Food Security and Glycemic Control Among Low-Income Patients with Diabetes

Abstract

Background: Food insecurity -- lack of dependable access to adequate foods -- may play a role in poor diabetes control and be associated with poor health outcomes. Objective: To determine the relationship between food security status and multiple health outcomes -- including glycemic control, depression, diabetes distress and medication adherence -- among low-income individuals with diabetes. Design: Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. Participants: Participants had poorly controlled type 2 diabetes (A1c ¡Ý8.0%), household income <250% of the federal poverty level and were 30-70 years old, recruited from a large public hospital, VA medical center and community-health center in King County, Washington. Intervention: Home-based diabetes self-management intervention delivered by community health workers. Main Measures: Food security status determined by Department of Agriculture¡&hibar;s 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Hypoglycemic episodes per patient report. Glycosylated hemoglobin (A1c) values obtained through fingerstick blood sample. Key Results: The prevalence of food insecurity was 47.4%. Food-insecure participants more likely to be depressed (74.1% vs. 35.6%, p<0.001), report diabetes distress (55.1% vs. 33.7%, p<0.001), have low medication adherence (52.9% vs. 37.2%, p=0.02) and higher incidence of hypoglycemia (57.7% vs. 45.2%, p=0.04). Those with food insecurity had significantly higher A1c levels (9.4% vs. 8.7%, p=0.001) after adjusting for socio-demographic characteristics, depression, diabetes distress and medication adherence. Conclusions: The prevalence of food insecurity among low-income individuals with diabetes was high. Food insecurity was associated with multiple adverse health outcomes, including poor glycemic control. Without dependable access to safe and nutritious foods, optimal health and glycemic control likely remain out of reach for those with food insecurity.