IntroductionPoor diet is the leading cause of poor health in USA, with fresh vegetable consumption below recommended levels. We aimed to assess the impact of medical prescriptions for fresh (defined as picked within 72 hours) vegetables, at no cost to participants on cardiometabolic outcomes among adults (predominantly Mexican-American women) with or at risk of type 2 diabetes (T2D).MethodsBetween February 2019 and March 2020, 159 participants (122 female, 75% of Mexican heritage, 31% with non-insulin treated T2D, age 52.5 (13.2) years) were recruited using community outreach materials in English and Spanish, and received prescriptions for 21 servings/week of fresh vegetable for 10 weeks. Pre-post comparisons were made of weight; waist circumference; blood pressure; Hemoglobin A1c (HbA1c, a measure of long-term blood glucose control); self-reported sleep, mood and pain; vegetable, tortilla and soda consumption. After obtaining devices for this study, 66 of 72 participants asked, agreed to wear blinded continuous glucose monitors (CGM).ResultsPaired data were available for 131 participants. Over 3 months, waist circumference fell (−0.77 (95% CI −1.42 to 0.12) cm, p=0.022), as did systolic blood pressure (SBP) (−2.42 (95% CI −4.56 to 0.28) mm Hg, p=0.037), which was greater among individuals with baseline SBP >130 mm Hg (−7.5 (95% CI −12.4 to 2.6) mm Hg, p=0.005). Weight reduced by −0.4 (−0.7 to –0.04) kg, p=0.029 among women. For participants with baseline HbA1c >7.0%, HbA1c fell by −0.35 (-0.8 to –0.1), p=0.009. For participants with paired CGM data (n=40), time in range 70–180 mg/dL improved (from 97.4% to 98.9%, p<0.01). Food insecurity (p<0.001), tortilla (p<0.0001) and soda (p=0.013) consumption significantly decreased. Self-reported sleep, mood and pain level scores also improved (all p<0.01).ConclusionsMedical prescriptions for fresh vegetables were associated with clinically relevant improvements in cardiovascular risk factors and quality of life variables (sleep, mood and pain level) in adults (predominantly Mexican-American and female) with or at risk of T2D.Trial registration numberClinicalTrials.gov Identifier: NCT03940300.

Background: In the United States, Latino families have a disproportionate burden of diabetes and associated complications. Aim: This pilot study assessed the feasibility of using medical prescriptions of organic vegetables to improve health outcomes among Latinos with type 2 diabetes (T2D). Methods: Latino participants ( n = 21, 91% female, age 56 ± 11.1 years) with T2D received 12 weeks of medically prescribed organic vegetables. Weight, waist circumference, blood pressure, and HbA1c were measured pre and post-intervention. Food security was also assessed. Results: Over 12 weeks, there was a significant fall in systolic ( p = 0.03) and diastolic ( p = 0.01) blood pressure. A total of 14 participants lost weight (median weight loss among responders was 1.9 pounds), and waist circumference decreased in 9 of 19 responders by a median of 1.5 inches. HbA1c was unchanged (6.7 ± 1.1% at baseline versus 7.0 ± 1.1% post-intervention). Conclusions: Medical prescriptions of organic vegetables may have measurable health benefits for adult Latinos with T2D.

For adults with T2D, food insecurity and low socio-economic status are major barriers to accessing nutritious food, leading to compensatory consumption of foods harmful to health. In particular, consumption of fresh vegetables is well below recommended levels in the United States. The aim of this project was to examine the health impact of improving access to fresh vegetables through the use of medical prescriptions for organic vegetables for adults with or at risk of T2D (ADA Risk Calculator). Over 12 weeks (and after obtaining informed consent), participants provided baseline clinical information and then received weekly medical prescriptions of 21 servings of locally sourced organic vegetables at three community based distribution centers in Santa Barbara, CA, after which baseline measurements were repeated. No additional structured nutrition education was provided. Overall, 145 adults (74% Hispanic/Latino, aged 53 [42-62] years (median [IQ range]), 78% female, with (31%) or at risk of T2D have been enrolled. At entry, 62% were food insecure which reduced to 37% after 12 weeks (p&lt;0.0001) associated with lowering of systolic blood pressure (SBP) (-2.5 [95%CI: -4.8 to -0.2] mmHg, p=0.035) which was greater for those with an initial SBP &gt;130 mmHg (-6.8 [95%CI: -11.7, -1.9] mmHg, p=0.005), and a reduction in waist circumference (0.9 [95%CI -1.6 to -0.2] cm, p=0.002). The change in waist circumference was also significant with baseline high-risk values of &gt;88 cm (p=0.02) for women and &gt;102 cm (p=0.02) for men. Median weight also fell slightly (-0.45 kg, p=0.04). For participants with a baseline HbA1c &gt;7.0%, this reduced significantly (-0.6 [95% CI -1.2 to -0.05] %, p=0.01). Overall self-reported sleep quality, mood and pain (100 mm visual analogue scales) also improved (all p&lt;0.001). Medical prescriptions of organic vegetables are associated with measurable clinical and psychosocial benefits for adults with or at risk of T2D. Disclosure M.A. Kujan: None. N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. C. Conneely: None. V. Chen: None. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc. Funding U.S. Department of Agriculture (2018-01793)

In the United States, type 2 diabetes (T2D) has a disproportionate impact on underserved populations, and this appears to be related to excess weight. Although reasons are likely multifactorial, it is unclear if there are gender-related influences on obesity risk for these populations. We compared body habitus by gender for 218 adults [84% Mexican-American, 152 females, mean (SD) age 56.2 (10.7) years, HbA1c 8.1 (2.0) %, BMI 31.2 (6.7) kg/m2, 45% uninsured, 42% food insecure (U.S. Household Food Security Survey)] with T2D participating in 2 clinical trials (NCT03830840 and NCT03940300). Comparisons were made for BMI, waist circumference (WC), relative fat mass (RFM), systolic blood pressure (SBP), HbA1c, and food security by gender (Table). Results expressed as mean (SD), unless specified. Significant associations (Spearman’s Rho) were found between WC and BMI (rs= 0.82) and WC and RFM (rs=0.66, both p&lt;0.001) for all participants and when stratified by gender (p&lt;0.001). There were no significant associations between HbA1c and RFM or BMI, except for BMI and HbA1c in males (rs=-0.31, p=0.02). Food insecure adults had higher HbA1c (%) levels than those who were food secure (median [IQR] 7.65 [6.98-9.35] versus 7.30 [6.40-8.63], p=0.02). In conclusion, gender may be an important influence on body habitus for underserved populations with T2D. Food insecurity is also common and can impact glycemic control. Disclosure W.C. Bevier: None. N.M. Glantz: Research Support; Self; Abbott, Eli Lilly and Company. A.J. Larez: Research Support; Self; Eli Lilly and Company. M.A. Kujan: None. C. Conneely: None. K.N. Castorino: Research Support; Self; Abbott, Dexcom, Inc., Medtronic, Mylan, Novo Nordisk Inc. D. Kerr: Advisory Panel; Self; Novo Nordisk A/S, Sanofi-Aventis. Research Support; Self; Eli Lilly and Company. Stock/Shareholder; Self; Glooko, Inc. Funding Eli Lilly and Company; U.S. Department of Agriculture (2018-01793)