Adherence to Dietary Recommendations and Sleep Quality Among Type 2 Diabetes Mellitus Patients in Enugu, Nigeria: A Cross-Sectional Study

Adherence to Dietary Recommendations and Sleep Quality Among Type 2 Diabetes Mellitus Patients in Enugu, Nigeria: A Cross-Sectional 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 Adherence to Dietary Recommendations and Sleep Quality Among Type 2 Diabetes Mellitus Patients in Enugu, Nigeria: A Cross-Sectional Study Precious oluchi Chilotam, Sunday Francis Iyama, Chukwudike Eric Enem, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9243664/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 14 You are reading this latest preprint version Abstract Background Type 2 Diabetes Mellitus (T2DM) is a global public health concern, particularly in low- and middle-income countries where adherence to self-care practices remains suboptimal. Among key components of disease management, adherence to dietary recommendations and quality of sleep play a critical role in glycaemic control and prevention of complications. Objectives To assess the level of adherence to dietary recommendations and the quality of sleep among T2DM patients attending health facilities in Enugu, Nigeria. Methods A descriptive cross-sectional study was conducted among adult T2DM patients in Enugu using a multistage sampling technique. Data were collected through structured questionnaires including validated scales for dietary adherence and sleep quality. Descriptive and inferential statistics were used for analysis. Results Among 350 respondents, 24% of study participants had a good UKDDQ score of healthy diet adherence, 33.7% had moderate adherence and 42.2% had poor adherence. 55.71% of study participants had good sleep quality score, while 44.28% had poor sleep quality. Overall, more Females (27.4%) showed Good diet adherence than males(20%)while more males (59.4%) had Good sleep quality compared to females(52.6%) Conclusion The study reveals suboptimal adherence to dietary recommendations and poor sleep quality among T2DM patients in Enugu. These findings underscore the need for targeted educational and behavioural interventions to enhance self-care practices in this population. Type 2 diabetes mellitus dietary adherence sleep quality self-care Enugu Nigeria Introduction Type 2 diabetes mellitus (T2DM) is a major chronic health condition characterized by insulin resistance and impaired insulin secretion[1]. Diabetes is seen as one of the biggest challenges in health given the anticipated increase in prevalence and population effect. In 2019, an estimated 488 million people aged 20 to 99 years worldwide were living with diabetes, and this number is projected to increase to 578 million in 2030, 642 million by 2040 and 700 million in 2045 [2,3]. Officially, data has shown continual increase in the incidence of diabetes and an increased burden of disease for both the patients and the health care system despite huge investments being made. It poses significant public health challenges worldwide, particularly in sub-Saharan Africa where the prevalence is rising rapidly due to urbanization, dietary transitions, and sedentary lifestyles[4]. According to the International Diabetes Federation, approximately 24 million adults were living with diabetes in Africa in 2021, a figure projected to rise sharply in the coming decades. In Nigeria, T2DM contributes substantially to morbidity, mortality, and healthcare costs[5]. The successful management of T2DM extends beyond pharmacotherapy to include critical lifestyle modifications such as adherence to dietary recommendations and maintenance of good sleep hygiene[6]. Dietary adherence involving the consistent consumption of balanced, nutrient-rich meals while avoiding high-sugar and high-fat foods plays a fundamental role in achieving glycemic control and preventing complications. However, many individuals with T2DM struggle to maintain appropriate dietary patterns due to various personal, socioeconomic, and environmental factors. Sleep quality is another often overlooked but vital component of diabetes management. Emerging evidence suggests that poor sleep characterized by short duration, sleep fragmentation, or disorders such as insomnia is associated with poor glycemic control, insulin resistance, and increased risk of diabetes-related complications. Inadequate sleep may also undermine self-care behaviors, including adherence to diet and medication regimens[7,8]. Patients with diabetes mellitus (DM) often experience reduced quality of life due to its diverse clinical complications. Individuals with DM frequently struggle with both sleep and wakefulness as a result of physiological disturbances and co-existing sleep disorders. Clinical studies indicate that up to one-third of people with DM also suffer from sleep-related conditions, compared to just 8.2% in those without the disease. Additionally, another study found that more than half of individuals with type 2 DM are classified as "poor sleepers."[9,10]. Despite the recognized importance of lifestyle factors in diabetes control, there is limited research from Nigeria assessing how T2DM patients adhere to dietary guidelines and the quality of their sleep. Understanding these patterns within the local context is essential to developing culturally relevant interventions aimed at improving overall diabetes management outcomes. In Enugu, Nigeria, the epidemiological shift towards non-communicable diseases necessitates a closer evaluation of lifestyle practices among T2DM patients. This study assesses adherence to dietary recommendations and sleep quality, aiming to provide evidence for more tailored public health interventions. Methods Study Design This was a hospital-based descriptive cross-sectional study carried out among patients diagnosed with type 2 diabetes mellitus attending selected health facilities in Enugu, Nigeria from June to July 2024. Area of Study This study was conducted in Enugu state, south eastern geopolitical zone in Nigeria[11]. Two sites chosen for this study are Brit Care Hospital (Brit Specialist Clinic) and University of Nigeria Teaching Hospital (UNTH) at Ituku-Ozalla. Population of study The study population comprises Type 2 DM patients attending health facilities in Enugu, Enugu State, Nigeria. These patients seek medical care and management for their condition at both public and private healthcare facilities within the state. This study finding will be generalized to all type 2 DM patients attending health facilities in Enugu, Enugu State. About 4.7 million Nigerians have type 2 diabetes mellitus [12]. Inclusion criteria T2DM patients aged 18 and above, must be registered in the selected health facility, must have received care for at least 3 months, must give consent. Exclusion criteria Type 1 diabetes patients, below 18 years of age, registered or not registered in the selected health facility, received care for less than 3 months or more, and non-consenting Sample and sampling technique A multistage sampling technique was employed to select participants for this study. In Enugu state there are 17 Local Government Areas (LGAs), and two LGA were selected based on population density and availability of healthcare facilities. Within the selected LGAs (Enugu North and Awgu), one public and one private healthcare facility was selected based on patient load. All consenting type 2 diabetes mellitus patients visiting these facilities from June 1st to July 1st 2024 were included in the study. The first stage involves dividing the population into clusters, which in this case are the Local Government Areas (LGAs) of Enugu State. Two LGAs (Enugu North and Awgu) are selected from the total set of LGAs in the state. This stage utilizes cluster sampling because the population is naturally divided into distinct clusters (LGAs), and one or more clusters are randomly selected for inclusion in the study. Within the selected LGAs, one healthcare facility was chosen conveniently in each LGA as secondary sampling units (SSUs). One public and one private healthcare facility was selected based on patient load, acceptance and approval from the hospital management. Sampling of Participants within Healthcare Facilities: All consenting type 2 diabetes mellitus (T2DM) patients visiting the selected healthcare facilities during the specified period (June to July ) were included in the study. This stage did not involve sampling, as all eligible individuals within the selected facilities were included in the sample. The sample size was determined using the Cochran formula : n = pq (z2 )/e2 where Z represents the standard normal deviate (1.96) e denotes the margin of error (0.05), p signifies the adherence prevalence estimated at 0.225 based on a prior investigation [13] and q = 1-p. The calculated sample size amounted to 268. An additional 10% was included to account for potential incomplete responses by participants, resulting in a final calculated sample size of 294. Nonetheless, a sample size of 350 was utilized for this study. Instruments for Data Collection Demographic section collects basic data including; Age, marital status, age at disease diagnosis, disease duration, level of education and employment status, this information aids in contextualization of level of adherence to healthy lifestyles among respondents. Pittsburgh Sleep Quality Index (PSQI): This questionnaire was used to assess the sleep quality index among type 2 diabetes mellitus patients. [14] UK Diabetes and Diet Questionnaire (UKDDQ): To assess dietary intake, a modified version of the United Kingdom Diabetes and Diet Questionnaire (UKDDQ) was employed. This tool, which can be culturally adapted to suit different populations, was originally developed to evaluate dietary behaviors in adults diagnosed with or at risk for type 2 diabetes. The UKDDQ has been shown to possess good reliability and validity. [15] Data collection and Analysis Data collection was conducted using a hard copy questionnaire. Research assistants were trained and engaged in each selected facility to administer the questionnaires to eligible participants in the selected healthcare facilities. Participants were briefed on the research aim and purpose, informed consent was obtained from the respondents before data collection. Completed questionnaires were checked for completeness and consistency. Data were entered into Microsoft Excel and analyzed using SPSS version 25. Results A total of 350 respondents participated in the study. As seen in Table 1 and 2 , 54.3% were female, The mean ± SD age of participants was 50.4 years (SD ± 6.8) For analysis, age was grouped into two categories: <40 years (n = 80, 22.9%) and ≥ 40 years (n = 270, 77.1%). Most respondents (26%) had at least secondary education and (57.1%) had lived with diabetes for more than five years. The majority of participants (49.7%), were married and (51%) employed. Table 1 shows that 24% of study participants had a good UKDDQ score of healthy diet adherence, 33.7% had moderate adherence and 42.2% had poor adherence. Overall, more Females (27.4%) showed Good adherence than males(20%). Table 1 Sociodemographic/Clinical Characteristics and Dietary Adherence Variable Total N (%) (N = 350) Good adherence (n = 84) Moderate Adherence (n = 118) Poor adherence(n = 148) Age Group < 40 yrs 80 (22.9%) 10 (12.5%) 25 (31.25%) 45 (56.25%) ≥ 40 yrs 270 (77.1%) 74 (27.41%) 93 (34.44%) 103 (38.15%) mean ± SD= 50.4 ± 6.8 Gender Male 160 (45.7%) 32 (20%) 48 30%) 80 (50%) Female 190 (54.3%) 52 (27.4%) 70 (36.8%) 68 (35.8%) Employment Status Employed 180 (51%) 30 (16.7%) 70 (38.9%) 80(44.4%) Self Employed 70 (20%) 20 (26.8%) 30(42.9%) 20 (28.6%) Unemployed 100 (29%) 34 (13%) 18 (24%) 48 (63%) Marital Status Married 174 (49.7%) 40 (23%) 60 (34.5%) 74 (42.5%) Divorced/seperated/Widowed 81 (23.14%) 20(24.7%) 30 (37%) 31 (38.3%) Never married 95 (27.14%) 24 (25.3%) 28 (29.5%) 43 (45.3%) Education Level No formal 90 (25.7%) 20 (22.2%) 30 (33.3%) 40 (44.4%) Primary 60(17.1%) 15(25.0%) 20(33.3%) 25(41.7%) Secondary 91(26%) 10(11%) 30(33%) 51(56%) Tertiary 109 (31.1%) 39 (35.8%) 38 (34.9%) 32(29.4%) Monthly Income <₦70,000 180 (51.4%) 20 (11.1%) 55 (30,6%) 105 (58.3%) ≥₦70,000 170 (48.6%) 64 (37.6%) 63 (37.1%) 43 (25.3%) Age at T2DM Diagnosis < 40 yrs 140 (40%) 20 (14.3%) 45 (32.1%) 75 (53.6%) ≥ 40 yrs 210 (60%) 64 (30.5%) 73 (34.8%) 73 (34.8%) Duration of T2DM Management < 5 years 160 (45.7%) 30 (18.75%) 60 (37.5%) 70 (43.75%) ≥ 5 years 190 (54.3%) 54 (28.42%) 58 (30.53%) 78 (41.05%) Family History of T2DM Yes 200 (57.1%) 64 (32%) 68 (34%) 68 (34%) No 150 (42.9%) 20 (13.33%) 50 (33.33%) 80 (53.33%) T2DM-Related Complications Yes 120 (34.3%) 18 (15%) 35 (29.17%) 67 (55.83%) No 230 (65.7%) 66 (28.7%) 83 (36.09%) 81 (35.22%) Table 2 shows that 55.71% of study participants had a good sleep quality score, while 44.28% had poor sleep quality. Overall, more males (59.4%) had Good adherence than females(52.6%). Proportion of participants with good sleep quality was highest among self-employed participants ( 71.4%). Table 2 Sociodemographic/Clinical Characteristics and sleep quality Variable Total N (%) (N = 350) Good Sleep Quality (n = 195) 55.71% Poor Sleep Quality(n = 155) 44.28% Age Group < 40 yrs 80 (22.9%) 50(62.5%) 30(37.5%) ≥ 40 yrs 270 (77.1%) 145(53.7%) 125(46.3%) mean ± SD= 50.4 ± 6.8 Gender Male 160 (45.7%) 95 (59.4%) 65 (40.6%) Female 190 (54.3%) 100 (52.6%) 90 (47.4%) Employment Status Employed 180 (51%) 100 (55.6%) 80 (44.4%) Self Employed 70 (20%) 50 (71.4%) 20 (28.6%) Unemployed 100 (29%) 45 (45%) 55 (55%) Marital Status Married 174 (49.7%) 94 (54%) 80 (46%) Divorced/seperated/Widowed 81 (23.14%) 61 (75.3%) 20 (24.7%) Never married 95 (27.14%) 40 (42.1%) 55 (57.9%) Education Level No formal 90 (25.7%) 85(94.4%) 5 (5.6%) Primary 60(17.1%) 45(75%) 15 (25%) Secondary 91(26%) 30(33%) 61 (67%) Tertiary 109 (31.1%) 35(32.1%) 74 (67.9%) Monthly Income <₦70,000 180 (51.4%) 100(55.6%) 80 (44.4%) ≥₦70,000 170 (48.6%) 95 (55.9%) 60 (35.3%) Age at T2DM Diagnosis < 40 yrs 140 (40%) 80 (57.1%) 60 (42.9%) ≥ 40 yrs 210 (60%) 115 (54.8%) 95 (45.2%) Duration of T2DM Management < 5 years 160 (45.7%) 90 (56.3%) 70 (43.8%) ≥ 5 years 190 (54.3%) 105 (55.3%) 85 (44.7%) Family History of T2DM Yes 200 (57.1%) 110 (55%) 90 (45%) No 150 (42.9%) 85 (56.7%) 65 (43.3%) T2DM-Related Complications Yes 120 (34.3%) 60 (50%) 60 (50%) No 230 (65.7%) 135 (58.7%) 95 (41.3%) Table 3 Multiple Regression showing Relationships between Adherence to Dietary Recommendations, Sociodemographic and Clinical Characteristics of Type 2 DM Patients Attending Health Facilities in Enugu, Enugu State Model Standardized Coefficients t P-value 95.0% Confidence Interval for B R R2 Adj. R2 F Beta Lower Bound Upper Bound (Constant) 0.397 0.158 0.124 4.73 - 30.516 .000 29.953 34.084 Health facility .061 .956 .340 − .207 .597 Age .109 1.479 .140 − .073 .511 Gender .087 1.479 .140 − .076 .537 Employment Status − .043 − .685 .494 − .509 .247 Marital Status .062 .895 .371 − .223 .595 Education − .114 -1.189 .235 − .503 .124 Month Income − .023 − .280 .780 − .341 .256 Age of T2DM diagnosis − .185 -2.550 .011 − .113 − .015 Duration of T2DM management − .073 − .875 .382 − .356 .137 Family history of T2DM .328 5.435 .000 .580 1.238 T2DM related complications − .048 − .832 .406 − .423 .172 Note. R = Correlation coefficient; R 2 = Coefficient of determination; Adj. R 2 = Adjusted R-Squared \(\:\text{β}\) = standardized beta coefficient; p-value = Level of significance Significant at p < 0.05 Results in Table 3 showed that the joint relationship of independent variables (sociodemographic and clinical characteristics) on adherence to dietary recommendations was significant (F(11, 278) = 4.726; R = 0.397, R2 = 0.158, adjusted R2 = 0.124; p = 0.000). About 15.8% of the variation in adherence to dietary recommendations was accounted for by the independent variables. Also, the age of diagnosis for T2DM and family history of T2DM were significantly related to adherence to dietary recommendations. Table 4 Multiple Regression showing Relationships between Adherence to Quality Sleep, Sociodemographic and Clinical Characteristics of Type 2 DM Patients Attending Health Facilities in Enugu, Enugu State Model Standardized Coefficients t p -value 95.0% Confidence Interval for B R R 2 Adj. R 2 F Beta Lower Bound Upper Bound (Constant) 0.903 0.815 0.807 111.065 - 19.448 .000 18.480 22.643 Health facility .027 .913 .362 − .217 .593 Age − .017 − .506 .613 − .370 .219 Gender − .089 -3.219 .001 − .815 − .196 Employment status − .049 -1.650 .100 − .700 .062 Marital status − .149 -4.610 .000 -1.376 − .553 Education .270 5.996 .000 .647 1.279 Monthly income .008 .195 .845 − .271 .331 Age of T2DM diagnosis − .081 -2.394 .017 − .110 − .011 Duration of T2DM managt − .601 -15.370 .000 -2.185 -1.689 Family History of T2DM − .009 − .305 .761 − .383 .280 T2DM Related Complications − .002 − .082 .935 − .312 .287 a Dependent variable: Quality of sleep Note. R = Correlation coefficient; R2 = Coefficient of determination; Adj. R2 = Adjusted R-Squared \(\:\text{β}\) = standardized beta coefficient; p-value = Level of significance Significant at p < 0.05 Results in Table 4 show that the joint relationship of independent variables (clinical and sociodemographic characteristics) on the level of sleep quality was significant (F(11, 278) = 111.065; R = 0.903, R2 = 0.815, adjusted R2 = 0.807; p = 0.000). About 81.5% of the variation in the level of sleep quality was accounted for by independent variables. Also, gender, marital status, education, age of diagnosis for T2DM, and duration of T2DM management were significantly related to the level of sleep quality among T2DM patients attending health facilities in Enugu, Enugu State. Discussion This study evaluated the level of adherence to dietary recommendations and the quality of sleep among individuals with type 2 diabetes. In this study, 24% of participants demonstrated good adherence to dietary recommendations. This is comparable to the findings of the studies conducted in Hungary[16] Northern Ethiopia[17]. In contrast, the level of good adherence in this study was lower than findings from Addis Ababa, Ethiopia, where 48.6% of participants reported good dietary practices [18], from Washington, where the adherence rate was 48% [19] and Eastern Ethiopia 37.5% [20]. The multiple regression analysis revealed a statistically significant joint relationship between sociodemographic and clinical characteristics and adherence to dietary recommendations among individuals with type 2 diabetes mellitus (T2DM) in Enugu State (F(11, 278) = 4.726, p < 0.001). The model accounted for approximately 15.8% of the variance in dietary adherence (R = 0.397, R² = 0.158, adjusted R² = 0.124), indicating a modest yet meaningful explanatory power. Among the predictors, family history of T2DM emerged as the strongest positive predictor of adherence (β = 0.328, t = 5.435, p < 0.001), suggesting that individuals with a familial background of diabetes may be more motivated or informed to follow dietary guidelines. In contrast, age at diagnosis was negatively associated with adherence (β = -0.185, t = -2.550, p = 0.011), implying that those diagnosed at an older age might face greater challenges in modifying long-standing dietary habits. This finding is in line with the findings of the study in Ogun State [21]. Other variables such as gender, education level, and income did not show statistically significant associations. These findings highlight the need for tailored interventions that consider both clinical history and individual patient contexts when promoting dietary adherence among T2DM patients. . For sleep quality, 44.2% of participants with type 2 diabetes were identified as having poor sleep quality(PSQI > 5). This finding is consistent with similar study in China where a prevalence of 47.1% was reported [22] and lower than the 55.4 reported in Saudi Arabia[23]. However, the proportion observed in our study is slightly higher than those reported in Iran [24], which documented poor sleep quality in approximately 38% of individuals with type 2 diabetes. For sleep quality, our study reported a mean PSQI score of (= 2.68; SD = 0.68),which is lesser in comparison to the values reported by the study in West Bengal. (6.70 ± 3.32) [9] and (5.56 ± 3.34) reported in Northwest of Iran [23]. Our study participants reported experiencing a high level of sleep disturbance (= 11.46; SD = 2.24) this finding corroborates with the findings reported by the study in West Bengal[9]. The multiple regression analysis demonstrated a statistically significant joint relationship between sociodemographic and clinical variables and sleep quality among participants. The model explained a substantial 81.5% of the variance in sleep quality (R = 0.903, R² = 0.815, adjusted R² = 0.807), indicating a strong predictive power. Several variables showed significant associations with sleep quality. Notably, duration of T2DM management was the strongest negative predictor (β = -0.601, t = -15.370, p < 0.001), suggesting that prolonged disease duration may be associated with declining sleep quality, possibly due to disease burden or complications. Education was positively associated with better sleep quality (β = 0.270, t = 5.996, p < 0.001), while gender (β = -0.089, t = -3.219, p = 0.001) and marital status (β = -0.149, t = -4.610, p < 0.001) showed significant negative associations, indicating potential vulnerabilities among certain demographic groups. Additionally, age at diagnosis of T2DM was inversely related to sleep quality (β = -0.081, t = -2.394, p = 0.017), highlighting the potential impact of late diagnosis on overall wellbeing. These findings underscore the need for personalized diabetes care that considers educational background, disease duration, and demographic factors in efforts to improve sleep quality among T2DM patients. Strengths, Limitations, and Suggestions for Future Research This study has several strengths worth noting. Firstly, it adopted a hospital-based cross-sectional design and utilized a relatively large sample size (n = 300), which enhances the representativeness and generalizability of findings. The inclusion of both public and private healthcare facilities further strengthens the comprehensiveness of the data, providing insights into adherence behaviors across different healthcare settings. However, the study is not without limitations. The cross-sectional design limits causal inferences, as the observed associations do not imply temporal or cause-effect relationships. Additionally, the data on dietary adherence and sleep quality were self-reported, which may be subject to recall bias or social desirability bias. Another important limitation lies in the model explaining only 15.8% of the variance in dietary adherence (R² = 0.158), suggesting that other influential factors such as psychosocial determinants, cultural practices, or access to healthy food options may not have been captured in this study. This calls for more comprehensive modeling in future studies. Future research should consider employing longitudinal designs to track changes in lifestyle behaviors over time and establish potential causal relationships. Further studies should also explore qualitative perspectives to uncover deeper contextual and behavioral insights into dietary practices and sleep patterns among T2DM patients. Additionally, expanding the range of variables such as knowledge of diabetes management, psychological wellbeing, and community-level support systems may enhance the explanatory power of future models. Conclusion This study revealed that adherence to dietary recommendations and quality sleep among patients with type 2 diabetes mellitus (T2DM) attending health facilities in Enugu State remain suboptimal. Key factors associated with poor adherence included lower educational attainment, longer duration of disease management, and the presence of comorbidities. These findings underscore the need for targeted health education and counselling strategies that emphasize the importance of nutrition and sleep hygiene in diabetes care. Integrating behaviour change communication, peer support structures, and individualized care plans into routine diabetes management could significantly enhance self-care practices and reduce the risk of complications among T2DM patients. Declarations Ethical approval & Accordance Ethical approval for the study was obtained from the Health Research Ethics Committee of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Reference number, (UNTH/HREC/2024/04/975). All procedures were performed in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki[25]. Consent to participate: Written informed consent was obtained from each participant prior to participation. Each participant was provided with a copy of the participant information sheet and a signed consent form for their records. Confidentiality was ensured. Consent to publish: The written consent form clearly outlined the purpose of the study and included consent-to-publish. Participation was voluntary. Funding Declaration Authors declare that no funding was received for this work. Author Contribution S.F wrote the main manuscript text and obtained Ethical approvalP.O Developed the research idea and study design and reviewed the main manuscript textC.E Reviewed the main manuscript textN.I Conducted data collection and collationD.A Conducted data collection and collation Data Availability The datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request. References Motala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. Type 2 diabetes mellitus in sub-Saharan Africa: challenges and opportunities. Nature Reviews Endocrinology. 2022 Apr;18(4):219 − 29. Azharuddin MD, Kapur P, Adil M, Ghosh P, Sharma M. Health-related quality of life and sleep quality among North Indian type 2 diabetes mellitus patients: evidence from a cross-sectional study. Sleep Medicine. 2020 Sep 1;73:93–100. 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Diabetes, metabolic syndrome and obesity. 2020 Jul 23:2605-12. Akadri O, Akadri A. Lifestyle modification adherence among patients attending diabetes clinics in selected hospitals in Remo zone Ogun State, Nigeria: Lifestyle modification adherence. Babcock University Medical Journal. 2021 Jun 30;4(1):23–32.Richa R, Datta N, Raj V, Kumar R, Venugopal V. Sleep Quality in Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Hospital in West Bengal: A Cross-Sectional Study. Cureus. 2023 Sep 28;15(9). Zhu BQ, Li XM, Wang D, Yu XF. Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus. International Journal of Nursing Sciences. 2014 Sep 1;1(3):260-5. Darraj A, Mahfouz MS, Alsabaani A, Sani M, Alameer A. Assessment of sleep quality and its predictors among patients with diabetes in Jazan, Saudi Arabia. Diabetes, metabolic syndrome and obesity: targets and therapy. 2018 Sep 25:523 − 31. Shamshirgaran SM, Ataei J, Malek A, Iranparvar-Alamdari M, Aminisani N. Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran. World journal of diabetes. 2017 Jul 15;8(7):358. General Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. The Journal of the American College of Dentists. 2014;81(3):14 − 8. Additional Declarations No competing interests reported. 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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-9243664","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":629576130,"identity":"da40f459-61f8-42da-8ac9-1ecae6a7bd2f","order_by":0,"name":"Precious oluchi Chilotam","email":"","orcid":"","institution":"National Open University of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Precious","middleName":"oluchi","lastName":"Chilotam","suffix":""},{"id":629576131,"identity":"4d9dbf98-5ed8-4f5c-beff-428ea16df8ba","order_by":1,"name":"Sunday Francis Iyama","email":"data:image/png;base64,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","orcid":"","institution":"National Open University of Nigeria","correspondingAuthor":true,"prefix":"","firstName":"Sunday","middleName":"Francis","lastName":"Iyama","suffix":""},{"id":629576132,"identity":"52f4b556-0792-4294-8677-88b47b2c29e7","order_by":2,"name":"Chukwudike Eric Enem","email":"","orcid":"","institution":"Lamar University","correspondingAuthor":false,"prefix":"","firstName":"Chukwudike","middleName":"Eric","lastName":"Enem","suffix":""},{"id":629576133,"identity":"66ac985f-12e5-4eaf-b188-6691489df542","order_by":3,"name":"Nenechi Ifeoma Chiwetalu","email":"","orcid":"","institution":"National Open University of Nigeria","correspondingAuthor":false,"prefix":"","firstName":"Nenechi","middleName":"Ifeoma","lastName":"Chiwetalu","suffix":""},{"id":629576134,"identity":"9351ae3d-c80d-4fa5-8b45-0a5a88aad531","order_by":4,"name":"Doris Ayomide Johnson","email":"","orcid":"","institution":"Nnamdi Azikiwe University","correspondingAuthor":false,"prefix":"","firstName":"Doris","middleName":"Ayomide","lastName":"Johnson","suffix":""}],"badges":[],"createdAt":"2026-03-27 10:39:36","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9243664/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9243664/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108181949,"identity":"f86dbde0-29b8-49ea-9104-5f4a49529e3a","added_by":"auto","created_at":"2026-04-30 08:59:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":517072,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9243664/v1/1c77d875-5943-4ae0-9355-a852e0eb2d85.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Adherence to Dietary Recommendations and Sleep Quality Among Type 2 Diabetes Mellitus Patients in Enugu, Nigeria: A Cross-Sectional Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eType 2 diabetes mellitus (T2DM) is a major chronic health condition characterized by insulin resistance and impaired insulin secretion[1]. Diabetes is seen as one of the biggest challenges in health given the anticipated increase in prevalence and population effect. In 2019, an estimated 488\u0026nbsp;million people aged 20 to 99 years worldwide were living with diabetes, and this number is projected to increase to 578\u0026nbsp;million in 2030, 642\u0026nbsp;million by 2040 and 700\u0026nbsp;million in 2045 [2,3].\u003c/p\u003e \u003cp\u003eOfficially, data has shown continual increase in the incidence of diabetes and an increased burden of disease for both the patients and the health care system despite huge investments being made. It poses significant public health challenges worldwide, particularly in sub-Saharan Africa where the prevalence is rising rapidly due to urbanization, dietary transitions, and sedentary lifestyles[4]. According to the International Diabetes Federation, approximately 24\u0026nbsp;million adults were living with diabetes in Africa in 2021, a figure projected to rise sharply in the coming decades. In Nigeria, T2DM contributes substantially to morbidity, mortality, and healthcare costs[5].\u003c/p\u003e \u003cp\u003eThe successful management of T2DM extends beyond pharmacotherapy to include critical lifestyle modifications such as adherence to dietary recommendations and maintenance of good sleep hygiene[6]. Dietary adherence involving the consistent consumption of balanced, nutrient-rich meals while avoiding high-sugar and high-fat foods plays a fundamental role in achieving glycemic control and preventing complications. However, many individuals with T2DM struggle to maintain appropriate dietary patterns due to various personal, socioeconomic, and environmental factors.\u003c/p\u003e \u003cp\u003eSleep quality is another often overlooked but vital component of diabetes management. Emerging evidence suggests that poor sleep characterized by short duration, sleep fragmentation, or disorders such as insomnia is associated with poor glycemic control, insulin resistance, and increased risk of diabetes-related complications. Inadequate sleep may also undermine self-care behaviors, including adherence to diet and medication regimens[7,8]. Patients with diabetes mellitus (DM) often experience reduced quality of life due to its diverse clinical complications. Individuals with DM frequently struggle with both sleep and wakefulness as a result of physiological disturbances and co-existing sleep disorders. Clinical studies indicate that up to one-third of people with DM also suffer from sleep-related conditions, compared to just 8.2% in those without the disease. Additionally, another study found that more than half of individuals with type 2 DM are classified as \"poor sleepers.\"[9,10]. Despite the recognized importance of lifestyle factors in diabetes control, there is limited research from Nigeria assessing how T2DM patients adhere to dietary guidelines and the quality of their sleep. Understanding these patterns within the local context is essential to developing culturally relevant interventions aimed at improving overall diabetes management outcomes.\u003c/p\u003e \u003cp\u003eIn Enugu, Nigeria, the epidemiological shift towards non-communicable diseases necessitates a closer evaluation of lifestyle practices among T2DM patients. This study assesses adherence to dietary recommendations and sleep quality, aiming to provide evidence for more tailored public health interventions.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis was a hospital-based descriptive cross-sectional study carried out among patients diagnosed with type 2 diabetes mellitus attending selected health facilities in Enugu, Nigeria from June to July 2024.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eArea of Study\u003c/h3\u003e\n\u003cp\u003eThis study was conducted in Enugu state, south eastern geopolitical zone in Nigeria[11]. Two sites chosen for this study are Brit Care Hospital (Brit Specialist Clinic) and University of Nigeria Teaching Hospital (UNTH) at Ituku-Ozalla.\u003c/p\u003e\n\u003ch3\u003ePopulation of study\u003c/h3\u003e\n\u003cp\u003eThe study population comprises Type 2 DM patients attending health facilities in Enugu, Enugu State, Nigeria. These patients seek medical care and management for their condition at both public and private healthcare facilities within the state. This study finding will be generalized to all type 2 DM patients attending health facilities in Enugu, Enugu State. About 4.7\u0026nbsp;million Nigerians have type 2 diabetes mellitus [12].\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eInclusion criteria\u003c/strong\u003e \u003cp\u003eT2DM patients aged 18 and above, must be registered in the selected health facility, must have received care for at least 3 months, must give consent.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eExclusion criteria\u003c/strong\u003e \u003cp\u003eType 1 diabetes patients, below 18 years of age, registered or not registered in the selected health facility, received care for less than 3 months or more, and non-consenting\u003c/p\u003e \u003c/p\u003e\n\u003ch3\u003eSample and sampling technique\u003c/h3\u003e\n\u003cp\u003eA multistage sampling technique was employed to select participants for this study. In Enugu state there are 17 Local Government Areas (LGAs), and two LGA were selected based on population density and availability of healthcare facilities. Within the selected LGAs (Enugu North and Awgu), one public and one private healthcare facility was selected based on patient load. All consenting type 2 diabetes mellitus patients visiting these facilities from June 1st to July 1st 2024 were included in the study.\u003c/p\u003e \u003cp\u003eThe first stage involves dividing the population into clusters, which in this case are the Local Government Areas (LGAs) of Enugu State. Two LGAs (Enugu North and Awgu) are selected from the total set of LGAs in the state. This stage utilizes cluster sampling because the population is naturally divided into distinct clusters (LGAs), and one or more clusters are randomly selected for inclusion in the study. Within the selected LGAs, one healthcare facility was chosen conveniently in each LGA as secondary sampling units (SSUs). One public and one private healthcare facility was selected based on patient load, acceptance and approval from the hospital management.\u003c/p\u003e \u003cp\u003e Sampling of Participants within Healthcare Facilities: All consenting type 2 diabetes mellitus (T2DM) patients visiting the selected healthcare facilities during the specified period (June to July ) were included in the study. This stage did not involve sampling, as all eligible individuals within the selected facilities were included in the sample.\u003c/p\u003e \u003cp\u003eThe sample size was determined using the Cochran formula : n\u0026thinsp;=\u0026thinsp;pq (z2 )/e2\u003c/p\u003e \u003cp\u003ewhere \u003cem\u003eZ\u003c/em\u003e represents the standard normal deviate (1.96)\u003c/p\u003e \u003cp\u003e \u003cem\u003ee\u003c/em\u003e denotes the margin of error (0.05),\u003c/p\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e signifies the adherence prevalence estimated at 0.225 based on a prior investigation [13]\u003c/p\u003e \u003cp\u003eand \u003cem\u003eq\u0026thinsp;=\u0026thinsp;1-p.\u003c/em\u003e\u003c/p\u003e \u003cp\u003eThe calculated sample size amounted to 268. An additional 10% was included to account for potential incomplete responses by participants, resulting in a final calculated sample size of 294. Nonetheless, a sample size of 350 was utilized for this study.\u003c/p\u003e\n\u003ch3\u003eInstruments for Data Collection\u003c/h3\u003e\n\u003cp\u003eDemographic section collects basic data including; Age, marital status, age at disease diagnosis, disease duration, level of education and employment status, this information aids in contextualization of level of adherence to healthy lifestyles among respondents.\u003c/p\u003e \u003cp\u003ePittsburgh Sleep Quality Index (PSQI): This questionnaire was used to assess the sleep quality index among type 2 diabetes mellitus patients. [14]\u003c/p\u003e \u003cp\u003eUK Diabetes and Diet Questionnaire (UKDDQ): To assess dietary intake, a modified version of the United Kingdom Diabetes and Diet Questionnaire (UKDDQ) was employed. This tool, which can be culturally adapted to suit different populations, was originally developed to evaluate dietary behaviors in adults diagnosed with or at risk for type 2 diabetes. The UKDDQ has been shown to possess good reliability and validity. [15]\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData collection and Analysis\u003c/h2\u003e \u003cp\u003eData collection was conducted using a hard copy questionnaire. Research assistants were trained and engaged in each selected facility to administer the questionnaires to eligible participants in the selected healthcare facilities. Participants were briefed on the research aim and purpose, informed consent was obtained from the respondents before data collection. Completed questionnaires were checked for completeness and consistency. Data were entered into Microsoft Excel and analyzed using SPSS version 25.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eA total of 350 respondents participated in the study. As seen in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, 54.3% were female, The mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD age of participants was 50.4 years (SD\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8) For analysis, age was grouped into two categories: \u0026lt;40 years (n\u0026thinsp;=\u0026thinsp;80, 22.9%) and \u0026ge;\u0026thinsp;40 years (n\u0026thinsp;=\u0026thinsp;270, 77.1%). Most respondents (26%) had at least secondary education and (57.1%) had lived with diabetes for more than five years. The majority of participants (49.7%), were married and (51%) employed.\u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e shows that 24% of study participants had a good UKDDQ score of healthy diet adherence, 33.7% had moderate adherence and 42.2% had poor adherence. Overall, more Females (27.4%) showed Good adherence than males(20%).\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\u003eSociodemographic/Clinical Characteristics and Dietary Adherence\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\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal N (%) (N\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood adherence\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;84)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eModerate Adherence (n\u0026thinsp;=\u0026thinsp;118)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ePoor adherence(n\u0026thinsp;=\u0026thinsp;148)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (12.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25 (31.25%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e45 (56.25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e270 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e74 (27.41%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e93 (34.44%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e103 (38.15%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD= 50.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48 30%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e52 (27.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (36.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80(44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (26.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e20 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e34 (13%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18 (24%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48 (63%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (23%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (34.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e74 (42.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/seperated/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (23.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20(24.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (37%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e31 (38.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (27.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e28 (29.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (45.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (22.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e40 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(25.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25(41.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e51(56%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (35.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e38 (34.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e32(29.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;₦70,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (30,6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e105 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;₦70,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (37.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e63 (37.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e43 (25.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at T2DM Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (14.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e45 (32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e75 (53.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (30.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e73 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73 (34.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of T2DM Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30 (18.75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e70 (43.75%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e54 (28.42%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (30.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e78 (41.05%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily History of T2DM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64 (32%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e68 (34%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e68 (34%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20 (13.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e50 (33.33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e80 (53.33%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2DM-Related Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18 (15%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e35 (29.17%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67 (55.83%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66 (28.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e83 (36.09%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e81 (35.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows that 55.71% of study participants had a good sleep quality score, while 44.28% had poor sleep quality. Overall, more males (59.4%) had Good adherence than females(52.6%). Proportion of participants with good sleep quality was highest among self-employed participants ( 71.4%).\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\u003eSociodemographic/Clinical Characteristics and sleep quality\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\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal N (%) (N\u0026thinsp;=\u0026thinsp;350)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGood Sleep Quality\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;195) 55.71%\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePoor Sleep Quality(n\u0026thinsp;=\u0026thinsp;155) 44.28%\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge Group\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e80 (22.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30(37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e270 (77.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e145(53.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e125(46.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003emean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD= 50.4\u0026thinsp;\u0026plusmn;\u0026thinsp;6.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eGender\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (59.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (40.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (52.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (47.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEmployment Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (51%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100 (55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf Employed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e70 (20%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (71.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (28.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e100 (29%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45 (45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (55%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Status\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarried\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174 (49.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e94 (54%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (46%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorced/seperated/Widowed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81 (23.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e61 (75.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20 (24.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNever married\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95 (27.14%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e40 (42.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e55 (57.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation Level\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo formal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e90 (25.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85(94.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (5.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60(17.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(75%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (25%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e91(26%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(33%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e61 (67%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTertiary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e109 (31.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35(32.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e74 (67.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMonthly Income\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;₦70,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e180 (51.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e100(55.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80 (44.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;₦70,000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170 (48.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95 (55.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (35.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge at T2DM Diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e140 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e80 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;40 yrs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e210 (60%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e115 (54.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (45.2%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDuration of T2DM Management\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e160 (45.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e90 (56.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e70 (43.8%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;5 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e190 (54.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105 (55.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e85 (44.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFamily History of T2DM\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e200 (57.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e110 (55%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e90 (45%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e150 (42.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e85 (56.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e65 (43.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eT2DM-Related Complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e120 (34.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60 (50%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60 (50%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e230 (65.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e135 (58.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95 (41.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\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\u003eMultiple Regression showing Relationships between Adherence to Dietary Recommendations, Sociodemographic and Clinical Characteristics of Type 2 DM Patients Attending Health Facilities in Enugu, Enugu State\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e95.0% Confidence Interval\u003c/p\u003e \u003cp\u003efor B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eR\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdj.\u003c/p\u003e \u003cp\u003eR2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003eF\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4.73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e30.516\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e29.953\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e34.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.061\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.956\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.340\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.597\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.087\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.537\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployment Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.043\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.685\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.509\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarital Status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.062\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.895\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.371\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.124\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonth Income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.280\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.341\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge of T2DM diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.550\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.015\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of T2DM management\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.875\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.382\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.137\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily history of T2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.328\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.580\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2DM related complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.832\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.406\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.423\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.172\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003eNote. \u003cem\u003eR\u0026thinsp;=\u0026thinsp;Correlation coefficient; R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;Coefficient of determination; Adj. R\u003c/em\u003e\u003csup\u003e\u003cem\u003e2\u003c/em\u003e\u003c/sup\u003e\u0026thinsp;\u003cem\u003e=\u0026thinsp;Adjusted R-Squared\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"11\"\u003e\u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{\u0026beta;}\\)\u003c/span\u003e\u003c/span\u003e \u003cem\u003e= standardized beta coefficient; p-value\u0026thinsp;=\u0026thinsp;Level of significance\u003c/em\u003e Significant at \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eResults in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e showed that the joint relationship of independent variables (sociodemographic and clinical characteristics) on adherence to dietary recommendations was significant (F(11, 278)\u0026thinsp;=\u0026thinsp;4.726; R\u0026thinsp;=\u0026thinsp;0.397, R2\u0026thinsp;=\u0026thinsp;0.158, adjusted R2\u0026thinsp;=\u0026thinsp;0.124; p\u0026thinsp;=\u0026thinsp;0.000). About 15.8% of the variation in adherence to dietary recommendations was accounted for by the independent variables. Also, the age of diagnosis for T2DM and family history of T2DM were significantly related to adherence to dietary recommendations.\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\u003eMultiple Regression showing Relationships between Adherence to Quality Sleep, Sociodemographic and Clinical Characteristics of Type 2 DM Patients Attending Health Facilities in Enugu, Enugu State\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"11\"\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 \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eModel\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c6\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eStandardized Coefficients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003et\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e-value\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c11\" namest=\"c10\"\u003e \u003cp\u003e95.0% Confidence Interval for B\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003eAdj.\u003c/p\u003e \u003cp\u003e\u003cem\u003eR\u003c/em\u003e\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003eBeta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003eLower Bound\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003eUpper Bound\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"11\" rowspan=\"12\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(Constant)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.903\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.807\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e111.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e19.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e18.480\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e22.643\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHealth facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.027\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.913\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.362\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.217\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.593\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.506\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.613\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.219\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-3.219\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.815\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.196\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployment status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-1.650\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.700\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.062\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMarital status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.149\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-4.610\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-1.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.553\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.270\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e5.996\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e.647\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e1.279\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMonthly income\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.008\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.195\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.845\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.331\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge of T2DM diagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.081\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-2.394\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.011\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of T2DM managt\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e-15.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-2.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c11\"\u003e \u003cp\u003e-1.689\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFamily History of T2DM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.761\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.383\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.280\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eT2DM Related Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.082\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.935\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.312\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e.287\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cem\u003ea Dependent variable: Quality of sleep Note. R\u0026thinsp;=\u0026thinsp;Correlation coefficient; R2\u0026thinsp;=\u0026thinsp;Coefficient of determination; Adj. R2\u0026thinsp;=\u0026thinsp;Adjusted R-Squared\u003c/em\u003e \u003cspan class=\"InlineEquation\"\u003e\u003cspan class=\"mathinline\"\u003e\\(\\:\\text{\u0026beta;}\\)\u003c/span\u003e\u003c/span\u003e \u003cem\u003e= standardized beta coefficient; p-value\u0026thinsp;=\u0026thinsp;Level of significance Significant at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/p\u003e \u003cp\u003eResults in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e show that the joint relationship of independent variables (clinical and sociodemographic characteristics) on the level of sleep quality was significant (F(11, 278)\u0026thinsp;=\u0026thinsp;111.065; R\u0026thinsp;=\u0026thinsp;0.903, R2\u0026thinsp;=\u0026thinsp;0.815, adjusted R2\u0026thinsp;=\u0026thinsp;0.807; p\u0026thinsp;=\u0026thinsp;0.000). About 81.5% of the variation in the level of sleep quality was accounted for by independent variables. Also, gender, marital status, education, age of diagnosis for T2DM, and duration of T2DM management were significantly related to the level of sleep quality among T2DM patients attending health facilities in Enugu, Enugu State.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study evaluated the level of adherence to dietary recommendations and the quality of sleep among individuals with type 2 diabetes. In this study, 24% of participants demonstrated good adherence to dietary recommendations. This is comparable to the findings of the studies conducted in Hungary[16] Northern Ethiopia[17]. In contrast, the level of good adherence in this study was lower than findings from Addis Ababa, Ethiopia, where 48.6% of participants reported good dietary practices [18], from Washington, where the adherence rate was 48% [19] and Eastern Ethiopia 37.5% [20].\u003c/p\u003e \u003cp\u003eThe multiple regression analysis revealed a statistically significant joint relationship between sociodemographic and clinical characteristics and adherence to dietary recommendations among individuals with type 2 diabetes mellitus (T2DM) in Enugu State (F(11, 278)\u0026thinsp;=\u0026thinsp;4.726, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The model accounted for approximately 15.8% of the variance in dietary adherence (R\u0026thinsp;=\u0026thinsp;0.397, R\u0026sup2; = 0.158, adjusted R\u0026sup2; = 0.124), indicating a modest yet meaningful explanatory power. Among the predictors, family history of T2DM emerged as the strongest positive predictor of adherence (β\u0026thinsp;=\u0026thinsp;0.328, t\u0026thinsp;=\u0026thinsp;5.435, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that individuals with a familial background of diabetes may be more motivated or informed to follow dietary guidelines. In contrast, age at diagnosis was negatively associated with adherence (β = -0.185, t = -2.550, p\u0026thinsp;=\u0026thinsp;0.011), implying that those diagnosed at an older age might face greater challenges in modifying long-standing dietary habits. This finding is in line with the findings of the study in Ogun State [21]. Other variables such as gender, education level, and income did not show statistically significant associations. These findings highlight the need for tailored interventions that consider both clinical history and individual patient contexts when promoting dietary adherence among T2DM patients.\u003c/p\u003e \u003cp\u003e.\u003c/p\u003e \u003cp\u003eFor sleep quality, 44.2% of participants with type 2 diabetes were identified as having poor sleep quality(PSQI\u0026thinsp;\u0026gt;\u0026thinsp;5). This finding is consistent with similar study in China where a prevalence of 47.1% was reported [22] and lower than the 55.4 reported in Saudi Arabia[23]. However, the proportion observed in our study is slightly higher than those reported in Iran [24], which documented poor sleep quality in approximately 38% of individuals with type 2 diabetes.\u003c/p\u003e \u003cp\u003eFor sleep quality, our study reported a mean PSQI score of (=\u0026thinsp;2.68; SD\u0026thinsp;=\u0026thinsp;0.68),which is lesser in comparison to the values reported by the study in West Bengal. (6.70\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32) [9] and (5.56\u0026thinsp;\u0026plusmn;\u0026thinsp;3.34) reported in Northwest of Iran [23].\u003c/p\u003e \u003cp\u003eOur study participants reported experiencing a high level of sleep disturbance (=\u0026thinsp;11.46; SD\u0026thinsp;=\u0026thinsp;2.24) this finding corroborates with the findings reported by the study in West Bengal[9]. The multiple regression analysis demonstrated a statistically significant joint relationship between sociodemographic and clinical variables and sleep quality among participants. The model explained a substantial 81.5% of the variance in sleep quality (R\u0026thinsp;=\u0026thinsp;0.903, R\u0026sup2; = 0.815, adjusted R\u0026sup2; = 0.807), indicating a strong predictive power. Several variables showed significant associations with sleep quality. Notably, duration of T2DM management was the strongest negative predictor (β = -0.601, t = -15.370, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), suggesting that prolonged disease duration may be associated with declining sleep quality, possibly due to disease burden or complications. Education was positively associated with better sleep quality (β\u0026thinsp;=\u0026thinsp;0.270, t\u0026thinsp;=\u0026thinsp;5.996, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while gender (β = -0.089, t = -3.219, p\u0026thinsp;=\u0026thinsp;0.001) and marital status (β = -0.149, t = -4.610, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) showed significant negative associations, indicating potential vulnerabilities among certain demographic groups. Additionally, age at diagnosis of T2DM was inversely related to sleep quality (β = -0.081, t = -2.394, p\u0026thinsp;=\u0026thinsp;0.017), highlighting the potential impact of late diagnosis on overall wellbeing. These findings underscore the need for personalized diabetes care that considers educational background, disease duration, and demographic factors in efforts to improve sleep quality among T2DM patients.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eStrengths, Limitations, and Suggestions for Future Research\u003c/h2\u003e \u003cp\u003eThis study has several strengths worth noting. Firstly, it adopted a hospital-based cross-sectional design and utilized a relatively large sample size (n\u0026thinsp;=\u0026thinsp;300), which enhances the representativeness and generalizability of findings. The inclusion of both public and private healthcare facilities further strengthens the comprehensiveness of the data, providing insights into adherence behaviors across different healthcare settings.\u003c/p\u003e \u003cp\u003eHowever, the study is not without limitations. The cross-sectional design limits causal inferences, as the observed associations do not imply temporal or cause-effect relationships. Additionally, the data on dietary adherence and sleep quality were self-reported, which may be subject to recall bias or social desirability bias. Another important limitation lies in the model explaining only 15.8% of the variance in dietary adherence (R\u0026sup2; = 0.158), suggesting that other influential factors such as psychosocial determinants, cultural practices, or access to healthy food options may not have been captured in this study. This calls for more comprehensive modeling in future studies.\u003c/p\u003e \u003cp\u003eFuture research should consider employing longitudinal designs to track changes in lifestyle behaviors over time and establish potential causal relationships. Further studies should also explore qualitative perspectives to uncover deeper contextual and behavioral insights into dietary practices and sleep patterns among T2DM patients. Additionally, expanding the range of variables such as knowledge of diabetes management, psychological wellbeing, and community-level support systems may enhance the explanatory power of future models.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study revealed that adherence to dietary recommendations and quality sleep among patients with type 2 diabetes mellitus (T2DM) attending health facilities in Enugu State remain suboptimal. Key factors associated with poor adherence included lower educational attainment, longer duration of disease management, and the presence of comorbidities.\u003c/p\u003e \u003cp\u003eThese findings underscore the need for targeted health education and counselling strategies that emphasize the importance of nutrition and sleep hygiene in diabetes care. Integrating behaviour change communication, peer support structures, and individualized care plans into routine diabetes management could significantly enhance self-care practices and reduce the risk of complications among T2DM patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003ch2\u003eEthical approval \u0026amp; Accordance\u003c/h2\u003e \u003cp\u003e\u003cb\u003e\u003c/b\u003e Ethical approval for the study was obtained from the Health Research Ethics Committee of the University of Nigeria Teaching Hospital Ituku-Ozalla, Enugu. Reference number, (UNTH/HREC/2024/04/975). All procedures were performed in accordance with the ethical standards of the institutional research committee and with the Declaration of Helsinki[25].\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to participate:\u003c/strong\u003e \u003cp\u003e Written informed consent was obtained from each participant prior to participation. Each participant was provided with a copy of the participant information sheet and a signed consent form for their records. Confidentiality was ensured.\u003c/p\u003e \u003c/p\u003e \u003cp\u003e \u003cstrong\u003eConsent to publish:\u003c/strong\u003e \u003cp\u003eThe written consent form clearly outlined the purpose of the study and included consent-to-publish. Participation was voluntary.\u003c/p\u003e \u003c/p\u003e\u003ch2\u003eFunding Declaration\u003c/h2\u003e \u003cp\u003e \u003cb\u003e\u003c/b\u003e Authors declare that no funding was received for this work.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS.F wrote the main manuscript text and obtained Ethical approvalP.O Developed the research idea and study design and reviewed the main manuscript textC.E Reviewed the main manuscript textN.I Conducted data collection and collationD.A Conducted data collection and collation\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets generated and/or analyzed during the current study are not publicly available due to privacy and ethical restrictions but are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMotala AA, Mbanya JC, Ramaiya K, Pirie FJ, Ekoru K. 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Clinical Diabetes and Endocrinology, adherence to the dietary recommendation and barriers among type 2 DM patients: A cross-sectional study in an Ethiopian Hospital. BMC. 2018;4(21):Page 3 of 7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAyele K, Tesfa B, Abebe L, Tilahun T, Girma E. Self-care behavior among patients with diabetes in Harari, eastern Ethiopia: the health belief model perspective. PLoS One. 2012;7:e35515. doi:10.1371/journal.pone.0035515\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSwift CS, Armstrong JE, Beerman KA, Campbell RK, Pond-Smith D. Attitudes and beliefs about exercise among persons with non-insulin-dependent diabetes. Diab Educ. 1995;21:533\u0026ndash;540. doi:10.1177/014572179502100607\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMohammed AS, Adem F, Tadiwos Y, Woldekidan NA, Degu A. Level of adherence to the dietary recommendation and glycemic control among patients with type 2 diabetes mellitus in Eastern Ethiopia: a cross-sectional study. Diabetes, metabolic syndrome and obesity. 2020 Jul 23:2605-12.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkadri O, Akadri A. Lifestyle modification adherence among patients attending diabetes clinics in selected hospitals in Remo zone Ogun State, Nigeria: Lifestyle modification adherence. Babcock University Medical Journal. 2021 Jun 30;4(1):23\u0026ndash;32.Richa R, Datta N, Raj V, Kumar R, Venugopal V. Sleep Quality in Type 2 Diabetes Mellitus Patients Attending a Tertiary Care Hospital in West Bengal: A Cross-Sectional Study. Cureus. 2023 Sep 28;15(9).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu BQ, Li XM, Wang D, Yu XF. Sleep quality and its impact on glycaemic control in patients with type 2 diabetes mellitus. International Journal of Nursing Sciences. 2014 Sep 1;1(3):260-5.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDarraj A, Mahfouz MS, Alsabaani A, Sani M, Alameer A. Assessment of sleep quality and its predictors among patients with diabetes in Jazan, Saudi Arabia. Diabetes, metabolic syndrome and obesity: targets and therapy. 2018 Sep 25:523\u0026thinsp;\u0026minus;\u0026thinsp;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShamshirgaran SM, Ataei J, Malek A, Iranparvar-Alamdari M, Aminisani N. Quality of sleep and its determinants among people with type 2 diabetes mellitus in Northwest of Iran. World journal of diabetes. 2017 Jul 15;8(7):358.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGeneral Assembly of the World Medical Association. World Medical Association Declaration of Helsinki: ethical principles for medical research involving human subjects. The Journal of the American College of Dentists. 2014;81(3):14\u0026thinsp;\u0026minus;\u0026thinsp;8.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Type 2 diabetes mellitus, dietary adherence, sleep quality, self-care, Enugu, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-9243664/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9243664/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eType 2 Diabetes Mellitus (T2DM) is a global public health concern, particularly in low- and middle-income countries where adherence to self-care practices remains suboptimal. Among key components of disease management, adherence to dietary recommendations and quality of sleep play a critical role in glycaemic control and prevention of complications.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eTo assess the level of adherence to dietary recommendations and the quality of sleep among T2DM patients attending health facilities in Enugu, Nigeria.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA descriptive cross-sectional study was conducted among adult T2DM patients in Enugu using a multistage sampling technique. Data were collected through structured questionnaires including validated scales for dietary adherence and sleep quality. Descriptive and inferential statistics were used for analysis.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAmong 350 respondents, 24% of study participants had a good UKDDQ score of healthy diet adherence, 33.7% had moderate adherence and 42.2% had poor adherence. 55.71% of study participants had good sleep quality score, while 44.28% had poor sleep quality. Overall, more Females (27.4%) showed Good diet adherence than males(20%)while more males (59.4%) had Good sleep quality compared to females(52.6%)\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eThe study reveals suboptimal adherence to dietary recommendations and poor sleep quality among T2DM patients in Enugu. These findings underscore the need for targeted educational and behavioural interventions to enhance self-care practices in this population.\u003c/p\u003e","manuscriptTitle":"Adherence to Dietary Recommendations and Sleep Quality Among Type 2 Diabetes Mellitus Patients in Enugu, Nigeria: A Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-28 16:12:41","doi":"10.21203/rs.3.rs-9243664/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-05-07T04:23:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T05:06:26+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"3096597192028352425211343630390946446","date":"2026-04-25T20:28:55+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"237719629729856138085633457765104670373","date":"2026-04-24T16:18:47+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"103928914785283608877093229312001259778","date":"2026-04-23T06:24:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"171614896601044121304389881284763263864","date":"2026-04-22T16:07:48+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"96082802933948716177036952589074558874","date":"2026-04-22T14:22:45+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-21T16:13:32+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"339904124150453658719039574532483003649","date":"2026-04-20T17:24:43+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-20T15:57:31+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-15T05:54:44+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-04-15T00:55:07+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-14T14:58:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-04-14T13:51:05+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"180aaeb7-7fe0-43df-af8d-f081433769dd","owner":[],"postedDate":"April 28th, 2026","published":true,"recentEditorialEvents":[{"type":"decision","content":"Revision requested","date":"2026-05-07T04:23:37+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-04T05:06:26+00:00","index":75,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-17T12:08:16+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-28 16:12:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9243664","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9243664","identity":"rs-9243664","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}