1. BACKGROUND

Type 2 diabetes mellitus is an escalating public health 
problem in India that is associated with genetic susceptibility, 
dietary shift, and rapid lifestyle changes. Historically diabetes 
was considered to be a disease of the urban elite. Quantitative 
studies had conrmed rising prevalence rates among 
marginalized populations in rural India.(Matthew Little et al. 
2016).Dietary habits and sedentary lifestyle were the major 
factors for rapidly rising incidence of  type 2 Diabetes Mellitus 
among developing countries (Waqas Sami et al. 2017).The 
presence of the Public Distribution System that subsidized 
rice, sugar, and cooking oil had inuenced food intake in 
recent years. Commercialization of agriculture and improved 
access to packed foods reduced the local availability of 
healthy traditional staples that lead to increased consumption 
of high-fat and high-sugar foods (Matthew Little et al. 2016). 
Diabetes is a chronic disease which requires a multipronged 
approach for its management, wherein the individuals has an 
important role to play ( Raithatha SJ et al. 2014). They are 
required to follow certain self-care practices to achieve an 
optimal glycemic control and prevent complications. These 
practices include regular physical activity, appropriate 
dietary practices, daily foot care practice, compliance with 
treatment regimen and tackling complications such as 
hypoglycemic episodes (American Diabetes Asssociation. 
Standards of medical care in diabetes 2013). Studies have 
concluded that decreased physical activity was observed 
among the South Asians when compared to other ethnic 
groups (Hayes L et al. 2002, Khunti K et al . 2007). Several 
studies have focused on the risk factors and lifestyle 
modications on the individuals residing in urban area. Only  
few studies have focused about the dietary practices, food 
perceptions, and physical activity on the rural population 
especially among the southern part of Tamil Nadu. Thus it is 
essential to have awareness about self care practices among 
the diabetic individuals residing in rural area to improve the 
quality of life and prevent complications. Based on this 
background, the objective was designed to assess the 

practices of  diet and  physical exercise among Type 2 
diabetic patients residing  in selected rural area.

2. OBJECTIVE 
To assess the self care practices in terms of diet and physical 
activity among the subjects with type 2 diabetes residing in 
selected rural area

3. MATERIALS AND METHODS
A cross-sectional community-based study was conducted for a 
period of 3 months. The study was conducted in a village 
named Methigudi that is situated in Cuddalore district at 
Chidambaram taluk . Methigudi village is situated 2 km away 
from Chidambaram town and has the total population 
coverage around 2,700 and the particular village was selected 
due to limited access to health services. Around 90% of the 
subjects with type 2 diabetes mellitus receive their treatment 
either from Chidambaram govt hospital or from PHC. 
Regardless of ethnicity, a total of 90 participants with diabetes 
were selected by using Purposive sampling. The subjects with 
type 2 diabetes were tracked from the Non Communicable 
Disease register maintained by the village health nurse and 
the subjects attending NCD clinic at Chidambaram govt 
hospital. Subjects of both gender with poor glycemic control 
and taking oral hypoglycaemic agents were identied and 
included in the study. Individuals with signicant 
complications related to diabetes and systemic illness were 
excluded from the study. Before data collection, each 
participant was given a full explanation of the research 
project and its purpose and was then given to sign an 
informed consent form. Pilot study was carried out to nd out 
the reliability and validity of the questionnaire. The structured 
questionnaire was pretested on a sample of 30 subjects to nd 
out difculties in understanding the meaning of the questions 
and to estimate the amount of time to answer all the questions. 
A face-to-face interview was carried out for approximately 
10–15 min and was conducted at place comfortable for the 
participant. When it was necessary, appropriate probing 

SELF CARE PRACTICES ON DIET AND PHYSICAL ACTIVITY AMONG THE 
TYPE 2 DIABETIC SUBJECTS RESIDING IN RURAL AREA AT 

CHIDAMBARAM TALUK IN CUDDALORE DISTRICT

Original Research Paper

Mrs. R. Praveena 
M.Sc (N) Nursing Ph.D (N),Tutor in Community Health Nursing, Rani 
Meyyammai College of Nursing, Annamalai University,Chidambaram 

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Nursing

Background: Increased prevalence of diabetes in India is due genetic susceptibility, dietary shift and 
rapid lifestyle changes. Self care practices in terms of diet, physical activity and medication adherence 

reduce the risk of complications related to diabetes. 
Objective: The objective of this study is to assess the self care practice on diet and physical activity among Type 2 diabetic 
patients residing in  selected rural area at Chidambaram taluk in Cuddalore District. 
Materials and Methods: The cross-sectional study was conducted using structured interview guide among 90 subjects with 
Type 2 diabetes residing at selected rural area. Baseline characteristics of the study participants were elucidated and their 
practice regarding the diet and physical activity were assessed. In this study International physical activity questionnaire -short 
form (Version 2.0.april 2004) was used to assess the physical activity of the subjects with diabetes. 
Results: The mean age of the study population was found between 55-65years. The study results reveal that 55(61.11%) of 
subjects had inadequate dietary practices. Whereas 35(38.89%) respondents with diabetes had moderately adequate practice 
and none of them had adequate dietary practices. Only about 5(11.36 %) among males and 2(4.34%) among females are 
physically active and exercise apart from their normal work duties. 
Conclusion: During the past few years, there have been signicant advances in medications, insulin delivery and glucose 
monitoring technologies. Despite the advances, individuals with diabetes in rural areas have limited access health-care 
resources and education on importance of physical activity and adherence to dietary regimen. This highlight the need to 
address structural inequities and empower individuals to pursue health and well-being on their own.

ABSTRACT

KEYWORDS : Self care practice, Physical Activity , Dietary practice

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Dr. Mrs. Karaline 
Karunagari*

M.Sc (N) Ph.D(N), Principal,Rani Meyyammai College of Nursing, 
Annamalai University,Chidambaram *Corresponding Author



8 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS

questions were asked  and the participants were given 
freedom to express additional views on the topic at the end of 
the interview session to ensure completeness in data 
collection. The feedback revealed that the questionnaires 
were easy to understand and quite convenient for the 
respondents The study had been approved by the human 
ethical committee of Rajah Muthiah Institute of Health Science 
for conducting the study. Permission was obtained from the 
concerned authorities of the selected communities. The data 
collected were entered in Microsoft Excel Ofce 2007 and 
SPSS statistics version 20 was used for statistical analysis.

 Description of the data collection instrument 
Interview Schedule to assess the dietary practices 
A structured Interview guide which was prepared in 
vernacular language were utilized to assess the self care 
practice  on diabetes .The questions were organized under 
two domains namely, dietary practices and  adherence to 
physical activity to make the tool complete.  

a. Dietary practices domain: It consist of  questions of 
Dietary  intake practice were ascertained by 10 questions 
about the intake of complex carbohydrate and processed 
foods, inclusion of antioxidant, habit of reading food labels 
intermittent fasting. The subjects had to recall the dietary 
practices in the preceding week to assess the dietary  
practices, 'The answers were scored in three levels 'always' 
was given 2 marks sometimes' was given 1 marks and 'never' 
was given 0 mark in positive stated questions and vice versa in 
negatively stated questions. 

Scoring interpretation 

b. Physical activity questionnaire In physical activity 
domain, International physical activity questionnaire short 
form was used as a measure to evaluate the physical activity 
of the individuals with diabetes.  It consist of seven open 
ended questions surrounding individuals 7-day recall of 
physical activity to assess the intensity of physical activity and 
sitting time that individuals do as part of their daily lives are 
considered to estimate total physical activity in MET-
min/week.

Vigorous intensity physical activities refer to activities that 
take hard physical effort and make you breathe much harder 
than normal.  The samples should think about those physical 
activities that they did for at least 10 minutes at a time for the 
past 7 days. 

Moderate intensity activities refer to activities that take 
moderate physical effort and make you breathe somewhat 
harder than normal.  The individuals with diabetes should 
think about those physical activities that they did for at least 10 
minutes at a time for the past 7 days. 

Continuous Score  
Expressed as MET-min per week:  MET level x minutes of 
activity x events per week Categorical score 

Operational Denition

Self care Practice: The pattern and regularity of practices of 
the subjects with diabetes in terms of eating and  physical 
activity that helps to maintain optimal glycemic levels.

Physical activity: Physical activity is dened as any bodily 
movement produced by skeletal muscles that require energy 
expenditure.

Dietary practices : 
The dietary measures taken by the  subjects with diabetes in 
order  to maintain glycemic control that includes intake of 
bre rich foods and vegetables and fruits with low glycemic 
index and use of complex carbohydrate and unrened foods.

Analysis 
Table 1: Distribution of Socio demographic characteristics 
of the subjects

NS= not signicant P>0.05 not signicant

Table 1 denotes distribution of the subjects based on socio-
demographic variables in two groups. Nearly one third of the 
participants 50 (55.55) belonged to the age group of 55- 65 
years and fewer subjects 6 (6.67%) were in the age group  of 
35-45 years among the subjects with T2DM .The data on 
distribution of subjects according to their gender revealed that 
44(48.89 %)  were male and 46 (51.11%) were female. With 
regard to education, majority of the subjects 28 (31.12%) and 
eleven (12.22%) of the participants were illiterate respectively. 
With reference to occupation, Majority of the subjects, 
42(46.67%) were skilled labours, and fourteen (15.55%) of 
them are unemployed. Majority of the subjects 36(40%) had 
income between Rs.9,7 87-19,574 and fewer subjects 4(4.44%) 

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Level of practices  Range 
of score 

No of 
questions 

 Perce
ntage 

Adequate  diet practices 16-20 8-10 >75

Moderately adequate diet practices 12-14 6-7 50-75

Inadequate diet practices <10 5 <50

Activity MET levels                

Walking 3.3 METs   

Moderate Intensity 4.0 METs  

Vigorous Intensity 8.0 METs   

 No activity is reported
OR Some activity is 
reported but not 
enough to meet 
Categories 2 or 3.

activities 
achieving a 
minimum of at 
least 600 - 1500 
MET-min/week.-

activities achieving 
a minimum of at 
least 1500- 3000 
MET-minutes/week

Inactive
Category 1

Minimally Active
Category 2

Health Enhancing 
Physical Activity
Category 3

Demographic variables Chi square test

Group1(n=90)

N %

Age 35 – 45 years 6 6.67%

45 – 55 years 34 37.78%

55 – 65 years 50 55.55%

Sex Male 44 48.89%

Female 46 51.11%

Marital status Married 65 72.22%

Unmarried 6 6.67%

Others (divorcee/widow) 19 21.11%

 Education Illiterate 11 12.22%

Primary school 18 20.00%

Middle school 28 31.12%

High school 22 24.44%

Diploma 8 8.89%

Graduate 3 3.33%

Family income > Rs.19,575 16 17.78%

Rs.9,787-19,574 36 40.00%

Rs.4,894- 9,786 34 37.78%

Rs.2,936- 4,893 4 4.44%

<Rs.2,936 0 0.00%

Occupation Professional 0 0.00%

Clerical 9 10.00%

Skilled 42 46.67%

Unskilled 25 27.78%

Unemployed 14 15.55%

Socio-economic 
status

Upper 9 10.00%

Middle 67 74.44%

Low 14 15.56%



had income lesser than Rs,2936 respectively. Among 90 
subjects 9(10%)of subjects belong to upper income group, 

67(74.44%) of them belonged to middle income group and 
14(1  3.56%)  of subjects belonged to low income group. 

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VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

Table 2: Self care practices regarding diet among the subjects  

 sno Items Life style Practice score

Never Sometimes Always

N % n % n %

1  Take diet rich in complex carbohydrate & bre 10 11.11% 70 77.78% 10 11.11%

2  Include foods rich in antioxidants 13 14.44% 60 66.67% 17 19.89%

3   Take Processed foods ,soft drinks  and Maida products 36 40.00% 51 56.67% 3 3.33%

4 Take saturated fats like meat, coconut oil  often etc 20 22.22% 63 70.00% 7 7.78%

5 Consume unrened rice 31 34.44% 42 46.67% 17 18.89%

6  Consume at least 3 portions of fruits or vegetables with 
low glycemic index

23 25.56% 49 54.44% 18 20.00%

7 Have the habit of reading the food labels 55 61.11% 16 17.77% 19 22.22%

8 Eat meals at regular timings 13 14.44% 48 53.33% 29 32.22%

9 I compensate over eating by total fasting 13 14.44% 69 76.67% 8 8.89%

10 3 meals spaced over the day with intermittent spacing 45 50.00% 42 46.67% 3 3.33%

Table 2 displays the recall of dietary practices over the 
preceding week among the subjects .Out of 90 subjects, only 
few 10 (11.11%) exercised dietary control by largely by 
avoiding sweet items and reduce their intake of rened 
carbohydrates. On the other hand 10(11.11%) of the 
participants never had the habit of taking complex 
carbohydrate and bre like legumes, whole grains and plant 
bres as they were not able to relate complex carbohydrate 
with glycemic response . Only 1(19.89%) had the habit of 
taking foods rich in antioxidant and the majority of them were 
unaware that Glucose metabolism leads to oxidative stress in 
the diabetic subjects that leads to complications. Around 
51(56.67%) sometimes take processed foods, soft drinks and 
Maida product because fast food hotels are now available in 
their village and food products are affordable. A total of 
63(70%) of the respondents sometimes had the habit of taking 
saturated fats often especially meat, dalda etc. About 
19(22.22%) of the participants always had the habit of reading 
food labels regarding added sugar and dietary bre. Nearly 
two fourth of the participants 50(55.56%) in our study were 
skilled labourers and they expressed their opinion that it was 
not convenient for them to maintain every time a routine eating 
schedule.  Around 69(76.67%) of them compensate overeating 
by total fasting that spike the blood sugar level. About 45 
(50%) of the diabetic subjects never had the habit of gazing 
food items that make them more resistive to insulin and spike 
their post prandial blood glucose . Only18 (20%) of subjects 
had the regular habit of consuming fruits and vegetables with 
low glycemic index. During sorting exercises of foods based 
on the glycemic index most participants acknowledged the 
health benets of vegetables, although dietary recall data 
suggest that the consumption of these items was low, 
averaging less than one serving per day. In addition, very few 
participants avoided high-fat items. In regard to oil 
consumption, usually groundnut oil or palm oil was readily 
consumed by respondents and were identied as 'healthy' 
during the sorting exercise. The subjects also believe that 
wheat products contain negligible carbohydrates and can be 
taken in any amount.      
  
Table 3 : Distribution of subjects based Dietary practice 
score 

Table 3 highlights that among the subjects, 61.11% of them 
had inadequate dietary practice, 38.89% of them had 
moderately adequate practice and none of them   had 
adequate practice.           

Table 4: Adherence to Physical Activity Based On IPAQ 
among the Participants

 N=90

Table 4 species that most participants residing in selected 
rural area admitted that diet and medication adherence is 
important in management of diabetes than physical activity. 
Only very few 5 (11.36%) among males and 2(4.34%) among 
females are physically active and exercise apart from their 
normal work duties. Around 17 (38.63%) of males and 26( 
56.52%) of females are minimally active as they are involved 
in only moderate household activity and spent less time for 
vigorous physical activity that take hard physical effort. About 
22(50%) of males and 18(39.13)% of females are sedentary as 
they spent more time in watching television and carrying out 
light house hold work. Most commonly females they regarded 
themselves as very busy and cited that they lack free of time to 
make vigorous activity atleast for 10 min in a day. Since the χ2 
value is 3.53 lesser than the table value and p value greater 
than 0.05 indicates no signicant difference between the 
groups in terms of physical activity. Overall adherence to 
physical activity was also found to be poor. Only a few subjects 
accumulate activity for a healthy lifestyle. The following are 
the statements regarding activity among the subjects .

“My family members and neighbours will make fun if I do 
exercise in this age” 

“I wake up and make food for my family members, there is no 
time  for other activities ”

“Where is the time for activit ies, I  must full my 
responsibilities. …” 

“I feel tired to exercise”
         
These quotes also suggest that exercise is perceived to detract 
from work and family duties and is considered selsh, over 
smart or irresponsible. Particularly elderly participants 
viewed themselves as incapacitated by diabetes and 
therefore unable to exercise. Some recognized this as a 

Level of Diet practice score Group I  

n %

Inadequate diet practices 55 61.11%

Moderately   adequate diet practices 35 38.89%

Adequate diet practices 0 0.00%

Total 90 100.0%

Category Male (44) Female(46) Chi square 
test 

Number of 
Respondents

Perce
ntage

Number of 
Respond
ents

Perce
ntage

 

χ2= 3.53p 
value
0.17
 (NS)

Inactive 22 50.00 18 39.13

Minimally 
Active

17 38.63 26 56.52

Health 
Enhancing 
Physical 
Activity

5 11.36 2 4.34



negative cycle. During data collection it became apparent 
that exercise for health or leisure had little cultural importance 
or acceptance, and was often met with fears of appearing 
'abnormal.' 

DISCUSSION 

Table 2 displays the results of dietary practices that were 
recalled over previous week by the subjects in   selected rural 
area. About 70 (77.78 %) of the subjects sometimes take 
complex carbohydrate and  only 10 (11.11%)  had the habit of 
taking complex carbohydrate food regularly like whole grains 
and legumes .The ndings of study conducted by Khattab etal 
.,( 2010)   stated that  Whole grains and legumes full the four 
dietary objectives for people with diabetes specically high 
complex carbohydrates, high bre, low fat and rened sugar. 
The type of fats consumed is more important than total amount 
of fat when looking at metabolic goals and CVD risk. 
Shashank R Joshi et al., (2014) concluded that T2DM 
participants belonging to any part of India consume high 
C H O  i n  t h e i r  d i e t  i f  w e  c o m p a r e  w i t h  d i e t a r y 

 recommendations. The ndings of our study pointed out that 
almost 51( 56.67%)  of individuals with diabetes sometimes 
take Processed foods ,soft drinks  and Maida product because  
fast food hotels are now available in their village and  food 
products are available at cost they can afford.  Similarly the 
ndings of Marcy et al., (2011) have identied that high cost of 
healthy food and inability to resist the temptation to eat 
unhealthy as barriers in adopting new dietary habits among 
type 2 diabetes patients belonging to low-income group.   The 
ndings of the present study reveal that 63(70%) of the study 
subjects sometimes had the habit of taking saturated fats. 
Whereas  Multiple randomized controlled trials including 
patients with type 2 diabetes have reported that a 
Mediterranean-style eating pattern (Brehm BJ, Shai I 
Brunerova L Bloomeld HE) rich in monounsaturated fats can 
improve both glycemic control and blood lipids. MUFA 
improves insulin responsiveness in insulin-resistant and type 
2 diabetic subjects.

             

Approximately 49(54.44%) of the subjects sometimes consume 
fruits and vegetables because of the nancial inability and 
lack of market facility   that they consistently do not eat a 
healthy diet. Where as a study done by  Gopichandran  et  al., 

 (2012) and  Rajasekharan  et  al., (2015)  also showed only 
  26% consume fruits and vegetables regularly in their diet This 

low consumption in  our study could  be due lack  of  
awareness  about  the  importance  of  fruits  and vegetable 
intake and also due to their misperception that fruit intake  will 
increase blood sugar  levels.

             

The signicant nding is that 55 (61.11%) never had the habit 
of reading food labels and  the study ndings were in 
accordance to the study conducted by Jumma Al-Kaabi et al., 
(2008) explained that  among a  sample of 409 diabetic 
patients was recruited, 50% of whom were illiterate. Only 24% 
read food labeling. 76% reported being unable to distinguish 
clearly between low and high carbohydrate index food items 
and no one reported to count calorie intake.

Table 4  present that around 17 (38.63 %) of males and 26( 
56.52%) of females are minimally active as they are involved 
in only moderate household activity and spent less time for 
vigorous physical activity that take hard physical effort. About 
22(50%) of males and 18(39.13) % of females are sedentary as 
they spent more time in watching television and carrying out 
light house hold work. The study ndings were in agreement of 

 the study conducted by  Gracy Paulin  and Rama 
  (Subramanian 2019) to address the levels of activity among 

the subject with diabetes residing in urban area. Most of the 
physical activities done by the diabetic patients were 
moderate intensity physical activity like brisk walking or 
cycling. The proportion of study population involved in 

vigorous intensity physical activity was very low (1.5%). Nearly 
15% of them engaged in moderate physical activity in the 
transport domain. On an average, the study population spent 
only 18 minutes per week on physical activity in transport. 
                  
The present study ndings indicate that females they 
regarded themselves as very busy and cited that they lack free 
of time to make vigorous activity atleast for 10 min in a day. 
Since the χ2 value is 3.53 lesser than the table value and p 
value greater than 0.05 indicates no signicant difference 
between the groups in terms of physical activity. The study 
ndings were not similar to the study conducted by Carol 
Susan Devamani et al., (2018)   revealed that women had a 
higher prevalence of insufcient physical activity compared to 
men in rural (44.5% vs. 35.6%) areas. Rural participants had 
higher work and travel related Physical Activity. The high 
prevalence of insufcient  activity  found in present study 
shows that targeted interventions are needed to reduce 
insufcient physical activity  especially for rural populations.
                   
Currently, there is a pressing need to better understand the 
physiology and health outcomes specically derived from 
replacing sedentary time with non fatiguing types of light 
activity. It can be potentially achievable in more types of 
people  and thereby provide high impact at the population 
level.

Limitations: 
1. Social desirability bias may be existed in this study while 

this is questionnaire based interview study
2. Recall bias: Bias in recall occur when the study participant 

had a poorer recall in general. Other factors that inuence 
recall include age  and education

Recommendation 
1. Nurse should inuence policymakers to combat the 

nutrition transition and the diabetes epidemic in rural 
regions of India by promoting foods with higher ber 
c o n t e n t  a n d  l o w e r  g l y c e m i c  i n d i c e s .  H e n c e 
simultaneously reducing availability and consumption of 
'hyperpalatable' foods.

2. Dietary recommendations need to be individualized as 
'one size does not ts all' and accepted by the subjects with 
diabetes. It's important to note that the nutrition goals for 
diabvetes individuals should incorporate into their 
lifestyle. 

3. A special focus must be given by community health nurse 
for subjects with diabetes and other related comorbidity 
by providing them with additional information on dietary 
adherence.  

4. Nurses can organize “move program” in community  for 
the subjects  with diabetes to  encourage physical activity

CONCLUSION 
Diabetes mellitus (DM) is an incurable but controllable 
disease. Self-knowledge about the physical exercise is very 
important to enhance the insulin sensitivity. Hence, this study 
provides the valuable data on diet, physical activity and 
medication adherence. According to our ndings, non-
adherence to physical activity is high among T2DM is high as 
evidenced by 74.3% of the study participants reporting non-
adherence. Lack of knowledge on complications, presence of 
co-morbidities, lack of motivation, socio-cultural factors, 
family inuences were the most signicant barriers 
responsible for non-adherence. Therefore,  health 
professionals must become proactive in identifying and 
addressing these barriers and health care decision and 
policymakers should design effective practice guideline for 
people with T2DM especially in rural areas.

REFERENCES 
1. Matthew Little,  Sally Humphries,  Kirit Patel, and  Cate Dewey (2017).   

Decoding the Type 2 Diabetes Epidemic in Rural India : Med Anthropology 
36(2): 96–110

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

10 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS



2. Waqas Sami,  Tahir Ansari,  Nadeem Shaque Butt  and Mohd Rashid Ab 
Hamid (2017). Effect of diet on type 2 diabetes mellitus: A review Int J Health 
Sci (Qassim). Apr-Jun; 11(2): 65-  71

3. Raithatha SJ, Shankar SU, Dinesh K. (2014).Self-care practices among 
diabetic patients in Anand district of Gujarat. ISRN Family Med 2014. :743791. 

4. American Diabetes Association. Standards of medical care in diabetes 
mellitus. Diabetes Care 2013;36 Suppl 1:S11-S66.

5. Hayes L, White M, Unwin N, Bhopal R, Fischbacher C, Harland J, et al. 
(2002).Patterns of physical activity and relationship with risk markers for 
cardiovascular disease and diabetes in Indian, Pakistani, Bangladeshi and 
European adults in a UK population. J Public Health Med;24:170-8. 11. 

6. Juma Al-Kaabi., Al-Maskari, F., Saadi, H., Afandi, B., Parkar, H., & Nagelkerke, 
N. (2008). Assessment of dietary practice among diabetic patients in the 
United arab emirates. The review of diabetic studies : RDS, 5(2), 110–115. 
doi:10.1900/RDS.2008.5.110

7. Gracy Paulin1* and Rama SubramanianPhysical Inactivity among Diabetic 
Patients in Urban Tamilnadu: A Community-Based Study J Community Med 
Health Educ 9: 649, Vol 9(2)

8. CarolSusan Devamani Oommen, Anu & Mini, Gk & Abraham, VinodJoseph & 
George, Kuryan. (2019). Levels of physical inactivity in rural and urban Tamil 
Nadu, India: A cross-sectional study. Journal of Clinical and Preventive 
Cardiology. 8. 13. 10.4103/JCPC.JCPC_32_18.

9. Marcy TR, Britton ML, Harrison D. (2011).Identication of barriers to 
appropriate dietary behavior in low-income patients with type 2 diabetes 
mellitus. Diabetes Ther;2:9-19.

10. Hempler NF, Nicic S, Ewers B, Willaing I. (2015). Dietary education must t into 
everyday life: A qualitative study of people with a Pakistani background and 
type 2 .diabetes. Patient Prefer Adherence;9:347-54

11. BloomeldHE, KoellerE,GreerN,MacDonald R,KaneR,WiltTJ. (2016).Effects 
on health outcomes of a Mediterranean diet with no restriction on fat intake: a 
systematic review and meta-analysis. Ann Intern Med;165:491–500

12. Brehm BJ, Lattin BL, Summer SS, et al. (2009). One year comparison of a high-
monounsaturated fat diet with a high-carbohydrate diet in type 2 diabetes. 
Diabetes Care;32:215–220

13. Shai I, Schwarzfuchs D, Henkin Y, et al. ( 2008).Dietary Intervention 
Randomized Controlled Trial (DIRECT) Group. Weight loss with a low 
carbohydrate, Mediterranean, or low-fat diet. N Engl J Med 359:229–241 

14. Gopichandran SV, Lyndon MK, Angel PB, Manayalil BP, Blessy KR, Alex RG, et 
al. Diabetes self-care activities: a community-based survey in urban southern 
India. Natl Med J India. 2012;25(1):1-14. 8. 

15. Rajasekharan D, Kulkarni V, Unnikrishnan B, Kumar N, Holla R, Thapar R. 
Self-Care Activities Among Patients with Diabetes Attending a Tertiary Care 
Hospital in Mangalore Karnataka. India. Ann Med Health Sci Res. 
2015;5(1):59–64.

16. Hamilton, M. T., Healy, G. N., Dunstan, D. W., Zderic, T. W., & Owen, N. (2008). 
Too Little Exercise and Too Much Sitting: Inactivity Physiology and tshe Need 
for New Recommendations on Sedentary Behavior. Current cardiovascular 
risk reports, 2(4), 292–298. doi:10.1007/12170-008-0054-8

17. Joshi, S. R., Bhansali, A., Bajaj, S., Banzal, S. S., Dharmalingam, M., Gupta, 
S.,Joshi, S. S. (2014). Results from a dietary survey in an Indian T2DM 
population: a STARCH study. BMJ open, 4(10), e005138. doi:10.1136/bmjopen-
2014-005138.

VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra

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