Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions

Levi, Ronli; Bleich, Sara N.; Seligman, Hilary K.

doi:10.2337/dci23-0002

Cited by 23 publications

(7 citation statements)

References 62 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The U.S. national policy on hunger, nutrition and health aims to improve food access and affordability, empower consumers, support physical activity, integrate nutrition and public health and enhance research. These efforts, in concert with diabetes education and counseling that takes into account the social determinants of health [43], could yield downstream benefits for autonomic tone and diabetes outcomes.…”

Section: Discussionmentioning

confidence: 99%

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

Bermúdez-Millán,

Feinn,

Lampert

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

Aim We examined household food insecurity (HFI) and autonomic nervous system (ANS) function in a subset of low-income Latinos with type 2 diabetes with data from a stress management trial. Methods Inclusion Latino or Hispanic, Spanish speaking, age less than 18 years, ambulatory status, type 2 diabetes more than 6 months, A1c less than 7.0%. Exclusion Pain or dysfunction in hands (e.g., arthritis) precluding handgrip testing; medical or psychiatric instability. HFI was assessed with the 6-item U.S. household food security survey module; with responses to > = 1 question considered HFI. An ANS dysfunction index was calculated from xix autonomic function tests which were scored 0 = normal or 1 = abnormal based on normative cutoffs and then summed. Autonomic function tests were: 1) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (Holter) monitors; 2) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest; 3) difference between baseline supine and the minimal BP after standing up; and, from 24-hour urine specimens 4) cortisol, 5) normetanephrine, and, 6) metanephrine. Results Thirty-five individuals participated, 23 (65.7%) of them were women, age mean = 61.6 (standard deviation = 11.2) years, HbA1c mean = 8.5% (standard deviation = 1.6) and 20 participants (57.1%) used insulin. Twenty-two participants (62.9%) reported HFI and 25 (71.4%) had one or more abnormal ANS measure. Independent t-tests showed that participants with HFI had a higher ANS dysfunction index (mean = 1.5, standard deviation = 0.9) than patients who were food secure (mean = 0.7, standard deviation = 0.8), p = 0.02. Controlling for financial strain did not change significance. Total ANS index was not related to glycemia, insulin use or other socioeconomic indicators. In this sample, HFI was associated with ANS dysfunction. Policies to improve food access and affordability may benefit health outcomes for Latinos with diabetes.

show abstract

Section: Discussionmentioning

confidence: 99%

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

Bermúdez-Millán,

Feinn,

Lampert

et al. 2024

PLoS ONE

View full text Add to dashboard Cite

show abstract

“…This study evaluates the feasibility and effectiveness of a health intervention program targeted to patients diagnosed with diabetes and/or a lipid metabolism disorder and focused on food consumption and self-care management in a clinical setting but with a non-traditional partnership. Previous food bank pilots have highlighted the need for this kind of partnership to improve the way communities manage low-income members' health issues [17,22,32]. Food banks know how to reach vulnerable populations, while healthcare systems serve and care for diagnosed patients and targeted populations.…”

Section: Discussionmentioning

confidence: 99%

“…By using the "Before" period when the program was not in place, the individuals could have not been able to adjust their behavior due to possible future participation in the health intervention program. Individual behavioral pre-participation changes are regular problems in health intervention programs, because interventions can take time to be implemented [32]. Participants may feel compelled to change their behavior right before the start of such programs.…”

Section: Impact Analysis Methodologymentioning

confidence: 99%

Food as Medicine: FOODRx for Patients with Diabetes and Cardiovascular Disease in Central Minnesota—A PILOT STUDY

García-Pérez,

De Kesel Lofthus,

Tilstra

et al. 2024

Diabetology

View full text Add to dashboard Cite

The number of food-insecure individuals with diabetes is on the rise. FOODRx is a supplemental healthy food intervention program that gave disease-appropriate food boxes to food-insecure patients with diabetes at their care clinic and included nutrition and recipe materials in the patient’s preferred language (English, Spanish, or Somali). Implemented over a twelve-month period, we analyze FOODRx participants’ pre and post clinical measures, health care usage, and program/clinic satisfaction, and found that participation was linked to post improvements in fasting glucose and HgbA1c levels, reductions in ER visits and healthcare costs, and a decline in patients choosing between medication and food. Glucose levels decreased from 214 to 187 mg/dL and HgbA1c levels decreased from 9.6% to 9.1%. Average ER visits dropped from 1.21 to 1 visit and the reductions in healthcare costs were reflected in a decrease of an average of USD 250,000 in insurance claims. Patients were less likely to experience food insecurity, as measured in number of meals skipped and levels of hunger. Finally, the program improved patient satisfaction with the cultural responsiveness of the information shared with them.

show abstract

“…The prohibitive cost of “healthy” eating also reflects existing evidence of the negative impact of food insecurity on controlling diabetes in minority populations ( 95 – 97 ). Solving these broader socio-economic determinants is difficult within the scope of a single intervention but there are indications that providing transport ( 98 ), food coupons ( 99 ), or “food is medicine” type initiatives where nutritional food is prescribed by HCPs ( 100 ) can help low-income families manage diabetes ( 101 ). There is also the potential of CHWPs to visit individual households or provide remote sessions as ways of encouraging engagement with self-management support ( 102 ) though these are subject to issues of connectivity and digital literacy which can be limited in minoritized populations ( 103 ).…”

Section: Discussionmentioning

confidence: 99%

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Grant,

Litchfield

2024

Front. Clin. Diabetes Healthc.

View full text Add to dashboard Cite

ObjectiveEthnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.Materials and methodsThe major databases were searched for existing qualitative evidence of participants’ experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon’s Theoretical Framework of Acceptability.ResultsThe results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants’ satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.ConclusionMany of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.

show abstract

Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions

Cited by 23 publications

References 62 publications

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

Household food insecurity is associated with greater autonomic dysfunction testing score in Latinos with type 2 diabetes

Food as Medicine: FOODRx for Patients with Diabetes and Cardiovascular Disease in Central Minnesota—A PILOT STUDY

Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review

Contact Info

Product

Resources

About