Food Insecurity and Metabolic Control Among U.S. Adults With Diabetes

Abstract

OBJECTIVEWe sought to determine whether food insecurity is associated with worse glycemic, cholesterol, and blood pressure control in adults with diabetes.RESEARCH DESIGN AND METHODSWe 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.CONCLUSIONSFood 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.

Psychological Distress Mediates the Association between Food Insecurity and Suboptimal Sleep Quality in Latinos with Type 2 Diabetes Mellitus

“…Once a person is diagnosed with diabetes, his or her level of HFI is associated with being depressed and having greater emotional distress and suboptimal glycemic control (18,(53)(54)(55). Our findings suggest that the relation between HFI and sleep quality is complex and seems to be mediated by psychological distress.…”

The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes

“…1 In the United States, one in seven households experienced food insecurity in 2013. 2 For those with diabetes, being food-insecure is associated with poorer glycemic control, [3][4][5] as well as increased risk of hypoglycemic events and hypoglycemia-related emergency department visits. 6,7 The mechanisms through which food insecurity affects glycemic control are not well understood.…”

Health Promotion and Diabetes Prevention in American Indian and Alaska Native Communities — Traditional Foods Project, 2008–2014

“…Food insecurity, defined as uncertain or limited access to enough foods for an active healthy life because of a lack of money or resources, affected 28% of Native households with children in 2008, compared with 16% of U.S. households with children (26). Researchers have linked food insecurity to obesity in households with children (27), diabetes in adults (28), and poor glucose control for adults who have diabetes (29,30). Food insecurity is found on many reservations where food deserts (i.e., rural, low-income residents must travel more than 10 miles to access supermarkets or grocery stores) are prevalent (31)(32)(33).…”