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J Korean Diabetes Assoc. 2000 Oct;24(5):560-573. Korean. Original Article.
Chung SO , Song OK , Ko JM , Wi JH , Lee TH , Yum JH , Cho DK , Son JH , Nam HW , Yoo HJ , Lee YN , Kim SG , Moon HK , Kim ES .
Diabetes Clinic of National Medical Center, Seoul, Korea.
Department of Internal Medicine, Hallym University College of Medicine, Seoul, Korea.
Department of Institutional Food Service, Kyung Hee University, Seoul, Korea.
Department of Food and Nutrition Science, Dan Kook University, Seoul, Korea.

BACKGROUND: Diet control plays an important role in diabetic management, but it is often hard for diabetic patients to follow the dietary control program. Poor dietary compliance leads to metabolic derangements in patients with diabetes and it may derive mainly from defects in dietary education program rather than from patients themselves. Therefore, we performed a randomized prospective study to compare the effects of three different teaching methods for diet control. METHODS: Forty eight diabetic patients with poor glycemic control (mean HbA1c 11.4+/-1.5%) were enrolled during hospitalization and allocated at random to three different teaching methods i.e. Conventional diet sheet instruction (Group 1), Food recording on every meal (Group 2), and Meal time demonstration (Group 3). For evaluation, knowledge about DM diet and barriers to diet control were assessed by a questionnaire. Consistency in carbohydrate intake (Coefficient of variation) and serial HbA1C measurements were used for the estimation of dietary compliance and glycemic control respectively. RESULTS: During five months' follow-up period, there was no remarkable improvement in knowledge about diabetic diet control, dietary compliance and glycemic control in Group 1 patients. But both dietary compliance and glycemic control improved in Group 2 and 3 patients during follow-up period. In Group 2 CV (Coefficient of Variation ) fell from 36.4+/-15.2% to 27.7+/-17.3% and in Group 3 from 32.1+/-9.6% to 23.2+/-10.5% (p<0.05). In Group 2 HbA1c fell from 12+/-2.2% to 8.3 +/-2.0% and in Group 3 from 11.5+/-2.0% to 7.5+/-1.9% (p<0.01). The change of HbA1c level showed an appreciable correlation with dietary compliance (r= 0.75). Among the perceived barriers to dietary practice in patients of Group 2 and Group 3, extrinsic factors related to knowledge lowered during the intervention (p<0.05). Even though Group 3 patients had good dietary compliance, they still felt that intrinsic factors related to motive and attitude were the major barriers at the end of the study (p<0.05). CONCLUSION: We found that meal time demonstration teaching method may improve dietary compliance and glycemic control compared with the conven tional diet sheet instruction method.

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