Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes

Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California, USA.
Diabetes care (Impact Factor: 8.42). 12/2011; 35(2):233-8. DOI: 10.2337/dc11-1627
Source: PubMed


To determine whether food insecurity--the inability to reliably afford safe and nutritious food--is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes.
We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control.
The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A(1c) ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07-2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control.
Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.

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Available from: Elizabeth A Jacobs
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    • "Given the initial evidence of efficacy described here, future effectiveness studies should include a comparison intervention. Second, because of the various recruitment methods, we did not recruit a homogenous sample of women relative to socioeconomic status, a factor which is reported to have substantial impact on diabetes lifestyle behaviors [26, 27]. Therefore, our study is generalizable to AA women from various socioeconomic backgrounds with type 2 diabetes and who are at risk for the development or progression of diabetes-related complications. "
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    ABSTRACT: Objective: To assess the efficacy and acceptability of a group medical nutritional therapy (MNT) intervention, using motivational interviewing (MI). RESEARCH DESIGN & METHOD: African American (AA) women with type 2 diabetes (T2D) participated in five, certified diabetes educator/dietitian-facilitated intervention sessions targeting carbohydrate, fat, and fruit/vegetable intake and management. Motivation-based activities centered on exploration of dietary ambivalence and the relationships between diet and personal strengths. Repeated pre- and post-intervention, psychosocial, dietary self-care, and clinical outcomes were collected and analyzed using generalized least squares regression. An acceptability assessment was administered after intervention. Results: Participants (n = 24) were mostly of middle age (mean age 50.8 ± 6.3) with an average BMI of 39 ± 6.5. Compared to a gradual pre-intervention loss of HbA1c control and confidence in choosing restaurant foods, a significant post-intervention improvement in HbA1c (P = 0.03) and a near significant (P = 0.06) increase in confidence in choosing restaurant foods were observed with both returning to pre-intervention levels. 100% reported that they would recommend the study to other AA women with type 2 diabetes. Conclusion: The results support the potential efficacy of a group MNT/MI intervention in improving glycemic control and dietary self-care-related confidence in overweight/obese AA women with type 2 diabetes.
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    • "This study showed a significant association between poor socio-economic status and low-adherence. These findings are in agreement with other studies that showed food insecurity and poor socioeconomic status were associated with low-adherence and poor glycemic control in persons with diabetes (Raum et al. 2012; Wabe et al. 2011; Larranaga et al. 2005; Seligman and Schillinger 2010; Seligman et al. 2012). Individuals with low socioeconomic status cannot access education, information, transportation and obtain the required drugs on time. "
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    ABSTRACT: Low adherence to prescribed diabetes medications is one of the major reasons to poor glycemic control in developing countries. Therefore, this study attempted to assess the magnitude of medication adherence and factors associated with it among adult persons with diabetes in northwest Ethiopia. This study utilized a cross sectional study design with internal comparison. The study population was adult persons with diabetes attending the Diabetes Referral Clinic of Gondar University Hospital. Adherence was assessed using the eight-item Morisky Medication Adherence Scale (MMAS-8). In addition laboratory tests and chart reviews were carried out to collect relevant data. Ordinary logistic regression was used to identify factors associated with adherence. A total of 391 patients were studied. Based on the MMAS-8 scale, the self-reported adherence to diabetic medication was low for 25.4% [95% CI: 21, 29] of the patients, medium for 28.7% [95% CI: 24, 33], and high for 45.9% [95% CI: 41, 50] of the patients. The Mean (±SD) of glycosylated hemoglobin for the low adherence group was 8.2% (±2.1). It was 8.1% (±2.0), for the medium, and 7.4% (±1.6) for the high adherence group. In the multivariate analysis poor wealth status (AOR = 1.99; 1.15, 3.43), using traditional treatment (AOR = 2.90; 1.03, 8.15), and service dissatisfaction (AOR = 2.23; 1.04, 4.80) were significantly associated with low adherence to prescribed diabetic medications. Over half of the persons with diabetes did not adhere to medications. Adherence was poor among users of traditional treatment and those dissatisfied with services. Developing a more intensive communication strategies and improving the quality of services could improve the level of adherence.
    Full-text · Article · Apr 2014 · SpringerPlus
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    • "These findings are consistent with and extend those from prior reports. Previous clinic-based studies noted worse glycemic control among food-insecure diabetic patients in safety-net clinics (8,9), but did not evaluate lipid control. Additionally, no population-based study had previously examined glycemic, lipid, and blood pressure control among all adults with diabetes. "
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    ABSTRACT: OBJECTIVE We sought to determine whether food insecurity is associated with worse glycemic, cholesterol, and blood pressure control in adults with diabetes.RESEARCH DESIGN AND METHODS We conducted a cross-sectional analysis of data from participants of the 1999-2008 National Health and Nutrition Examination Survey. All adults with diabetes (type 1 or type 2) by self-report or diabetes medication use were included. Food insecurity was measured by the Adult Food Security Survey Module. The outcomes of interest were proportion of patients with HbA1c >9.0% (75 mmol/mol), LDL cholesterol >100 mg/dL, and systolic blood pressure >140 mmHg or diastolic blood pressure >90 mmHg. We used multivariable logistic regression for analysis.RESULTSAmong the 2,557 adults with diabetes in our sample, a higher proportion of those with food insecurity (27.0 vs. 13.3%, P < 0.001) had an HbA1c >9.0% (75 mmol/mol). After adjustment for age, sex, educational attainment, household income, insurance status and type, smoking status, BMI, duration of diabetes, diabetes medication use and type, and presence of a usual source of care, food insecurity remained significantly associated with poor glycemic control (odds ratio [OR] 1.53 [95% CI 1.07-2.19]). Food insecurity was also associated with poor LDL control before (68.8 vs. 49.8, P = 0.002) and after (1.86 [1.01-3.44]) adjustment. Food insecurity was not associated with blood pressure control.CONCLUSIONS Food insecurity is significantly associated with poor metabolic control in adults with diabetes. Interventions that address food security as well as clinical factors may be needed to successfully manage chronic disease in vulnerable adults.
    Full-text · Article · Jun 2013 · Diabetes care
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