Reliability and Structure of Diabetes Diet Adherence Scale (D-DAS): A Follow-up Study among Type 2 Diabetes Patients of India

Introduction Measuring dietary adherence is essential while prescribing a diet plan for type 2 diabetes. This study aims to develop and validate a diabetes diet adherence scale (D-DAS) among type 2 diabetes patients in India. Methods A four-month non-randomised follow-up study was conducted among (n=120) type 2 diabetes patients attending the outpatient clinic. The adherence to the prescribed diet plan was determined using the D-DAS scale, and the impact of the prescribed diet plan was assessed at the endline. Multiple correspondence analysis (MCA) was used to determine the underlying dimensions of the scale, and confirmatory factor analysis (CFA) with multiple reliability measures was used to determine the reliability and construct validity of the scale. Results Adherence was 53.85%, and no significant difference was observed in baseline and endline fasting blood glucose. MCA revealed dimensions explaining 68.4% of the variance. CFA showed high reliability (McDonald’s ω and Guttman’s λ2=0.836). D-DAS demonstrated a reliable underlying construct (composite reliability=0.90, average variance explained=0.56). Conclusion D-DAS is a reliable and valid scale for measuring dietary adherence among type 2 diabetes patients in India. Adherence was moderate, suggesting the need for targeted interventions to improve dietary compliance and diabetes management. ### Competing Interest Statement The authors have declared no competing interest. ### Funding Statement This study did not receive any funding ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institutes Ethics Committee, Postgraduate Institute of Medical Education and Research, Chandigarh, India I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors