Ninevah Journal of Public Health & Nursing
Online ISSN:1234-5678

Awareness and Perceived Therapeutic Efficacy of a Low Glycemic Index Diet Among Patients with Type 2 Diabetes Mellitus: A Cross-Sectional Study

Document Type : Original Article

Authors

Pareshan Wahid Mrad
Mahmood Arif Mahmood

College of Nursing, University of Raparin, Rania, Sulaymaniyah, Kurdistan Region, 46012 Iraq

10.64554/njphn.2026.192122
Abstract
Background: Dietary management is a cornerstone of type 2 diabetes mellitus (T2DM) care. Low glycemic index (GI) diets have been shown to improve glycemic control and reduce diabetes-related complications; however, patients' awareness and perceptions regarding their therapeutic benefits remain inadequately explored.
Objective: To assess awareness and perceived therapeutic efficacy of a low glycemic index diet among patients with type 2 diabetes mellitus.
Methods: A descriptive cross-sectional study was conducted among 242 adults with T2DM attending Raparin General Hospital, Kewaresh Health Center, and Chwarqwrna General Hospital, Kurdistan Region, Iraq, between December 17, 2024, and February 17, 2025. Participants were recruited using a purposive sampling technique. Data were collected using a structured questionnaire assessing sociodemographic characteristics, diabetes management practices, awareness of the glycemic index diet, and perceived therapeutic efficacy. Data were analyzed using IBM SPSS Statistics version 27. Descriptive statistics and Chi-square tests were applied, with statistical significance set at p < 0.05.
Results: The mean age of participants was 57.23 ± 11.57 years, and 69.8% were female. Most participants (81.0%) used oral hypoglycemic medications, whereas only 4.5% followed a diabetes-specific diet. Awareness of the glycemic index concept was limited, with 45.9% reporting that they had never heard of it and only 10.3% correctly identifying its meaning. Knowledge regarding low-GI foods and their role in glycemic control was generally poor, although 100% expressed interest in learning more about the diet. Nearly all participants (98.8%) reported barriers to following a low-GI diet. Despite limited knowledge, respondents generally perceived the low-GI diet as moderately effective for controlling blood glucose, stabilizing glycemic levels, reducing diabetes complications, and supporting long-term diabetes management.
Conclusion: Patients with type 2 diabetes demonstrated limited awareness and knowledge of the low glycemic index diet despite expressing positive perceptions of its therapeutic value. These findings highlight the need for structured nutrition education, individualized dietary counseling, and continuous professional support to improve knowledge, promote adherence to low-GI dietary recommendations, and optimize diabetes self-management.

Keywords

Type 2 diabetes mellitus
Glycemic index
Low glycemic index diet
Awareness
Dietary education
Therapeutic efficacy
Crossmark

Introduction

Type 2 diabetes mellitus (T2DM) is one of the most prevalent chronic metabolic disorders worldwide and is characterized by persistent hyperglycemia resulting from insulin resistance and progressive pancreatic β-cell dysfunction. The disease is associated with substantial morbidity, mortality, and healthcare costs because of its microvascular and macrovascular complications. According to the International Diabetes Federation (IDF), approximately 537 million adults were living with diabetes in 2021, and this number is projected to rise to 783 million by 2045, with T2DM accounting for approximately 90–95% of all diabetes cases [1,2].

Effective management of T2DM requires a comprehensive approach that includes pharmacological treatment, regular physical activity, weight management, self-monitoring of blood glucose, and appropriate nutritional therapy. Among these strategies, dietary modification is considered a cornerstone of diabetes management because it directly influences postprandial glucose levels and long-term glycemic control. Current international guidelines recommend individualized medical nutrition therapy as an essential component of diabetes care to reduce complications and improve quality of life [3,4].

The glycemic index (GI), introduced by Jenkins and colleagues in 1981, classifies carbohydrate-containing foods according to their effects on postprandial blood glucose concentrations. Foods with a low glycemic index produce a slower and more gradual increase in blood glucose and insulin responses than high-GI foods. Consequently, low-GI diets have been associated with improved glycemic control, enhanced insulin sensitivity, better lipid profiles, reduced body weight, and a lower risk of cardiovascular complications among patients with T2DM [5–7].

Several systematic reviews and randomized controlled trials have demonstrated the clinical benefits of low-GI diets in diabetes management. Consumption of low-GI foods has been shown to significantly reduce glycated hemoglobin (HbA1c), fasting blood glucose, and postprandial glucose excursions while improving overall metabolic outcomes [8,9]. Despite these well-established benefits, adherence to low-GI dietary recommendations remains suboptimal in many countries because of inadequate nutrition knowledge, cultural dietary practices, financial constraints, and limited access to individualized dietary counseling [10].

Patients' awareness and understanding of the glycemic index concept play an essential role in successful dietary adherence. Individuals who understand the effects of carbohydrate quality on blood glucose regulation are more likely to adopt healthier eating behaviors and participate actively in diabetes self-management. Conversely, poor nutritional knowledge has been associated with inadequate glycemic control, increased risk of diabetes-related complications, and reduced treatment adherence [11,12]. Therefore, assessing patients' knowledge regarding low-GI diets is essential for identifying educational needs and improving diabetes management strategies.

Although awareness of diabetes has increased globally, evidence regarding patients' knowledge and perceptions of low-GI diets remains limited, particularly in developing countries. In Iraq and the Kurdistan Region, few studies have evaluated diabetic patients' understanding of dietary glycemic index or their perceptions regarding its therapeutic effectiveness. This lack of evidence limits the development of culturally appropriate educational interventions that promote healthy dietary behaviors and improve diabetes outcomes.

Therefore, this study aimed to assess the level of awareness and perceived therapeutic efficacy of a low glycemic index diet among patients with type 2 diabetes mellitus attending selected healthcare facilities in the Raparin Administration, Kurdistan Region, Iraq. The findings may assist healthcare professionals in designing targeted nutritional education programs that improve dietary adherence and optimize glycemic control among patients with T2DM.

Materials and Methods

Study Design

A quantitative cross-sectional descriptive study was conducted to evaluate awareness and perceived therapeutic efficacy of a low glycemic index (GI) diet among patients with type 2 diabetes mellitus (T2DM). This design was selected to provide a comprehensive assessment of participants' knowledge, diabetes management practices, and perceptions regarding the therapeutic benefits of a low-GI diet.

Study Setting

The study was conducted at Raparin General Hospital, Kewaresh Health Center, and Chwarqwrna General Hospital in the Raparin Administration, Sulaymaniyah Governorate, Kurdistan Region, Iraq. Data were collected over a two-month period from 17 December 2024 to 17 February 2025.

Study Population and Sampling

The study population consisted of adult patients diagnosed with type 2 diabetes mellitus who attended the selected healthcare facilities during the study period. A non-probability purposive sampling technique with a convenience approach was used to recruit eligible participants. A total of 242 patients who met the inclusion criteria and agreed to participate were enrolled in the study.

Inclusion Criteria

Participants were eligible if they:

  • Were diagnosed with type 2 diabetes mellitus.
  • Were 18 years of age or older.
  • Attended one of the selected healthcare facilities during the study period.
  • Agreed to participate voluntarily and provided informed consent.

Exclusion Criteria

Patients were excluded if they:

  • Had not been diagnosed with diabetes mellitus.
  • Were younger than 18 years of age.
  • Were unconscious or had cognitive impairment that prevented completion of the questionnaire.
  • Declined to participate in the study.

Study Instrument

Data were collected using a structured interviewer-administered questionnaire developed after reviewing relevant literature on diabetes self-management and glycemic index diets. The questionnaire consisted of four sections:

  1. Sociodemographic characteristics, including age, sex, marital status, residence, education, occupation, monthly income, weight, height, and body mass index (BMI).
  2. Diabetes management practices, including insulin use, oral hypoglycemic medication, attendance at diabetes education programs, blood glucose monitoring frequency, family history of diabetes, smoking status, and adherence to a diabetes-specific diet.
  3. Awareness and knowledge of the glycemic index diet, comprising questions assessing participants' understanding of the GI concept, GI food categories, health benefits of low-GI diets, and barriers to dietary adherence.
  4. Perceived therapeutic efficacy of the low glycemic index diet, measured using a 10-point Likert-type rating scale evaluating participants' perceptions regarding the effectiveness of a low-GI diet in controlling blood glucose, preventing complications, improving diabetes management, and supporting long-term disease control.

Data Collection Procedure

Data were collected through face-to-face interviews conducted by the researchers using the structured questionnaire. Before participation, patients received an explanation of the study objectives and procedures, and written informed consent was obtained. Each interview required approximately 5–10 minutes to complete. Participant confidentiality was maintained throughout the study, and collected information was used exclusively for research purposes.

Statistical Analysis

Data were entered and analyzed using IBM Statistical Package for the Social Sciences (SPSS) version 27.0 (IBM Corp., Armonk, NY, USA). Descriptive statistics, including frequencies, percentages, means, and standard deviations, were used to summarize participant characteristics and study variables. Inferential analysis was performed using the Chi-square test to examine associations between categorical variables. Statistical significance was established at p < 0.05.

Ethical Considerations

Ethical approval was obtained from the Research Ethics Committee of the College of Nursing, University of Raparin, Kurdistan Region, Iraq, before commencement of the study. Written informed consent was obtained from all participants after explaining the study objectives, confidentiality of responses, and voluntary nature of participation. Participants were informed that they could withdraw from the study at any stage without any consequences, and all data were anonymized and securely stored to protect participant privacy.

Results

A total of 242 patients with type 2 diabetes mellitus participated in this study. The mean age of the participants was 57.23 ± 11.57 years (range: 32–93 years), with the largest proportion (36.0%) aged 50–59 years. Females constituted 69.8% of the sample, and 83.5% were married. Most participants resided in urban areas (85.1%) and had low educational attainment, with 57.0% being illiterate. Housewives represented the largest occupational group (67.8%), while 62.4% reported having barely sufficient monthly income. The mean body mass index (BMI) was 28.29 ± 4.91 kg/m², and more than half of the participants (52.9%) were overweight or obese (Table 1).

Diabetes management practices are presented in Table 2. Most participants (83.1%) did not use insulin therapy, whereas 81.0% managed their diabetes with oral hypoglycemic medications. A large majority (87.2%) reported attending diabetes education programs. Regarding blood glucose monitoring, 41.3% checked their blood glucose monthly, 37.6% monitored it weekly, and only 2.1% performed self-monitoring several times daily. More than two-thirds (68.2%) had a family history of type 2 diabetes, while 29.3% were smokers. Notably, only 4.5% reported following a diabetes-specific diet, indicating poor adherence to dietary recommendations despite participation in diabetes education (Table 2).

Participants demonstrated limited awareness and knowledge regarding the glycemic index (GI) diet (Table 3). Nearly half (45.9%) had never heard of the glycemic index concept, and only 10.3% correctly understood its meaning. Awareness of GI food categories was also poor, with only 19.0% recognizing the different GI classifications and 21.9% understanding their effect on blood glucose levels. Furthermore, only 21.5% knew that a low-GI diet is healthier than a high-GI diet, while just 9.1% had previously followed a GI-based dietary program. Knowledge regarding specific low-GI foods was particularly limited, with only 5.4% correctly identifying low-GI food choices. Nevertheless, almost all participants (98.8%) reported encountering barriers to following a low-GI diet, whereas 100% expressed interest in receiving additional education about glycemic index diets (Table 3).

Participants generally perceived the low glycemic index diet as beneficial for diabetes management (Table 4). Most respondents rated the ability of a low-GI diet to control blood glucose, maintain stable glucose levels, prevent diabetes-related complications, and improve overall diabetes management between 6 and 8 on the 10-point rating scale. Similarly, participants acknowledged the importance of continuous adherence to a low-GI diet and recognized the value of professional dietary advice in achieving better diabetes control. Although perceptions regarding the therapeutic effectiveness of the low-GI diet were generally positive, the variability in responses suggests differences in individual experiences and understanding of dietary management (Table 4).

Overall, the findings indicate a substantial gap between participants' knowledge and their perceptions regarding the low glycemic index diet. Despite demonstrating limited awareness of GI concepts and poor adherence to diabetes-specific dietary recommendations, most participants believed that low-GI diets could play an important role in improving glycemic control and preventing diabetes complications. These findings emphasize the need for structured nutritional education and individualized dietary counseling to bridge the gap between knowledge and practice among patients with type 2 diabetes mellitus.

Table 1. Sociodemographic characteristics of patients with type 2 diabetes mellitus (N = 242)

Variable Category n %
Age (years) 30–39 9 3.7
  40–49 54 22.3
  50–59 87 36.0
  60–69 49 20.2
  70–79 33 13.6
  80–89 8 3.3
  90–99 2 0.8
  Mean ± SD 57.23 ± 11.57  
Sex Male 73 30.2
  Female 169 69.8
Marital status Single 2 0.8
  Married 202 83.5
  Divorced 2 0.8
  Widowed 36 14.9
Residence Urban 206 85.1
  Suburban 10 4.1
  Rural 26 10.7
Educational level Illiterate 138 57.0
  Read and write 17 7.0
  Primary 49 20.2
  Secondary 24 9.9
  Undergraduate 9 3.7
  Postgraduate 5 2.1
Occupation Employed 30 12.4
  Self-employed 16 6.6
  Housewife 164 67.8
  Retired 32 13.2
Monthly income Insufficient 62 25.6
  Barely sufficient 151 62.4
  Highly sufficient 29 12.0
BMI (kg/m²) 16.40–26.40 97 40.1
  26.50–36.00 128 52.9
  36.00–44.90 17 7.0

BMI: Body Mass Index.

Table 2. Diabetes management practices among participants (N = 242)

Variable Category n %
Insulin therapy Yes 41 16.9
  No 201 83.1
Oral hypoglycemic medication Yes 196 81.0
  No 46 19.0
Attendance at diabetes education Yes 211 87.2
  No 31 12.8
Blood glucose monitoring Several times/day 5 2.1
  Daily 31 12.8
  Weekly 91 37.6
  Monthly 100 41.3
  Never 15 6.2
Family history of T2DM Yes 165 68.2
  No 77 31.8
Smoking Yes 71 29.3
  No 171 70.7
Following diabetes-specific diet Yes 11 4.5
  No 231 95.5

T2DM: Type 2 diabetes mellitus.

Table 3. Awareness and knowledge regarding the glycemic index (GI) diet (N = 242)

Statement Yes n (%) Uncertain n (%) No n (%)
Heard about the GI concept 73 (30.2) 58 (24.0) 111 (45.9)
Know what GI is 25 (10.3) 100 (41.3) 117 (48.3)
Aware of GI categories 46 (19.0) 123 (50.8) 73 (30.2)
Know GI categories affect blood glucose 53 (21.9) 131 (54.1) 58 (24.0)
Know low-GI diet is healthier 52 (21.5) 125 (51.7) 65 (26.9)
Previously followed GI diet 22 (9.1) 90 (37.2) 130 (53.7)
Can identify low-GI foods 13 (5.4) 92 (38.0) 137 (56.6)
Know white bread has higher GI than brown bread 57 (23.6) 145 (59.9) 40 (16.5)
Know apple has lower GI than watermelon 54 (22.3) 150 (62.0) 38 (15.7)
Know low-GI diet improves glycemic control 51 (21.1) 146 (60.3) 45 (18.6)
Know low-GI diet improves lipid profile 38 (15.7) 160 (66.1) 44 (18.2)
Encounter barriers to following GI diet 239 (98.8) 1 (0.4) 2 (0.8)
Interested in learning more about GI diet 242 (100.0) 0 (0.0) 0 (0.0)

GI: Glycemic Index.

Table 4. Perceived therapeutic efficacy of the low glycemic index diet among patients with type 2 diabetes mellitus (N = 242)

Statement Predominant rating (10-point scale) Interpretation
Ability of low-GI diet to control blood glucose 6 (32.2%) Moderate-to-high perceived effectiveness
Ability to maintain stable blood glucose 7 (32.6%) Positive perception
Ability to reduce diabetes complications 6 (27.3%) Moderate perceived benefit
Ability to prevent future complications 7 (27.3%) Positive perceived benefit
Ability to control diabetes effectively 7 (30.2%) Good perceived effectiveness
Need for continuous adherence to low-GI diet 7 (34.7%) Strong agreement
Value of the recommended low-GI diet 7 (26.4%) Positive perception
Overall effectiveness of low-GI diet 7 (26.0%) Good perceived benefit
Value of healthcare professionals' advice 7 (30.2%) Positive perception
Ability to cope with diabetes using a low-GI diet 7–8 (52.4%) Moderate-to-high confidence

Responses were rated on a 10-point Likert scale, where higher scores indicated greater perceived therapeutic efficacy of the low glycemic index diet

Discussion

The present study evaluated awareness and perceived therapeutic efficacy of a low glycemic index (GI) diet among patients with type 2 diabetes mellitus (T2DM). The findings revealed that although participants generally believed that a low-GI diet could improve diabetes management, their actual knowledge of the GI concept was limited and adherence to diabetes-specific dietary recommendations was poor. This discrepancy suggests that positive perceptions alone are insufficient to promote evidence-based dietary practices and highlights the need for comprehensive nutrition education tailored to patients with T2DM.

The demographic profile of the participants reflects the typical characteristics of individuals affected by T2DM in developing countries. Most participants were middle-aged or older adults, predominantly female, married, and overweight or obese. These findings are consistent with the International Diabetes Federation, which reports that advancing age and excess body weight remain the principal risk factors for T2DM globally [1]. Similar observations have been reported by Galicia-Garcia et al., who described obesity, aging, and lifestyle factors as major contributors to insulin resistance and disease progression [2]. Furthermore, more than half of the participants had limited educational attainment, a factor known to adversely influence health literacy, self-care behaviors, and diabetes outcomes [3,4].

Despite the high proportion of participants who reported attending diabetes education programs, only a small minority adhered to a diabetes-specific diet. This finding suggests that current educational strategies may improve awareness of diabetes in general but fail to produce meaningful behavioral changes regarding nutritional management. Diabetes self-management education is most effective when it includes individualized counseling, continuous reinforcement, and practical skills that enable patients to translate knowledge into daily practice [5]. Likewise, systematic evidence indicates that dietary adherence remains one of the most challenging aspects of diabetes self-management despite advances in patient education and clinical care [6].

One of the most important findings of the present study was the remarkably low awareness of the glycemic index concept. Nearly half of the participants had never heard of the glycemic index, and only a small proportion correctly understood its meaning or could identify foods with low glycemic index values. Knowledge regarding GI food categories and their effects on blood glucose regulation was also limited. These findings are comparable with previous studies conducted in different populations, where patients demonstrated insufficient understanding of carbohydrate quality despite being familiar with general dietary recommendations for diabetes [7,8]. Similar findings reported by Yalçın et al. demonstrated that patients frequently lack the practical knowledge required to distinguish between foods with high and low glycemic indices, thereby limiting their ability to make informed dietary choices [9].

Although participants demonstrated limited knowledge, their perceptions regarding the therapeutic efficacy of a low-GI diet were generally favorable. Most respondents believed that low-GI diets could improve blood glucose control, reduce glucose fluctuations, decrease the risk of diabetes-related complications, and facilitate long-term disease management. These perceptions are supported by substantial scientific evidence. Meta-analyses of randomized controlled trials have consistently shown that low-GI diets significantly improve glycated hemoglobin, fasting plasma glucose, and postprandial glucose responses among individuals with T2DM [6]. Similarly, Jenkins et al. demonstrated that replacing conventional carbohydrate sources with low-GI foods resulted in clinically significant improvements in glycemic control [10]. The American Diabetes Association also recognizes individualized nutrition therapy, including appropriate carbohydrate quality, as an essential component of diabetes management [11].

Nearly all participants reported encountering barriers to following a low-GI diet, despite expressing unanimous interest in learning more about this dietary approach. These findings suggest that inadequate knowledge is only one of several obstacles influencing dietary behavior. Previous investigations have identified limited access to nutritional counseling, financial limitations, cultural food preferences, low availability of appropriate foods, and insufficient family support as important determinants of poor dietary adherence among individuals with diabetes [12,13]. Therefore, effective interventions should address not only educational deficits but also the environmental and socioeconomic factors that influence patients' ability to adopt healthier eating patterns.

The coexistence of poor knowledge and positive perceptions observed in this study indicates a substantial gap between theoretical beliefs and practical implementation. Patients appear to recognize that healthy eating contributes to diabetes control but lack the specific knowledge required to apply glycemic index principles during meal planning and food selection. Healthcare professionals, particularly nurses and dietitians, should therefore emphasize practical nutrition education by teaching patients how to identify low-GI foods, interpret food labels, substitute high-GI foods with healthier alternatives, and integrate low-GI choices into traditional dietary habits. Evidence suggests that structured diabetes self-management education focusing on practical dietary skills produces greater improvements in long-term glycemic control than education based solely on theoretical information [5,14].

The findings of this study have important implications for diabetes care in Iraq and similar resource-limited settings. As the prevalence of T2DM continues to increase, strengthening nutrition education should become an integral component of routine diabetes services. Culturally appropriate educational materials, regular dietary counseling, multidisciplinary diabetes clinics, and community-based awareness programs may improve patients' nutritional literacy and facilitate greater adherence to evidence-based dietary recommendations. Future interventions should also evaluate whether structured low-GI educational programs can improve long-term clinical outcomes, including glycemic control, body weight, and quality of life.

Overall, the present study demonstrates that patients with T2DM have limited awareness of the glycemic index despite recognizing its potential therapeutic benefits. Bridging this knowledge gap through comprehensive, patient-centered nutrition education and individualized dietary counseling may improve adherence to healthy eating behaviors, optimize glycemic control, and ultimately reduce the burden of diabetes-related complications.

Limitations

This study has several limitations that should be considered when interpreting the findings. First, the cross-sectional design limits the ability to establish causal relationships between awareness, perceived therapeutic efficacy, and dietary behaviors. Second, the study was conducted in selected healthcare facilities within the Raparin Administration, which may limit the generalizability of the findings to other regions of Iraq or different healthcare settings. Third, a non-probability convenience sampling technique was employed, introducing the possibility of selection bias. Fourth, the data were based on self-reported responses, making the findings susceptible to recall bias and social desirability bias. Finally, the study evaluated participants' awareness and perceptions of the glycemic index diet without measuring objective clinical outcomes such as glycated hemoglobin (HbA1c), fasting blood glucose, or long-term dietary adherence. Future multicenter longitudinal studies incorporating objective metabolic indicators are recommended to better evaluate the effectiveness of low-glycemic index dietary interventions in patients with type 2 diabetes mellitus.

Conclusion

The present study demonstrated that patients with type 2 diabetes mellitus had limited awareness and knowledge of the glycemic index despite generally recognizing its potential therapeutic benefits. Although most participants believed that a low-glycemic index diet could improve glycemic control and reduce diabetes-related complications, adherence to diabetes-specific dietary recommendations remained poor, indicating a substantial gap between knowledge, perception, and actual dietary practice. These findings emphasize the need for structured, culturally appropriate nutrition education programs that focus on practical application of glycemic index principles. Integrating individualized dietary counseling into routine diabetes care may improve nutritional literacy, promote healthier eating behaviors, and ultimately contribute to better glycemic control and reduced risk of diabetes-related complications.

 
 
 
 

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Ninevah Journal of Public Health & Nursing
Volume 1, Issue 1
Summer 2026

  • Receive Date 01 February 2026
  • Revise Date 11 May 2026
  • Accept Date 23 June 2026
  • First Publish Date 22 July 2026
  • Publish Date 01 August 2026

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