Introduction
Diabetes is a significant health challenge and dramatically growing
worldwide, especially in low-and middle-income countries
(Guariguata et al., 2014). Diabetes
prevalence in Iran is estimated to be 10.1% in 2015, which translates
to 4.6 million adults (20-79 years) with diabetes
(IDF, 2015). Uncontrolled diabetes in the
long-term can progressively lead to complications, including
retinopathy, nephropathy, neuropathy, and cardiovascular effects
(Alberti and Zimmet, 1998,
IDF, 2013). Maintenance of blood glucose,
cholesterol, and blood pressure to near normal levels can delay or
prevent diabetes complications (IDF,
2013). The American Diabetes Association (ADA) recommends lower
saturated fat intake in people with diabetes. It considers carbohydrate
monitoring using carbohydrate counting as a critical strategy in the
management of blood glucose (ADA, 2019).
Furthermore, physical activity is an influential component in diabetes
management (Clark et al., 2004,
Wheeler et al., 2012). Definitions of the
included behaviours are as follows: Low-fat food/meal consumption was
defined as “reducing saturated fat intake by low-fat dairy products,
using polyunsaturated and monounsaturated oils [plant based],
avoiding fried foods and trimming the fat from meat [Lean meat]”
(Diabetes Australia, 2015). Carbohydrate counting was defined as
“identifying which foods contain carbohydrate, then assessing how much
carbohydrate a serving of food (or an entire meal) contains concerning
recommendations and if you use insulin, match with insulin dose” (ADA,
2017; Joslin Diabetes Center, 2019) and physical activity was defined as
“engaging in moderate physical activity for at least 150 minutes per
week [half an hour/day, most of the days of week]” (Diabetes
Australia, 2015).