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

TLDR

To determine whether food insecurity 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. Using multivariable regression on a cross‑sectional survey and chart review of 711 safety‑net clinic patients, the authors examined food insecurity prevalence and its association with glycemic control, and tested mediation by diet difficulty, self‑efficacy, and emotional distress. Food‑insecure patients had higher odds of poor glycemic control (A1c ≥ 8.5%) and were more likely to struggle with diet affordability, have lower self‑efficacy, and experience greater emotional distress; diet difficulty and emotional distress partially mediated the relationship, indicating food insecurity is an independent risk factor for poor glycemic control in safety‑net settings.

Abstract

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.