This concrete information on the role of healthy dietary

section describes various studies on T2D in order to provide insight for
conducting the study at hand. Diverse literatures relevant to the study have
been reviewed so as to gather related information with significance to the
study. It therefore provides concrete information on the role of healthy
dietary practices, relationship between diet and T2D, dietary recommendations
in diabetes conditions, enablers for compliance to recommended feeding
behaviors in diabetes as well as barriers to comply with the recommended
feeding regime in the context of T2D. The section further describes the theoretical framework which
guides the study.

2.0 The role of healthy dietary

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living with type II diabetes should consider making access to healthy food a
priority.  Foods choices should consider
food sources that are lower in calorie and which have no or do not require
additional sugar while also limit as much as possible the intake of saturated
fats. They should increase their intake of fruits and vegetables as they are
good sources of dietary fibres. 
Compliance to a well balanced diet adjusted to meet the needs of a
diabetic patients  contribute in
maintaining an ideal body weight which further 
reduce the risk of developing other 
complications that would arise  as
a result of poorly managed diabetes. Restricting dietary practices especially
in this population group is therefore one way to the reduction of symptoms or
to the reversal of hyperglycaemia typical of type II diabetes1.

2.1 Relationships between diet and
type II diabetes

the past years, type II diabetes was highly observed among rich people who also
were reported to have a significant excessive consumption of oil, flour and
sugar.  In the contrary, mortality rates
attributed to diabetes were less documented in populations experiencing food
shortage and famine for considerable duration7. Today, rapid
increase in urbanization has led to a number of lifestyle changes which has
also influenced feeding patterns among various population groups. Distances
covered from home and workplace coupled with heavy traffic roads makes it
difficult to access  the food prepared at
home all the time, which in this case would have been carefully selected and
prepared to meet the individual’s requirement. The mushrooming of various fast
food places has replaced to a large extent the previously common family plate
sharing. It’s also regrettable that most of considerably cheap foods in such
places are high in fats and sugars not recommended for patients with T2D.  While the disproportionate quantity and quality
of food consumed tend to worsen the wellbeing of T2D patients, the intake of
red meat, sweets and fried foods contribute to a large extent the resistance of
insulin leading to many other complications among T2D patients. However,
consumption of high fibre diet from vegetables and fruits has shown the delay in
development stages of T2D8.

intake of soft drinks has also been associated with obesity which is a
predisposing factor to diabetes. Some of the ingredients used in the
manufacturing process of such products contain a considerable large amount of
sugars which on consumption tend to raise blood glucose at levels which cannot
be well tolerated by the body systems9.  Glycated chemicals used in the production of
soft drinks tend to impair the normal functioning of insulin leading to
abnormal high levels of blood glucose, a major sign of diabetes disease.


2.3 Dietary practices and their
implications towards type II diabetes

have revealed that healthy dietary pattern acts as a primary treatment to type
II diabetes. Following a health feeding regime contribute significantly to the
maintenance of blood glucose levels within normal range while also minimizing
the complications of type II diabetes. It is therefore important that the primary
focus for a T2D patient diet be able to meet the patient’s recommended daily
allowance by providing all essential nutrients, energy sources, maintaining an
ideal body weight, maintaining acceptable ranges of blood lipids as well as
regulating the blood glucose levels within a normal range2.

an ideal body weight provides both preventive and curative majors to type II
diabetes. A consistent intake of a well diversified diet comprising of vegetables
and fruits has shown to be one way an individual can maintain an ideal weight2.
It is therefore important that patients with diabetes consider reducing
excessive weight and aim at keeping their ideal weight sustainable. Following
feeding instructions and carefully selecting when and what they eat also help
them to stay much healthier by keeping blood glucose levels within normal range
for longer periods.


2.4 Factors identified to enhance
healthy feeding

from relatives and friends plays an important role in achieving a nutritional
stable diet. The emotional influence gained from interactions from family and
friends, improves access to healthy feeding patterns and even adherence to
other medical recommendations7. The general understanding of special
requirement of a family member under special feeding needs bridges the gap that
would be created if the patient would miss such support.7. Further, education,
social support and accessibility of community-based recreational and social
gatherings are the key promoters of a good health10.


2.5 Barriers to healthy feeding

2.5.1 Strict dietary plans

strict dietary plans requires a lot of modifications and adjustment which may
also take time to be accommodated by an individual. Patients with diabetes find
it challenging to follow special feeding patterns as a result of perceived
changes in food palatability resulting from cooking methods (boiling against
frying) and ingredients which are added on not added to the food. Perceived low
self efficacy among patients tend to subject them into reflections that feeding
restrictions are less important and hence may tend to ignore them especially in
situations where there is no health practitioner to witness. As such, following
diet high in sodium or sugar instead of sweeteners is a common practice among diabetic

food choices during social gatherings may occasionally dictate what patients
eat. In such circumstances T2D patients may suffer a social distance resulting
from either the fear of being tempted to eat foods they are forbidden to or
what may be perceived among rest of members. Also in trying to cope with
anxiety and stress which is common among this population group, over eating
becomes a habitual practice which also creates a threat towards achieving a
desired feeding pattern recommended to keep blood sugar levels as normal as


2.5.2 Changes in the lifestyle

that one has been diagnosed with a lifetime condition signals a number of
lifetime adjustments in order for a patient to accommodate such changes.
However, a loss in control may lead to crisis, requiring great moral strength
to hold the personality together. That freedom they had been used to in the
previous including feeding patterns have to be limited in order to maintain a
health state possible. Keeping an eye for each serving before consumption as
well as taking precautions not to fall into an abnormal blood glucose levels
leads to feelings of frustrations 6. Coping with new feeding pattern
may be perceived as a punishment among patients. Uncertainties of what will
happen in the future and how family members feel about them brings more tension
and a sense of frustration. Among married couples feelings of frustration may
rise as result of sexual dysfunction leading to sexual disatsifaction12.


2.6 Theoretical framework

study will use the Health Belief Model (HBM) which was developed for explaining
health related behavior and possible reasons for non-compliance14.
The theory stresses that health practice is an outcome of personal beliefs and
perceptions about a health event and the mechanisms available to suppress the
occurrence. The theory builds on four main constructs essentially used to
explain health behavior either at an individual or a combination of individual
and surrounding environment. The framework applies on perceived seriousness,
perceived susceptibility, perceived benefits and perceived barriers for health
action with recommended action. Cues to action, motivating factors and self
efficacy have also been incorporated to the theory to effect on other
influences towards a health behavior. Modifying variables; culture, level of
education, past experience, skill and motivation were included to complement
the first four theoretical constructs which basically address individual