# Impact of Dietary Habits on Glycemic Control in Type 2 Diabetic Patients Attending a Tertiary Care Hospital

## TL;DR

This study shows that poor dietary habits like high sugar intake and low fiber are linked to worse blood sugar control in Pakistani type 2 diabetes patients.

## Contribution

The study provides culturally specific evidence on dietary factors affecting glycemic control in Pakistani T2DM patients.

## Key findings

- High sugar intake was associated with higher HbA1c levels in T2DM patients.
- Inadequate fiber intake and fewer daily meals were linked to poor glycemic control.
- Multivariate analysis confirmed sugar, fiber, and meal frequency as independent predictors of poor glycemic control.

## Abstract

Introduction: Poor glycemic control remains a major challenge in managing type 2 diabetes mellitus (T2DM) in Pakistan, increasing the risk of complications. Dietary habits are a key modifiable factor influencing glycemic outcomes, yet evidence specific to the Pakistani population remains limited.

Objective: To evaluate the association between dietary habits and glycemic control among patients with T2DM attending a tertiary care hospital in Khyber Pakhtunkhwa, Pakistan, and to provide culturally and economically relevant insights to inform dietary recommendations.

Methodology: This cross-sectional study was conducted at the Department of Endocrinology, Khyber Teaching Hospital, Peshawar, over 12 months. A total of 177 adults with T2DM were recruited using consecutive non-probability sampling. Dietary patterns were assessed using a culturally adapted, structured Food Frequency Questionnaire, and glycemic control was determined by glycated hemoglobin (HbA1c), with <7% considered good control. Associations between dietary variables and glycemic control were analyzed using Chi-square tests, t-tests/ANOVA, and multivariate logistic regression adjusting for potential confounders.

Results: Among the 177 participants (mean age 54 ± 10.6 years; 55% female), 118 (66.7%) had poor glycemic control. High sugar intake (more than two servings/day) was significantly associated with higher mean HbA1c (8.6 ± 1.7%) compared to low sugar intake (less than one serving/day; 7.5 ± 1.1%, p = 0.011). Inadequate fiber intake (less than five servings/day) was linked to higher HbA1c (8.3 ± 1.5%) than adequate fiber intake (7.4 ± 1.2%, p = 0.004). Participants consuming two or fewer meals/day had the highest HbA1c (8.7 ± 1.5%), compared to those eating three meals/day (8.0 ± 1.4%) or more than three meals/day (7.8 ± 1.3%, p = 0.027). Multivariate analysis confirmed high sugar intake (adjusted odds ratio (AOR) = 2.67; 95% CI: 1.39-5.12), inadequate fiber intake (AOR = 2.45; 95% CI: 1.19-5.02), and low meal frequency (AOR = 2.21; 95% CI: 1.02-4.79) as independent predictors of poor glycemic control, after adjusting for age, gender, BMI, diabetes duration, and treatment regimen.

Conclusion: High sugar consumption, inadequate fiber intake, and infrequent meals were significantly associated with higher HbA1c and poor glycemic control in this cohort of Pakistani T2DM patients. These findings underscore the importance of culturally sensitive dietary counseling and targeted interventions to improve glycemic outcomes in this population.