both cases and controls were subject to an exit interview at the end of their routine follow \\u0026ndash;up services in diabetes clinics.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMeasurements\\u003c/h2\\u003e \\u003cp\\u003eThe data were collected by trained nurses working in the diabetes outpatient clinics department using pretested structured questionnaire through face to face interview and record review. The questionnaire was prepared orginally in English and then translated to Amharic for data collection purpose and then re-translated back to English for consistency of the information.\\u003c/p\\u003e \\u003cp\\u003eHeight was measured to the nearest 0.1cm with respondents standing on a hard surface against a wall, using a square and tape measure to the wall. Weight was also measured to the nearest 100gm using a calibrated instrument. Blood samples were collected from all participants for Hga1c lab test. Three ml of venous blood was collected in EDTA tube and then the samples were inverted for 8\\u0026ndash;10 times after collection and reinverted just prior to use. The samples were checked for the presence of hemolysis, lipemic icteric and clotted sample to ensure the data quality. The determination of HbA1c was made by a turbidimetric-immune inhibition method using the fully automated Beckman Coulter DXC 700AU clinical chemistry analyzer.The technique has been certified by the NGSP from the patients\\u0026rsquo; vein for HgA1c test.\\u003c/p\\u003e \\u003cp\\u003eThe outcome variable of interst in this study is glycemic control status.However, diet adherence, medication adherence, age, income, diabetes comorbidities, dietary education, following dietary recommendation, and diabetes complications were considered as the explanatory variables. Poor glycemic control refers to HgA1c measurement\\u0026thinsp;\\u0026lt;\\u0026thinsp;7% and fasting blood sugar( FBS) measurement\\u0026thinsp;\\u0026gt;\\u0026thinsp;130mg/dl while HgA1c measurement\\u0026thinsp;\\u0026ge;\\u0026thinsp;7% and FBS 70-130mg/dl indicates good glycemic control[\\u003cspan citationid=\\\"CR30\\\" class=\\\"CitationRef\\\"\\u003e30\\u003c/span\\u003e]. For this particular study we used HgA1c measurement.Diabetes diet is a healthy eating plan which consists of fruits, vegetables, whole grains and that\\u0026rsquo;s naturally rich in nutrients and low in fat and calories [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e].Diabetes diet adherence implies a person having a good diabetes diet adherence if he/she consumed a healthy diet for at least 4 days in the week where as a person considered to have poor diabetes diet adherence if he/she consumed a healthy diet\\u0026thinsp;\\u0026lt;\\u0026thinsp;4 days in the week [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePoor medication adherence is refers to patients who did not adhere to their medications based on MMAS-8 score which is less than 6 while patients are considered adherent to their medication when the MMAS-8 score is greater or equal to 6 [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e].Physical exercise adherence was understood as adhering to physical exercise for 30 minute or 150 min/week or more of moderate intensity physical activity whereas non-adherence to physical exercise was if the patient exercises for less than 30 minute or less regular exercise per day or less than 150 min/week or less of moderate intensity physical activity [\\u003cspan citationid=\\\"CR32\\\" class=\\\"CitationRef\\\"\\u003e32\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec9\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eData quality control\\u003c/h2\\u003e \\u003cp\\u003eData collectors and supervisors were trained on the objectives of the study and how to maintain privacy of the study participants. The questionnaire was pretested before the actual task of data collection and all necessary modification was made based on the findings of the pretest. questionnaires were checked for completeness,consistency,and missed information on daily basis by the data supervisor and and amendements were made to finalize the final version of the tool for data collection. Moreover, the laboratory procedures were done following standard operating procedure (SOPs) to determine FBS and HgA1c.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec10\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eStatistical Methods\\u003c/h2\\u003e \\u003cp\\u003eData were double entered on to EpiData software version 4.0.2 and exported to SPSS version 25 statistical packages for analysis. The data were also explored to check outliers, missing data and all important assumptions.Descriptives statiscs was used to describe independent variables in relation to the outcome variable. Bivariable binary logistic regression analyses were performed to select candidate variables for multivariable analysis. All variables with a p-value\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.25 during bivariable analyses were entered into multivariable logistic regression model to control for all possible confounders and identify predictors of glycemic control among Type 2 DM adult patients.Model fitness and multicollinearity were checked using Hosmer and Lemshow test and variance inflation factor (VIF) indicating the adequacy of model and absence of multicollinearity between independent variables respectively .Odds ratio alongside 95% confidence intervals (CIs) were estimated to measure the strength of the association between variables of interest. Level of statistical significance was declared at a p-value of less than 0.05.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eSocio-demographic characterstics of the study participants\\u003c/h2\\u003e \\u003cp\\u003eA total of 156 type 2 diabetes mellitus patients ( 104 controls and 52 cases ) were participated in the study .The mean (\\u0026plusmn;\\u0026thinsp;SD) age of the respondents was 52.65(\\u0026plusmn;\\u0026thinsp;9.94) years among cases and 51.04(\\u0026plusmn;\\u0026thinsp;10.81) years among controls respectively. Of 156 participants, 30(57.7%) of cases and 55(52.9%) controls were females while 22(42.3%) of cases and 49(47.1%) of controls were males respectively.The majority of patients 30(57.7%) of cases and 78(75.5%) of controls were urban residents. Nearly, 37% of cases and 94%) of controls were married. About (42.3% of cases were unable to read and write whereas nealy 37% of controls attended college/university and above education (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e ).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSocio-demographic characteristics adult diabetic out patients in TASH and St. Paul\\u0026rsquo;s millennium hospital, Addis Ababa, Ethiopia,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCases (n/%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eControls(n/%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTotal N/%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eAge (in years )\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(32.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e54(51.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e71(45%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35(67.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e50(48.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85(55%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSex\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e49(47.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e71(45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFemale\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e55(52.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85(54.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eResidence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eRural\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e26(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e48(30.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUrban\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e78(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e108(69%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eMarital status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSingle\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e4(3.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7(4.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMarried\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(36.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e98(94.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e117(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDivorced\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(32.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0(%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e17(10.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eWidowed\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(1.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e15(9.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"6\\\" rowspan=\\\"7\\\"\\u003e \\u003cp\\u003eOccupational status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eHouse wife\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e35(33.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e48(30.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCivil servant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e34(32.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e44(28.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eFarmer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e9(17.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(13.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23(14.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMerchant\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(9.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e15(14.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e20(12.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eDaily laborer\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(21.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1(1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e12(7.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePensioner\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4(7.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(2.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e7(4.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eStudent\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(1.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2(1.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"4\\\" rowspan=\\\"5\\\"\\u003e \\u003cp\\u003eEducational status\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eUnable to read\\u003c/p\\u003e \\u003cp\\u003eand write\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e3(2.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e25(16%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePrimary level(1\\u0026ndash;8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(30.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(23.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e45(28.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSecondarylevel(9\\u0026ndash;12)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e8(15.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e33(31.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e41(26.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCollege/university and above\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e4(7.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e38(36.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e42(26.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTechnical\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2(3.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e6(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e8(5.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"3\\\" rowspan=\\\"4\\\"\\u003e \\u003cp\\u003eLiving arrangment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiving alone\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(51.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e7(6.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e34(21.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiving with partner\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(36.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e90(86.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e109(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiving with parent/s\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5(4.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e9(5.12%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eLiving with children\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e3(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2(1.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5(3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eIncome(in Ethiopian birr\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;2500\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(48.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e75(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e52(33%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;2500\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(51.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29(27.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e104(67%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePayment\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eOut of pocket\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e24(23.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e46(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eMedical insurance\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e80(76.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e110(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eClinical related profile\\u003c/h2\\u003e \\u003cp\\u003eAmong 156 study participants, the majority of cases 57.7% and 54.8% of controls were \\u0026ge;\\u0026thinsp;10 years and \\u0026lt;\\u0026thinsp;10 years since diagnosis respectively. Nearly eighty one (80.8%) of controls and 69.2% of cases had family history of diabetes mellitus respectively. Nearly eighty nine percent (88.5%)of cases and slightly more than half (52.9%) of controls suffered from diabetes related comorbidities. With regard to their nutritional status 26.9%and 57.7% of cases and 88.5% and 16.3% of controls were overweight and obese respectively. Dyslipidemia is common among 65.4% of cases and 37.5% of controls while hypertension is common among 78.8% of cases and 50% of controls respectively .Most of the study participants (80.8%) of cases and less than half (41.3%) of controls suffered from diabetic complications.The most common diabetic complication in this study was diabetic retinopathy, which affected 59.6% of cases and 21.2% of controls. The 2nd most common diabetic complication was peripheral neuropathy affecting 51.9% of cases and 11.5% of controls. Nearly three fouthe (73.1%) of cases and 88.5% of controls received dietary education from health care providers at every follow up visit (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical and patient related characteristics of T2DM patients at TASH and St. Poulos millennium hospital, Addis Ababa,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"5\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCases\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eControls\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDuration since diagnosis\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e57(54.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e79(50.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;10\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47(45.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e77(49.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eFamily history\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e36(69.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e84(80.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e120(77%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16(30.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e36(23%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eSelf-management of blood glucose\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e75(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e88(56.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29(27.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e68(43.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eComorbidities\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(38%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e79(51%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e64(62%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e77(49%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eObesity\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e17(16.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e47(30%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87(83.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e109(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDyslipidemia\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34(65.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e39(37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e73(46.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(34.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e65(62.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e83(53.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eHypertension\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41(78.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e52(50%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e93(59.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(21.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e52(50%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e63(40.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetic complications\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42(80.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43(41.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e85(54.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e61(58.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e71(45.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eTypes of complications\\u003c/p\\u003e \\u003cp\\u003eRetinopathy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31(59.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22(21.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e53(34%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e21(40.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82(78.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e103(66%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eCardiovascular\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17(32.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e14(13.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e31(19.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e35(67.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e90(86.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e125(80.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003ePeripheral neuropathy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(51.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(11.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e39(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(48.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92(88.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e117(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eNephropathy\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e11(21.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e5(4.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e16(10.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e41(78.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e99(95.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e140(89.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetic education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38(73.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92(88.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e130(83.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(26.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(11.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e26(16.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eFollow diet recommendation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e94(90.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e133(85%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(9.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e23(15%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePerceived dietary adherence scores of T2DM patients\\u003c/h2\\u003e \\u003cp\\u003eLess than half (42.3%) of cases and nearly three fourth of (73.1% of controls followed a healthful eating plan for more than 4 days within a week. Almost equal proportion of cases (61.5%) and controls (62.5%) adhered to consumption of fruit and vegetables with in the last 7 days prior to the survey. Intake of carbohydrate containing foods with a low glycemic index such as dried beans, lentils, barley, pasta, low fat dairy carbohydrates was 50% among cases and 80.8% among controls respectively. Nearly thirty three percent (32.7%) of cases and 64.4% of controls reported a good adherence to intake of foods with a low glycemic index such as dried beans, lentils, barley, pasta, low fat dairy, and carbohydrates in the the last seven days prior to the survey respectively. On the otherhand, consumption of foods high in fats such as high fat dairy products, fatty meal, fried foods, and deep fried foods was poorly adhered to among cases, 71.2%, compared with controls(38.5%) (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eProportion of perceived dietary adherence status among T2DM patients in TASH and St. Paul\\u0026rsquo;s millennium hospital, Addis Ababa,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCases\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eControls\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days have you followed a healthful eating plan?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22(42.3%)\\u003c/p\\u003e \\u003cp\\u003e30(57.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e76(73.1%)\\u003c/p\\u003e \\u003cp\\u003e28(26.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e98(62.8%)\\u003c/p\\u003e \\u003cp\\u003e58(37.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat the number of fruit and vegetables?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32(61.5%)\\u003c/p\\u003e \\u003cp\\u003e20(38.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e65(62.5%)\\u003c/p\\u003e \\u003cp\\u003e39(37.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e97(62%)\\u003c/p\\u003e \\u003cp\\u003e59(38%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat, carbohydrate containing foods with a low glycemic index? (e.g., dried beans, lentils, barley, pasta, low fat dairy carbohydrates)\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e26(50%)\\u003c/p\\u003e \\u003cp\\u003e26(50%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e84(80.8%)\\u003c/p\\u003e \\u003cp\\u003e20(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e110(75%)\\u003c/p\\u003e \\u003cp\\u003e46(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat foods high in sugar such as rice, potatoes, etc.?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17(32.7%)\\u003c/p\\u003e \\u003cp\\u003e35(67.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e67(64.4%)\\u003c/p\\u003e \\u003cp\\u003e37(35.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e84(54%)\\u003c/p\\u003e \\u003cp\\u003e72(46%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat food low in sugar such as oatmeal, high fiber cereals and whole grains?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e29(55.7%)\\u003c/p\\u003e \\u003cp\\u003e23(44.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e78(75%)\\u003c/p\\u003e \\u003cp\\u003e26(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e107(69%)\\u003c/p\\u003e \\u003cp\\u003e49(35%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you space carbohydrate throughout the day?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e24(46%)\\u003c/p\\u003e \\u003cp\\u003e28(54%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e63(60.6%)\\u003c/p\\u003e \\u003cp\\u003e41(39.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e87(55.8%)\\u003c/p\\u003e \\u003cp\\u003e69(44.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat fish or other foods rich in omega-3 fat?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9(17.3%)\\u003c/p\\u003e \\u003cp\\u003e43(82.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e40(19.2%)\\u003c/p\\u003e \\u003cp\\u003e64(61.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e49(31%)\\u003c/p\\u003e \\u003cp\\u003e107(69%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of last seven days did you eat foods that contained or prepared with canola, walnut, olive, or flux oils?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18(35%)\\u003c/p\\u003e \\u003cp\\u003e34(65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e80(77%)\\u003c/p\\u003e \\u003cp\\u003e24(23%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e98(63%)\\u003c/p\\u003e \\u003cp\\u003e58(37%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOn how many of the last seven days did you eat foods high in fats such as high fat dairy products, fatty meal, fried foods, deep fried foods?\\u003c/p\\u003e \\u003cp\\u003eGood adherence\\u003c/p\\u003e \\u003cp\\u003ePoor adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15(28.8%)\\u003c/p\\u003e \\u003cp\\u003e37(71.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64(61.5%)\\u003c/p\\u003e \\u003cp\\u003e40(38.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e79(51%)\\u003c/p\\u003e \\u003cp\\u003e77(49%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOverall adherence\\u003c/p\\u003e \\u003cp\\u003eGood diet adherence\\u003c/p\\u003e \\u003cp\\u003ePoor diet adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18(34.6%)\\u003c/p\\u003e \\u003cp\\u003e34(65.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e67(64%)\\u003c/p\\u003e \\u003cp\\u003e37(36%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e85(54%)\\u003c/p\\u003e \\u003cp\\u003e71(46%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMedication adherence score of T2DM patients\\u003c/h2\\u003e \\u003cp\\u003eAmong study participants ,42% of cases and 24% of controls reported that they sometimes forget to take their medication. Similarly, 36.5% of cases and 27.9% of controls forgot to take their medication when they travel or leave home. In contrary ,80.8% of cases and 84.6% of controls never experience difficulty remembering their medication. Moreover, 9.6%) of cases and 6 .7% of controls experience difficulty remembering their medication once in a while, 5% of cases and 3.8% of controls experience difficulty remembering their medication sometimes ,and nearly equal proportion, 4% of cases and 4.8% of controls experience difficulty remembering their medication usually. On the otherhand, 32.7% of cases and 22% of controls cut back or stopped their medication without telling their doctor. Overall, 37% of cases and 61% of controls were adherent to their medication (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e ).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eMedication adherence scores of T2DM patients in TASH and St. Paul\\u0026rsquo;s millennium hospital, Addis Ababa, 2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eQuestions/Items\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCases\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eControls\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal N(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo you sometimes forget to take your medication?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22(42%)\\u003c/p\\u003e \\u003cp\\u003e30(58%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(24%)\\u003c/p\\u003e \\u003cp\\u003e79(76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e47(30%)\\u003c/p\\u003e \\u003cp\\u003e109(70%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePeople sometimes miss taking their medications for reasons other than forgetting. Over the past 2 weeks, were there days when you did not take your medication?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e27(52%)\\u003c/p\\u003e \\u003cp\\u003e25(48%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e32(30.8%)\\u003c/p\\u003e \\u003cp\\u003e72(69.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e59(38%)\\u003c/p\\u003e \\u003cp\\u003e97(62%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHave you ever cut back or stopped taking your medication without telling your doctor because you felt worse when you took it?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17(32.7%)\\u003c/p\\u003e \\u003cp\\u003e35(67.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e23(22%)\\u003c/p\\u003e \\u003cp\\u003e81(78%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(26%)\\u003c/p\\u003e \\u003cp\\u003e116(74%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhen you travel or leave home, do you sometimes forget to bring your medication?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19(36.5%)\\u003c/p\\u003e \\u003cp\\u003e33(63.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e29(27.9%)\\u003c/p\\u003e \\u003cp\\u003e75(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e48(31%)\\u003c/p\\u003e \\u003cp\\u003e108(69%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDid you take all your medication yesterday?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5(9.6%)\\u003c/p\\u003e \\u003cp\\u003e47(90.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e5(4.8%)\\u003c/p\\u003e \\u003cp\\u003e99(95.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(6.4%)\\u003c/p\\u003e \\u003cp\\u003e146(93.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhen you feel like your symptoms are under control, do you sometimes stop taking your medication?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e15(28.8%)\\u003c/p\\u003e \\u003cp\\u003e37(71.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(24%)\\u003c/p\\u003e \\u003cp\\u003e79(76%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(26%)\\u003c/p\\u003e \\u003cp\\u003e116(74%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eTaking medication every day is a real inconvenience for some people. Do you ever feel hassled about sticking to your treatment plan?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22(42%)\\u003c/p\\u003e \\u003cp\\u003e30(5.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34(33%)\\u003c/p\\u003e \\u003cp\\u003e70(67%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e56(36%)\\u003c/p\\u003e \\u003cp\\u003e100(64%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHow often do you have difficulty remembering to take all your medication?\\u003c/p\\u003e \\u003cp\\u003eNever/Rarely\\u003c/p\\u003e \\u003cp\\u003eOnce in a while\\u003c/p\\u003e \\u003cp\\u003eSometimes\\u003c/p\\u003e \\u003cp\\u003eUsually\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42(80.8%)\\u003c/p\\u003e \\u003cp\\u003e5(9.6%)\\u003c/p\\u003e \\u003cp\\u003e3(5%)\\u003c/p\\u003e \\u003cp\\u003e2(4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e88(84.6%)\\u003c/p\\u003e \\u003cp\\u003e7(6.7%)\\u003c/p\\u003e \\u003cp\\u003e4(3.8%)\\u003c/p\\u003e \\u003cp\\u003e5(4.8%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e130(83%)\\u003c/p\\u003e \\u003cp\\u003e12(7.7%)\\u003c/p\\u003e \\u003cp\\u003e7(4.4%)\\u003c/p\\u003e \\u003cp\\u003e7(4.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAdherence to the recommended medication\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19(37%)\\u003c/p\\u003e \\u003cp\\u003e33(63%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e63(61%)\\u003c/p\\u003e \\u003cp\\u003e41(39%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e82(53%)\\u003c/p\\u003e \\u003cp\\u003e74(47%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePhysical exercise adherence\\u003c/h2\\u003e \\u003cp\\u003eOf all 156 study participants ,35% cases and 68% controls practiced physical exercise. The most practiced exercise was brisk walking among both cases and controls. Less number of cases (17%) and more number of controls (42%) adhered to physical exercise\\u0026lsquo;s recommendations (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab5\\\" class=\\\"InternalRef\\\"\\u003e5\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab5\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 5\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eDistribution of adherence to physical exercise among T2DM patients in TASH and St. Paul\\u0026rsquo;s millennium hospital, Addis Ababa, 2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eQuestions\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCases\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eControls\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003cp\\u003eN(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDo you practice physical exercise?\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18(35%)\\u003c/p\\u003e \\u003cp\\u003e34(65%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e71(68%)\\u003c/p\\u003e \\u003cp\\u003e33(32%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e89(57%)\\u003c/p\\u003e \\u003cp\\u003e67(43%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eWhat type of exercise did you perform?\\u003c/p\\u003e \\u003cp\\u003eBrisk walking\\u003c/p\\u003e \\u003cp\\u003eRunning\\u003c/p\\u003e \\u003cp\\u003eClimbing stairs\\u003c/p\\u003e \\u003cp\\u003eCycling\\u003c/p\\u003e \\u003cp\\u003eSwimming\\u003c/p\\u003e \\u003cp\\u003eOther aerobic activities\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e7(38%)\\u003c/p\\u003e \\u003cp\\u003e6(33%)\\u003c/p\\u003e \\u003cp\\u003e3(16%)\\u003c/p\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003cp\\u003e2(11%)\\u003c/p\\u003e \\u003cp\\u003e0(0%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e31(44%)\\u003c/p\\u003e \\u003cp\\u003e14(20%)\\u003c/p\\u003e \\u003cp\\u003e9(13%)\\u003c/p\\u003e \\u003cp\\u003e9(13%)\\u003c/p\\u003e \\u003cp\\u003e5(7%)\\u003c/p\\u003e \\u003cp\\u003e4(5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36(23%)\\u003c/p\\u003e \\u003cp\\u003e22(14%)\\u003c/p\\u003e \\u003cp\\u003e11(7%)\\u003c/p\\u003e \\u003cp\\u003e9 (5%)\\u003c/p\\u003e \\u003cp\\u003e7(4%)\\u003c/p\\u003e \\u003cp\\u003e4(3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDuration of exercise\\u003c/p\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;30 min/day\\u003c/p\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;30min/day\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e14(60%)\\u003c/p\\u003e \\u003cp\\u003e9(39%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(44.2%)\\u003c/p\\u003e \\u003cp\\u003e44(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e41(44%)\\u003c/p\\u003e \\u003cp\\u003e53(56%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNumber of days you exercise per week\\u003c/p\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;5 days\\u003c/p\\u003e \\u003cp\\u003e\\u0026gt;\\u0026thinsp;5 days\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9(50%)\\u003c/p\\u003e \\u003cp\\u003e9(50%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(44.2%)\\u003c/p\\u003e \\u003cp\\u003e44(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e36(40%)\\u003c/p\\u003e \\u003cp\\u003e53(60%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eOverall adherence to the recommended exercise\\u003c/p\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e9(17%)\\u003c/p\\u003e \\u003cp\\u003e43 (83%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e44(42%)\\u003c/p\\u003e \\u003cp\\u003e60 (58%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53(34%)\\u003c/p\\u003e \\u003cp\\u003e103(66%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec17\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eAssociation between adherence to diabetes diet and glycemic control\\u003c/h2\\u003e \\u003cp\\u003eAmong the study participants, 11.5% of cases and 41.6% of controls had good diabetes dietary adherence (Fig.\\u0026nbsp;1). Chi-square test was used to examine the association between glycemic control and diabetes dietary adherence. Accordingly, there is a significant association at 5% significance level between glycemic control and adherence to diabetes diet among respondents (x2\\u0026thinsp;=\\u0026thinsp;10.827, df\\u0026thinsp;=\\u0026thinsp;1, P\\u0026thinsp;=\\u0026thinsp;0.001).\\u003c/p\\u003e \\u003cp\\u003eFigure 1 : Association between adherence to diabetes dietry and glycemic control among T2DM patients in TASH and S.t Paul\\u0026rsquo;s hospitals,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec18\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003ePredictors of poor glycemic control among T2DM patients\\u003c/h2\\u003e \\u003cp\\u003eIn multivariable logistic regression, after controlling for the possible effects of confounders, poor adherence to diabetes diet [(AOR\\u0026thinsp;=\\u0026thinsp;3.89,95%CI:(1.58,9.54)], not receiving dietary education [(AOR\\u0026thinsp;=\\u0026thinsp;4.97,95% CI:(1.56,15.87)], poor adherence diabetes medication [(AOR\\u0026thinsp;=\\u0026thinsp;3.74,95% CI:(1.42,9.85)], patient\\u0026rsquo;s income level of \\u0026le;\\u0026thinsp;2500 Ethiopian birr (ETB) [(AOR\\u0026thinsp;=\\u0026thinsp;3.17,95%CI:(1.24,8.07)], presence of diabetes comorbidities [(AOR\\u0026thinsp;=\\u0026thinsp;4.78,95% CI:(1.37,16.71)] and diabetes complications [(AOR\\u0026thinsp;=\\u0026thinsp;5.11,95% CI:( (1.60,15.87)] were significantly associated with poor glycemic control ascertaining the association between adherence to diabetes dietand glycemic control (Table\\u0026nbsp;\\u003cspan refid=\\\"Tab6\\\" class=\\\"InternalRef\\\"\\u003e6\\u003c/span\\u003e).\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab6\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 6\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eResults of multivariable binary logistic regression on determinants of glycemic controls in T2DM patients in St. Paul\\u0026rsquo;s and TASH, Addis Ababa,2022.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"6\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c5\\\" colnum=\\\"5\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c6\\\" colnum=\\\"6\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eVariables\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eCategory\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eCases\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eControls\\u003c/p\\u003e \\u003cp\\u003en(%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003eCOR(95%CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003eAOR (95%CI)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetes diet adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(34.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e67(64.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34(65.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e37(35.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e3.42(1.70,6.87)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.90(1.58,9.54*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetes medication adherence\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eGood\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e19(37%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e63(61%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003ePoor\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e33(63%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e41(39%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.6(1.31\\u0026ndash;5.31)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.74(1.42, 9.85*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e18\\u0026ndash;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e18(34.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e53(51%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;50\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e34(65.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e51(49%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.2(1.10\\u0026ndash;4.45)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e2.12(0.84\\u0026ndash;5.29)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eIncome (ETB)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;2500\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e25(48.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e75(72.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.8(1.39\\u0026ndash;5.58)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e3.10(1.24, 8.07*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;2500\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e27(51.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e29(27.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetes comorbidities\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e40(38%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e4.8(1.87\\u0026ndash;12.24)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e4.78(1.37\\u0026ndash;16.71*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e64(62%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDietary education\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e38(73.1%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e92(88.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e14(26.9%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e12(11.5%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e2.82(1.19\\u0026ndash;6.66)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e4.97(1.56\\u0026ndash;15.87*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eFollow dietary Recommendation\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e39(75%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e94(90.4%\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e13(25%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e10(9.6%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5.4(1.19\\u0026ndash;15.34)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e1.70(0.44\\u0026ndash;6.63)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eDiabetes complications\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eYes\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e42(80.4%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e43(41.3%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e5.95(2.69\\u0026ndash;13.16)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e5.10(1.60-16.26*)\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eNo\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e10(19.2%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e61(58.7%)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c5\\\"\\u003e \\u003cp\\u003e1\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c6\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003e1\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Disscusion\",\"content\":\"\\u003cp\\u003eThis study aimed to assess the association between diabetes diet adherence and glycemic control among Type 2 Diabetes Mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia.Poor glycemic control was found to be linked with poor diabetes diet and medication dherence, low income, lack of dietary education, diabetes related comorbidities and complications.\\u003c/p\\u003e \\u003cp\\u003eDiet is one of the most important factors that can modify many aspects of the body physiology including the physiology of pancreas that secretes insulin hormone. Moreover, good dietary adherence is one of the important strategies of life style modification which helps to control the blood glucose level. Hence, failure to adhere to diabetes diet could lead to poor glycemic control.\\u003c/p\\u003e \\u003cp\\u003eAccordingly, this study showed that the odds of poor glycemic control were 3.89 times higher among patients with poor diabetes dietary adherence compared with patients with good diabetes dietary adherence. The finding is consistent with other similar studies done in Malaysia[\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e], Bangladesh [\\u003cspan citationid=\\\"CR34\\\" class=\\\"CitationRef\\\"\\u003e34\\u003c/span\\u003e], Iraq [\\u003cspan citationid=\\\"CR35\\\" class=\\\"CitationRef\\\"\\u003e35\\u003c/span\\u003e], Jordan [\\u003cspan citationid=\\\"CR36\\\" class=\\\"CitationRef\\\"\\u003e36\\u003c/span\\u003e]\\u003csup\\u003e,\\u003c/sup\\u003eKenya[\\u003cspan citationid=\\\"CR37\\\" class=\\\"CitationRef\\\"\\u003e37\\u003c/span\\u003e] and Ethiopia [\\u003cspan citationid=\\\"CR26\\\" class=\\\"CitationRef\\\"\\u003e26\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR38\\\" class=\\\"CitationRef\\\"\\u003e38\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR39\\\" class=\\\"CitationRef\\\"\\u003e39\\u003c/span\\u003e]. Nontheless ,a study done in Nekemte referral hospital, western Ethiopia, shows that diabetes dietary adherence is not significantly associated with glycemic control [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe odds of poor glycemic control were 3.7 times higher among patients with poor adherence to diabetes medication compared with their counterparts.It is in agreement with result of previous studies done in Singapore, Japan, Democratic republic of Congo, Ghana,and Ethiopia[\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan additionalcitationids=\\\"CR41 CR42\\\" citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR43\\\" class=\\\"CitationRef\\\"\\u003e43\\u003c/span\\u003e]. This may be due to the fact that anti-diabets medications influence the pancreas release more insulin. limit the liver\\u0026rsquo;s ability to make and release glucose, block the actions of enzymes that aid in the process of glycolysis ,and improve cell\\u0026rsquo;s sensitivity to insulin.Thus s non-adherence to these medication could result in distortions this functions leading to poor glycemic control.Moreover, adherence to prescribed medication regimen is crucial to reach metabolic control as non-adherence to blood glucose lowering agents results in higher Hba1c value [\\u003cspan citationid=\\\"CR44\\\" class=\\\"CitationRef\\\"\\u003e44\\u003c/span\\u003e]. In contray, a study done in western part Ethiopia showed that medication adherence is not significantly associated with glycemic control [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDiabetes dietary education has also influenced the level blood glucose level whereby the odds of poor glycemic control were 4.97 times higher among patients who didn\\u0026rsquo;t receive diabetes dietary education compared with patients who received the education. This result is in accordance with similar previous studies conducted done in Croatia and South Korea [\\u003cspan citationid=\\\"CR45\\\" class=\\\"CitationRef\\\"\\u003e45\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR46\\\" class=\\\"CitationRef\\\"\\u003e46\\u003c/span\\u003e].This may be due to the reason that patients who didn\\u0026rsquo;t receive dietary education were less likely to have knowledge about the benefit of food management in diabetes control. Additionally, patients who have received dietry education may perceive the fatality of the disease when they fail to adhere to dietary recommendations.\\u003c/p\\u003e \\u003cp\\u003eThis study also revealed that the odds of poor glycemic control were 3.1 times higher among patients from low economic class compared with their counterparts. This finding is in line with previous studies conducted in some parts of Ethiopia [\\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR47\\\" class=\\\"CitationRef\\\"\\u003e47\\u003c/span\\u003e]. However, studies done in India and Portugal showed an absence of statistically significance association between level of income and poor glycemic control [\\u003cspan citationid=\\\"CR48\\\" class=\\\"CitationRef\\\"\\u003e48\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR49\\\" class=\\\"CitationRef\\\"\\u003e49\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003ePoor glycemic control was 5.1 times more common among patients who had diabetes complications compared with their counterparts.This find is consistent with the studies conducted in England, northern Ireland and Scotland, and some parts of Ethiopia [\\u003cspan additionalcitationids=\\\"CR51\\\" citationid=\\\"CR50\\\" class=\\\"CitationRef\\\"\\u003e50\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR52\\\" class=\\\"CitationRef\\\"\\u003e52\\u003c/span\\u003e]. This may be explained by the fact that high blood glucose level induces tissue damage through mitochondrial superoxide production which may lead to cellular damage including capillary endothelial cells in the retina, mesangial cells in the renal glomerulus ,and neurons and Schwann cells in peripheral nerves. These cells are particularly at high risk of damage as they are unable to regulate uptake of glucose during hyperglycemia. Therefore, a prolonged hyperglycemia is associated with metabolic imbalances, accumulation of advanced glycation end products, oxidation stress, and lipid alterations leading to diabetes polyneuropathy and multiple organ damage increasing the risk of diabetis complications and eventual death.\\u003c/p\\u003e \\u003cp\\u003eThe odds of poor glycemic control were nearly five time higher among patients with superimposed comorbidities compared with their counterparts. Former studies conducted in Italy, Congo, and some parts Ethiopia have reported similar findings[\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR40\\\" class=\\\"CitationRef\\\"\\u003e40\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR54\\\" class=\\\"CitationRef\\\"\\u003e54\\u003c/span\\u003e].This could be attributed to the effect of polypharmacy that patients with diabetes comorbidities may not adhere to their diabtes medication because of loss of appetite secondary to multiple medication intake which collectively results in poor glycemic control. On the other hand, other studies conducted in Netherland, Croatia, and Canada [\\u003cspan additionalcitationids=\\\"CR56\\\" citationid=\\\"CR55\\\" class=\\\"CitationRef\\\"\\u003e55\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR57\\\" class=\\\"CitationRef\\\"\\u003e57\\u003c/span\\u003e] didn\\u0026rsquo;t show the relationship between comorbidities and level of HgA1c may be attributed to difference in tools applied to assess comorbidity and an advanced approach in management of comorbidities .\\u003c/p\\u003e\"},{\"header\":\"Conclusion\",\"content\":\"\\u003cp\\u003eIn this study, poor adherence to diabetes diet was associated with poor glycemic control. Moreover, lack of education on diabetes diet, poor adherence to diabetes medication, diabetes related comorbidities and complications, land ow economical status were determinants of poor glycemic control.More efforts need to be made in strengthening and disseminating health education programs for diabetes patients at each follow up visit while emphasizing on the importance of achieving dietary and medication adherence.Health care providers should design appropriate interventions including better management of medication and dietary adherence to minimize diabetes comorbidities and complications toachieve the diabetes management goal through good glycemic control. Although, non-adherence to physical exercise was not significantly associated with glycemic control patients need to be advised to exercise regularly.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eADA: American Diabetes Association, BMI: Body Mass Index, CFG: Canadian Food Guide, CVD: Cardio Vascular Disease, CA: cases ,CON: controls , \\u0026nbsp;DALYs : Disability Adjusted Life Years, DM: Diabetes Mellitus, FBS: Fasting Blood Sugar, FMOHE: Federal Ministry of Health Ethiopia, HgA1c: HemoglobinA1c, IDF: International Diabetes Federation, NCD: Non- Communicable Disease, PDAQ: Perceived Dietary Adherence Questionnaire , SDG: Sustainable Development Goal, T2DM: Type 2 Diabetes Mellitus\\u003c/p\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e\\u003cstrong\\u003eEthics approval and consent to participate\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe study was approved\\u0026nbsp; by \\u0026nbsp;ethical review committee of School of Public Health (SPH-Rec) , College of Health Sciences, Addis Ababa University \\u0026nbsp; with \\u0026nbsp;the \\u0026nbsp;approval identification (ID) number of 96/SPH-Rec ; dated 15 /March/2022. The procedure and purpose of this study was explained to the department of diabetes clinic to get support letter.\\u0026nbsp;This study involves human participants and\\u0026nbsp;was conducted in accordance with the Declaration of Helsinki.\\u0026nbsp;Patients were asked their oral and written consent to confirm their willingness to participate in the study after discussing the purpose,benefit ,risks,and confidentiality of the provided informations was maintained and the anonymity of the participants was kept by using codes to\\u0026nbsp;indicate participants\\u0026rsquo; card and and collected specimen by using codes instead of using the participants\\u0026rsquo; name.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e: Not applicable\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAvailability of data and materials:\\u003c/strong\\u003e Data are available upon reasonable request\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCompeting interests:\\u003c/strong\\u003e None declared.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eFunding:\\u003c/strong\\u003e None\\u0026nbsp;\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAuthors\\u0026apos; contributions\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eME: was responsible the conception of the study \\u0026nbsp; including designing, collecting and analyzing interpreting the data , and drafting \\u0026nbsp;the manuscript.:GE: supervised the research \\u0026nbsp;work and critically reviewed \\u0026nbsp;the study at the design stage \\u0026nbsp;stage and data analysis \\u0026nbsp;and finalized \\u0026nbsp;the manuscript write up.YD: supervised the research work and contributed to study at the design stage and during \\u0026nbsp;data analysis , AA: supported \\u0026nbsp;the \\u0026nbsp; designing of the study , supervised the research work including \\u0026nbsp;laboratory data collection process and \\u0026nbsp;reviewed \\u0026nbsp; the \\u0026nbsp;manuscript.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAcknowledgements\\u003c/strong\\u003e\\u003c/p\\u003e\\n\\u003cp\\u003eThe authors express their deepest gratitude to Addis Ababa University for its whole rounded support during the research work.Additionally,our gratitude goes to Black lion specialized hospital,S.t.Paul millennium hospital ,data collectors and study participants for their willingness and cooperation during the data collection time\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eWorld health organization.Reducing the burden of non-communicable disease through strengthening prevention and control of diabetes. 2021. 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BMC Endocr Disord. 2019;19(1):1\\u0026ndash;34.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLuijks H, Biermans M, Bor H, van Weel C, Lagro-Janssen T, de Grauw W, et al. The effect of comorbidity on glycemic control and systolic blood pressure in type 2 diabetes: a cohort study with 5 year follow-up in primary care. PLoS ONE. 2015;10(10):1\\u0026ndash;18.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBralić Lang V, Bergman MB. Prevalence of comorbidity in primary care patients with type 2 diabetes and its association with elevated HbA1c: a cross-sectional study in Croatia. Scand J Prim Health Care. 2016;34:66\\u0026ndash;72.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHudon C, Fortin M, Dubois M-F, Almirall J. .Comorbidity and glycemia control among patients with type 2 diabetes in primary care. Diabetes Metab Syndr Obes. 2008;1:33\\u0026ndash;7.\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"Diabetes mellitus, diabetes dietary adherence, Ethiopia, glycemic control, HgA1c\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-4659131/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-4659131/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eSuboptimal adherence to diabetes diet can drive the occurrence of diabetes complications. However, the association between adherence to diabetes diet and glycemic control was limited to non-analytical surveys and fasting blood sugar determinationin in low-income countries. This study was aimed to assess the association between adherence to diabetes diet and glycemic control among adult type 2 DM patients on follow-up in selected hospitals, Addis Ababa, Ethiopia.\\u003c/p\\u003e\\u003ch2\\u003eMethods\\u003c/h2\\u003e \\u003cp\\u003eHospital-based unmactched case-control study was conducted among 156 diabetes patients ( 104 controls and 52 cases ) from May to September 2022. Data were collected using pretested structured questionnaire .Blood sugar level was tested using HgA1c test. Cases were patients with HgA1c\\u0026thinsp;\\u0026lt;\\u0026thinsp;7% while controls had HgA1c\\u0026thinsp;\\u0026ge;\\u0026thinsp;7%. Descriptive statistics was used to describe all relevant data. Binary logistic regression analysis was done to assess the association between glycemic control and adherence to diabetes diet and other predictors. Adjusted odds ratios alongside 95% confidence intervals (CIs) were estimated to measure the strength of association between response and explanatory variables at p-value less than 0.05.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003eA total of 156 type 2 diabetes patients were enrolled in this study. The mean (\\u0026plusmn;\\u0026thinsp;SD) age of respondents was 52.65(\\u0026plusmn;\\u0026thinsp;9.94) and 51.04 (\\u0026plusmn;\\u0026thinsp;10.84) years among cases and controls respectively. In multivariable analysis, poor adherence to diabetes diet [(adjusted odds ratio(AOR)\\u0026thinsp;=\\u0026thinsp;3.89,95%CI:(1.58,9.54)] and diabetes medication [(AOR\\u0026thinsp;=\\u0026thinsp;3.74,95% CI:(1.42,9.85)], lack of dietary education [(AOR\\u0026thinsp;=\\u0026thinsp;4.97,95% CI:(1.56,15.87)], patient\\u0026rsquo;s income level of \\u0026le;\\u0026thinsp;2500 Ethiopian birr (ETB) [(AOR\\u0026thinsp;=\\u0026thinsp;3.17,95%CI:(1.24,8.07)], presence of diabetes comorbidities [(AOR\\u0026thinsp;=\\u0026thinsp;4.78,95%CI:(1.37,16.71)] and diabetes complications [(AOR\\u0026thinsp;=\\u0026thinsp;5.11,95%CI:( (1.60,15.87)] were significant determinants of poor glycemic control.\\u003c/p\\u003e\\u003ch2\\u003eConclusion\\u003c/h2\\u003e \\u003cp\\u003ePoor dietary and medication -adherence ,lack of dietary education, low economic status, presence of comorbidities ,and diabetes complications were determinants of poor glycemic control. Thus, health care providers should design appropriate interventions in line with modifiable determinants of poor glycemic control.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Association between adherence to diabetes diet and glycemic control among type 2 diabetes mellitus adult patients attending diabetes clinics in selected hospitals, Addis Ababa, Ethiopia: a health facility based unmatched case-control study.\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2024-07-26 16:44:50\",\"doi\":\"10.21203/rs.3.rs-4659131/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"38ed964d-c3d8-4612-b6bd-a1ae88bfabca\",\"owner\":[],\"postedDate\":\"July 26th, 2024\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2025-05-27T09:24:08+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2024-07-26 16:44:50\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-4659131\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-4659131\",\"identity\":\"rs-4659131\",\"version\":[\"v1\"]},\"buildId\":\"qtupq5eGEP_6zYnWcrvyt\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}