!"#
$
%
&
! " #$ % :
& '( ) % *
+ ,- .% / 01
2
3 ) /$
) 4 56 # '%
. 8'9 4 # :
;
< = >
?@;
9 A= B:% #
< 06 ) 3
C 6 D ' & E6 .
= # : : F'/
06
$ GH;
'I G 3 %
3 A J + & K! F 016 # # " ) 2
) L C 6
D ' & E6 . 3 /% F )'H L
M NO
%
'/ (
. P # 3 Q;
3 = F) A ) )
#K ' ) ( NO T6 ( '9 ) ) UL T6 ( '/ A ( .
V #K '
UW X < = ! % Y
F ) U
#9 .
= "K- V ) #9 0 T9
?@; #/
3 '/( /$ 2#
2
< ) )
Z[; ! 4 0
, [(
Q\
)
= "K- F
+ 5/ # # T9 ) 9
@; [1 .
, 6
9 # :
?I 9 A= 2
< 06 )
] 3
?I ^ ) _ E/%
' F' . F
& 6 F T % 9
=
,6 = )SPSS ANCOVA
) / B:% t
`a /
` '/ A ( V KH; ) # E; P
.
,19 $ : Q\1
_
$ F) A 3 A'//$
3 = G F) A #"
'9 ' F'9 1 .
+ F ) X *9 $ 0
6 ' cT d2 /e 9
@;
Q\1 0 ]
?I ^ '
# :
#
%
+ F ) #$ ' = 0
6 ' cT .
@;
- 0 / '16 F'9 1 .
6 9 :
>f;
F G
*9 $ _
0 [, )
?I 3
C 6 D .
< = : d
?@;
# d C 6 D d 9 A=
d
< 06
) )*
! )
# $ " !
%&+
(
,- . : 01 / 3 /
%&3 . " 456
: /
&
/
%&3 7 .8
:
&
/ 1 /
%&3
d )g" F'/" 6 3 ,; J + & K! F 016 2 ', G GH; "6 ) ', F'J16 2# ?@; h i:G E16
j = : 3 ,;
M
% l G6 3
M j'( 3 M / % + 3 M 3 ,; J + & K! F 016 M
', F'J16
', G GH; "6 ) M
# ?@; F) A
TK;
: mm`nopnq M
`rn 6 : mm`nopnq M
`rn J 6) J "+
s_shabbidar@razi.tums.ac.ir:
'I G GH; ' ) 2 6 = $ d % + j / $ D
D
3 # 3 [
L / M D
% ) - Vh
t / N
% - W
V % '6
) (.
*
'/(
E #E 6 #h 3 2
'6 ;
6 u ! # E/
d u ! #K -
' 9 h ^" # 3 ; v;) + 2 9
9 )
_ , l Q! 2 6 w) ! . %= 6 ) 2
# Kh 9
^1_ ) 9
h F ) D .(
01 + ,- .% / & '( #h ; P 2
06 P 3 ) /h
2 )'H , )
x
) ' # ) -
= '9 -) # : u '
) W2 (.
01 + ' Kh *G6 # ) V # ?@; < = )
L .(
1
C 6 3
D
< = 2
B HP 2
@; .- )
3)' /h ,6
y 9 4 3 #6 A A
) U2W (.
A'6 F /h 2
; ) ( /h # E/
f )
u !
3= F 9
" 6 ) g
z\ #h '9 >
= A'6 F #/ \ ' F' <
) N .(
{ 3 2 % $
#/ 9 9 1h #h 9
6 % E 8 P # % ;
,
V %) ) 2 6 h )
3 '//h 2
#h % 'G 1 .; #
< = 8 P I 9 1h )
t (.
?I ^ ] ! ) < = *G6 9 # #- ;
6 F .% / @; ) B HP
3 % A'
#5 V ( *9 h #h
) u !
,6
>f;
[|
# % F 9 6 "6 ) 6 ) Q ( 9
8'9 4 # : 2'
;
>f;
^ ] < =
9 A= 3 .% / ?I 2
< 06 )
3 JK !
& E6 ' .
F'/ = # : 6
0 2 ) UL T6
# - B T ' , F 06 # F'//h # # " )
3 A J + & K! F 016 2
' & E6 .
-
L M NO
# % Q; <) #h '6
F %
h ,-
'6' l \ 6 # : .
O T6
% K! #
3 [6 F
9 ) # E; ,6 ) '6' 8? # :
F V KH;
9 ) L T6
# [
C 6 D
A P
. NO F) A T6 3 =
)
#K ' ( ) UL T6
F) A '9 '/ A ( .
[! l \ 6
:
M
% L
M NO
%
D M
' z \1;
L 0 %
M 6 3 '/(
mg/dL
WO
W M
# : h # V ; , 6 )
#h
#h '/ J + Z
) # 6 ) ?I ^ ] } @; & K "
2 6
'6' 8? # : .
2# : ' ! X ' ' F
#K )
< = (
) i - 0 + ' F
' )=
.
# : 3 Vh U
F
.
V = # 6 H
W
! %
# T9 < =
' # F
2
2 % V 2 #/
!
~
#K 9 # • ^ 2
2# 6 > u ! 2# ) u !
) [( *G6
?I B HP # 6 2
€ X
6 ) ?I # ,; ) ' W
! % 9 < = D
# T9
V • X @; [1 + 5/ # &) F J1 2 / = ,|H
#
?I ^ ] @;
) )
. : 2F' F < = .
! X
% V ) 2‚/-
# 3 '
. h 9 A=
#K %) # 3 A'//h L
#/ A
# : %
Kristal
) ƒ (
#- ; ‚„% ) ' F' E/%
' A € P 4 # : # .
06 , #/ F T % ^ ] ) %
O
#/ A
€ P F' 2 ' F' E/%
)
… [6) h
= UD / O (.
F '6
F' A
i- < 06 #/
9 #
F'!) < 06 2 A
< 06 ) l _ + ?I 9
F V| [ /I 9 ?I 8 Q # ["6 9
[% ) ,
#/ F T % W
#/ A J
)
"
; ^G
"
^T \ ( . , ] # ["6 % < 06 ; 6
^h l _ ) I 8 Q 9 ? + [ 3 16 .
?I 0 # /1% + F T % # ?@; 0 )
O (
' F' E/%
.
# /1% + W
#/ A
#/ Y W
"(
) A 9 ; #1 9 (
F' E/% ?I 0 • [;
' )
… [6) h T =
= t / O (.
‡/+
F '6 ?I 0
' A
d _ 9 +
#
/ _ 3 /!
) LO / O
= ( / 16 - 2 )
U / O
= (
@; 2
( A 8 Q )
UN / O
= (
… % 9 ?I 9 + 2 F'
) N / O
= ( / 0 - ) )
U / O
= .(
; 6
+
%
?I 0 # /1 2
^h ?I ! 3 16 _
.
h #6 ) ] 6 ) _ F T % 3 A'//h
+
% ˆ J; # /1
?I 8 Q F '6
A ' .
4 # : € X 2
€ X D ) V G #K ' '9
(
) 0 + ) 3 = ' 23 = V[(
( h .
#
5/
F '6 A
8 2‡ 6
) 4) )
V[(
V G 3 = 3 = V[( ) 3 = '
V G
0 + ( 3 = F T %
ANCOVA
' F' E/%
.
t G
#/ ) 2
#" G # +
Post Hoc 9
,9) A '9
#K ' ) ' = % #
.
?I ^ ] 0 9 @ )
V G JK !
JK ! V[(
( 3 =
ANCOVA
3 % A • X
; 5/ # Y "- 9) A z\1 ,
,
' F T % .
! )'-
$ Q\1
,9) A F'//$
'9 #K ' ) : C)
# 3 16 '9
. G
#"
9
$ Q\1 8 #$ 3 16 F) A ) 3 A'//$
,9) A '9
9 #K ' ) y
+ Q\1 ‰
#
'6 -) .
# : #$ ,6= = "K- $ 3
#$ 3 16 2'6'6 % 3 + # t
/ Ut
% V( '
W ; t '/ $ #"K- .
#" G 9) A 9
8 ?I ^ ] - _ 9 A=
Q\1
) F) A # :
3 16 )
OO / O
P<
2
Nt / DN
= ] DƒO 2 D [ .(F
A
#K ' F) F) A # ["6 ; 6
'9 .
'6 ( z\1 ^9 0 + F #% ' 8
) OO / O
P<
2 W / Ut
= ] Dtƒ 2 D [ .(F
$ < 06 #" G 3 A'//$
) ?I ^ ]
) #K ' F) A Q\1 8 #$ 3 16 % '9 '6 -) 0 + F #% ) #K ' F #% ' .
K ! Q\1 8 #K ' >
3 16 ?I ^ ] B HP ! )
)'- D (.
$ ?I ^ ] K ! )=
#$ 3 16 3 A'//$
^$ ^ ] z\1 X # #K ' F) A
#" G _
F) A 9
'
#K
‚+
3 = )
OO / O
P<
2
WU / tL
= ] DƒO 2 D [ (F
0 + #K ) )
OO / O
P<
2
WD / UU
= ] Dtƒ 2 D [ (F
# '6 .
!
"
#
$% &' ( ' ) * + , ' - . /01 2
( ( 3 +% 4
3 5 . /01
UL ) Wt
%
( (%LD )NO 3 ' ;
Lt ) tƒ
%
( (%ƒ )UW 3 6 ' ;
D /
±t D /
WO W /D±N/t ( % ) %
ƒ /
±U /
t N/U±L/t ( % ) '
3 )
L
%
( (%U)W ?I ^ ]
Wƒ ) NL
%
( (%UN )WN )
t ) D
%
( (% W ) O ) F 9 # ?I ^ ] L
) t
%
( (% )ƒ "6
W 6=
0 ]
^
?I
Q\1 8
) #K ' F) A '9
- - 0
/ HP ] B
^
?I + ) 3 = ‚+ #K 0
3 16 .
_ ]
?I ^ F T % #$
#[% H FFQ
2'
Q\1 8 06
,9) A ) #K '
'9
‚+ #K 3 =
.
#K
‚+
#K ' 23 =
*9 $ _
$ 'P j % #$
_ V$
2 % g
>
) OO / O
P<
2 Lƒ / U
= ] Dtƒ 2 D [ (.F
3 =
Post Hoc
3 16
#$
# #K ' F) A
X / _
$ F) A # ["6 '9
+ #K 0
F $ '6 ) OOO /
P<O 2 )
tU / DN ]=
DƒO 2 D [ .(F
) 'P (
$ _
#K ' F) A
ƒ / L
% + #K
# 3 = * D
/ D
%
#K
‚+
3 = ) OO /
P<O ( ) /
% + #K
0
) O / O
P<
(
*9 $ .
V G
@; 'P
$
_ F) A
'9
; ; # . U
%
# U / L
% )
W / L
% V[( #K
< = ‚„% ) < = #K #
+ 0 *9 $ .
_ C [
$ 'P P # #$
_ F) A z\1 X # 2 % F' F 3 16 C [
#K ' + #K
*
‚+ #K # 3 = ' ^$ 3 =
) OO /
P<O 2 UL /
= ] DƒO 2 D
F[ .(
3 =
Post Hoc
#$ 3 16 # #K ' F) A
X _ z\1
$ C [ F) A # ["6
'9
F $ '6
#$
+ #K 8 0
#
) OO /
P<O 2 Wt / DW
= ] DƒO 2 D
F[ .(
] 6 V$
+ #K ' F) A #6 ) F) A ;
'9 + #K 3 = ‚+ #K # 3 = *
) OO / O
P<
2 NL / WN
= ] Dtƒ 2 D [ .(F
"
#$ 3 16 4 # : 9 A= Q\1 @;
2
3 = V[( # ["6 #K ' F) A K ! ) < 06
#
% F' = % )
N (.
: VP ‡ 6 0
6
3 16 '9
< = F ) ‰ ‚+ 9 A= #$
] ! )
?I ^
* '
) 2N2U2W .(
# : ^, " # 2 4
1 *9 $
F) A # ["6 #K ' F) A _ '9
#$
' cT 0 + F #% X .
! 6
# 7 8*9 ( : - ( ( % 4 ;' (
3 +% 4
<
( ;'
: - % 4 ;' < % 4 8*9
t 3 +% 4 t 3 +% 4 t 3 +% 4 =
O §
/
W U/t N/W D/tW** U/ƒ N/D MO/N U/U U/W # ?@; 9 A=
UL
/ D/L D/N /Lt D/L D/U /D D/L D/U % ) ?I < 06 Ut§
/
L L/D D/L t/Wt*** D/D D/U O/Nt D/D D/D (V$ ) ?I ^ ] 0 Nt§
/
L D D/W N/ W*** D D/W O/OD /t /ƒ / 16 -
tL§
/
W D/W D/U L/WL D/W D/U O/WW D/ D/ / _ 3 /! # _ 9 + WW***
/ D/N /D N/ D*** D/N /D O/ N D/N D/N F $… % ?I 9 + WL§
/
W D/D D/t U/D*** D/D D/t /Lt D/D D/ ( A 8 Q ' ! N
/ /ƒ /t /U /ƒ /t /Ot /ƒ /t / 0 -
L***
/
M W O DDL D/t ** WLt D M / L Wƒt Ut,L ( $ K $ )#6 ) ] 6
LO*
/ D
M L/W / MW/O *** L/U D/ O/OW U L/ƒ ('P )V$ _ $ OO**
/
M D O/t MW/ U*** D/ O/ O/O D/D D/W ('P )C [ _ $ OOO
/ O
P<
OO § / O
P<
O ***
/ O
P<
OL **
/ O
P<
L
3 = ‚+ #K + # ["6
3 = * F) A
2#K ' _
# F '6 t /
% V G U
/ O
% F) A
'9 2 +
; ' = .
"
f
#
#K ' F) A #$ % 3= 06
= ‚+
3
! % 8 '9 % # /
_ ) "
)
$ O
%
$ _ 6
) /9 j % 9
^ % # - DOOO
( ) D .(
G
#"
9 3) 9) A F) A 2'9
$'6 *9 $
_ + #K + #K # 3 = *
0 3 16
d V *9 $
_ F) A
'9
% 3 = >
d 2
; # /1% + #%
8 Q WL (
#G ) '6 $ V $ F * X
$ #$ -)
F) A 3 A'//$
'9 9 A=
["6 _
ŽV$ )
?I 3 $ +
/1% + F )= % # # /
' ) )
?I ! 3 1
>f;
' # ?A
.
^, # 2 0
9 A= * _
)
% Ž?@
F) A #$
'9 ' cT .
< 06
]
?I ^
@;
+ 6 ' . 4 ; B
"
f ] ) ?I < 06 #$ % 3= #
^
?I
@;
"
% \%
d
$ ) 3 A'//$
3
# - /%
] • :; # ( F 6 i - )
6 '/ "
.
@;
0 z\1
]
?I ^ - #
‰
) - 0 / ( + #K #$ ' F'9 1 # : ' 0
cT A ' .
@; &'!
-
0 /
# '6 ;
4 ; #$ ' K!
- H
0 /
#"K-
^9
) ' #~
L / Dƒ
% '/ '6 x #"K- .
) 4 # :
: 0
2 [( ) < = *G6
% 3
\ 3 16 9
/ '
) 2 (.
= >f; 23 GGH F' G! # 2<
6
#$
K ! #[/-
# A
2 1 9 A= )
)
K !
/ *
+ ' '/$
) W .(
# : 6 0
" *G6 g
9 A= < = >
2
< 06
K ! )
\ 3 z\1
< A ) A
' ) L (.
6 X < = >
9 A= ' 3
) + 0
& E6 *9)•+ 3 6= "
23 = F' 9 A= *
)
+ 3 ) j "H *9 $
% # ) U (.
Uddin
3 J 9 ) 6
# # : 6
% ‡
'/
9 A= #$
F 6 9
3 $ $ #$
'6 2 '
HP < = ] B
?I ^
* '
) N (.
# $
%& '
# : F' = % # ! X 4
$ 3=
@; #$ % 0
]
?I ^ '6 ;
& A "\6 #
: *9 $ %
' . 56 #
# 6 '%
9
0 6 5/ # ) •/9 # #- ; #K ' *
, /%
,- # - -
;
>f
?A ) 1
g
; >
&
' .
( :
n M
… •6]=
.
% + ' ]
‰ -
O
', $ %
2 6 F 16 $ 3 % , .
)
! ', F 0/$
)
+ 01 . + & K! F 016 F 16 $
. 3 = F tO .
D M 6 .
?@; < =
# . 9 J + & K! F 016 .
) ‘ _ . 9 :
d %
Nƒ .
M '
€ ’ 2 K"
5 / 2j 8
2 '
&
.
>f;
HP < = ] B
?I ^ 9 A=
K ! ) < 06 C 6
D . [X w . . t d W
) W (:
DON M D D .
W M (
~
^ G
“ . 9 A=
2 K ! ) < 06 3
# -
6 $ # F'//$
% / [;
#:
. E/+
?@; F 0/$
# 3 .
3 ,;
. , Nt .
U
5- American Diabetes Association: economic consequence of diabetes mellitus in the US in 1997. Diabetes Care. 1997;
21: 296-98.
6- Amini M. Prevalence and risk factor of diabetes mellitus in the Isfahan city population in1993. Diabetes Res Clin Practice. 1997; 38: 135-40.
7- Brown SA, Gracia AA, Kouzekanani K, Hanis CL. Culturally component diabetes self-management education for Mexican American: The Starr County border health initiative. Diabetes Care. 2002; 25: 259-68.
8- Fritscge A, Stumvoll M, Goebbe LS. Reinauer KM. Long Term effect of a structured in patient diabetes teaching and treatment program in type 2 diabetic patients: influence of mode of follow- up diabetes. Res Clin Pract. 1999; 46:135- 41.
9- Kristal AR, Brown DJ, Curry S, Shattuck AL, Henry HJ. Nutrition knowledge, attitudes, and perceived norms as correlates of selecting low fat diets. Health Educ Res. 1990; 5: 467-77.
10- Bruni B, Barbero PO, Carlini M. Principles Means and evaluation of a program for diabetes education. Press Med.
2001; 24: 43-70.
11- Grial GA. Magana MA, Arriazu ES. Diet based on rations, practical teaching for type II diabetes. Rev Enferm.
1998; 21: 11-40.
12- Kathleen ML, Scot SS. Kraus's food nutrition and diet therapy. 3rded. St.Louis: Mosby; 2000.
13- Kristal AR, Curry S, Shattuck AL, Henry HJ. Patterns of dietary behavior associated with selected diets low in fat:
reliability and validity of a behavioral approach to dietary assessment. J Am Diet Assoc. 1990; 90:214-20.
14- Miller C, Brown DJ. Knowledge and use of the food label among senior women in the management of type 2 diabetes mellitus. Department of Nutrition and Food Service Systems. University of North Carolina, USA. J Nutr Health Aging. 1998; 3: 152-57.
15- Uddin I, Iftikhar R, Ahmed TJ. Knowledge, attitude and Practice of diabetic patients before and after education.
Diabetes Int.2001; 11: 20-28.
16- Raudenbush S, Bryk A, Cheong YF, Congdon R. Hierarchical linear and non-linear modeling. Lincolnwood. IL, Scientific Software International. 2000.
17- Luvill M, Chambrier C. Nutritional needs and food supplements evaluation of nutritional status. J Annu Diabetol Hotel Dieu. 2003; 48: 91-97.
N
Title: Effects of nutrition education on knowledge and attitudes of type 2 diabetic patients Authors: S. Shabbidar3, B. Fathi4
Abstract
Background and Aim: Diabetes Melitus is one of the most common metabolic complications that is rapidly growing. Thus, a proper preventive measure is necessary to control the disease. The aim of this study was to determine the effects of nutrition education on knowledge and attitudes of type 2 diabetic patients.
Materials and Methods: This prospective study was conducted in Rasht Razi Hospital on 135 randomly selected individuals with type 2 diabetes, aged between 35-70 years; diagnosed with type 2 diabetes after 35 years of age. Intervention consisted of 64 contact hours during several months. The intervention involved 3 months of weekly instructional sessions on nutrition, self monitoring of blood glucose, exercise and other self-care topics, in addition to 3 months of biweekly support sessions to promote behavior changes. At the end, dietary behaviors, knowledge, attitudes and fat intake of the cases were analyzed. To do so, the differences between the cases' behaviors before and after intervention were evaluated by means of statistical tests of ANOVA and student-t tests at the significant level of PI0.05.
Results: Significant reduction was seen in fat intake among the cases compared with those in the control group. This reduction was maintained during 3-months of follow up assessment. Likewise, significant changes in dietary patterns, which were also maintained after the study, were reported. These changes were not observed in dietary pattern replacement.
Conclusions: This model of health promotion seems to have the potential for decreasing fat and improving dietary patterns in type 2 diabetic patients.
Key Words: Nutrition education; Diabetes; Knowledge; Attitudes
3PhD. Student. Tehran University of Medical Sciences. Tehran, Iran s_shabbidar@razi.tums.ac.ir
4Nurse
