*3.1.2.2 Attitudes regarding diabetes*

Attitudes are considered the most important determinants of behavior and behavior change among patients with diabetes. Attitudes towards diabetes and its treatment are associated with self-care, including adherence to a diabetes dietary plan, exercise, and medication [35]. Positive attitudes toward diabetes and its treatment may lead patients to adopting an active lifestyle and changing their behavior to control their diabetes, in contrast to patients with negative attitudes [23]. A cross-sectional study conducted in the Free State province of South Africa among Type-2 Diabetes Mellitus (T2DM) patients reported negative attitudes towards diabetes among patients, which may contribute to morbidity and mortality [36]. Another South African study reported positive attitudes among patient towards diabetes treatment and lifestyle modifications, which may contribute to better diabetes outcomes [37].

### *3.1.2.3 Practice related to diabetes*

Practice related to diabetes management is critical and involves adherence to new treatment regimens [38]. Practice includes remembering and administering medication, honoring medical appointments, adhering to diabetes self-care practices, monitoring glucose levels, and adhering to dietary treatment and physical activity [39]. Behavioral changes and intensive lifestyle interventions are key components in the management of T2DM [36]. Poor practices, such as non-adherence to treatment, are a great concern to public health. A cross-sectional South African study reported poor practices among patients with diabetes-related to healthy lifestyle modifications [36]. Poor practices related to unhealthy eating among patients were reported in Lebanon [40]. Similar findings of poor practices related to diabetes management were also reported by a cross-sectional study conducted in Mpumalanga [41]. There is therefore a need to employ new measures to improve practices for improved diabetes outcomes.
