Understanding Food Security as a Social Determinant of Diabetes-Related Health during Pregnancy

Gomez, Helen B.; DiTosto, Julia D.; Niznik, Charlotte M.; Yee, Lynn M.

doi:10.1055/s-0041-1740194

“…For example, risk of youth-onset obesity and insulin resistance is significantly higher among offspring of women with diabetes during pregnancy, 9 , 28 but this maternal risk differs by race and ethnicity 29 and is driven by exposure to adverse SDOH. 30 , 31 Youth-onset obesity and prediabetes risk are reduced by engagement in health-promoting behaviors, including physical activity and consumption of nutrient-dense foods; unfortunately, these health behaviors are often hardest to achieve for youths from communities which, due to oppressive policies and practices, have concentrated poverty and high rates of community violence. 9 We also note that the prevalence of adverse SDOH in this cohort was relatively higher than the general population.…”

Section: Discussionmentioning

confidence: 99%

“…For example, risk of youth-onset obesity and insulin resistance is significantly higher among offspring of women with diabetes during pregnancy, 9,28 but this maternal risk differs by race and ethnicity 29 and is driven by exposure to adverse SDOH. 30,31 Youth-onset obesity and prediabetes risk are reduced by engagement in healthpromoting behaviors, including physical activity and consumption of nutrient-dense foods;…”

Section: Discussionmentioning

confidence: 99%

Prediabetes Prevalence by Adverse Social Determinants of Health in Adolescents

Harrison,

Peyyety,

Rodriguez Gonzalez

et al. 2024

JAMA Netw Open

3

0

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ImportanceSeveral clinical practice guidelines advise race- and ethnicity-based screening for youth-onset type 2 diabetes (T2D) due to a higher prevalence among American Indian and Alaska Native, Asian, Black, and Hispanic youths compared with White youths. However, rather than a biological risk, this disparity likely reflects the inequitable distribution of adverse social determinants of health (SDOH), a product of interpersonal and structural racism.ObjectiveTo evaluate prediabetes prevalence by presence or absence of adverse SDOH in adolescents eligible for T2D screening based on weight status.Design, Setting, and ParticipantsThis cross-sectional study and analysis used data from the 2011 to 2018 cycles of the National Health and Nutrition Examination Survey. Data were analyzed from June 1, 2023, to April 5, 2024. Participants included youths aged 12 to 18 years with body mass index (BMI) at or above the 85th percentile without known diabetes.Main Outcomes and MeasuresThe main outcome consisted of an elevated hemoglobin A1c (HbA1c) level greater than or equal to 5.7% (prediabetes or undiagnosed presumed T2D). Independent variables included race, ethnicity, and adverse SDOH (food insecurity, nonprivate health insurance, and household income &lt;130% of federal poverty level). Survey-weighted logistic regression was used to adjust for confounders of age, sex, and BMI z score and to determine adjusted marginal prediabetes prevalence by race, ethnicity, and adverse SDOH.ResultsThe sample included 1563 individuals representing 10 178 400 US youths aged 12 to 18 years (mean age, 15.5 [95% CI, 15.3-15.6] years; 50.5% [95% CI, 47.1%-53.9%] female; Asian, 3.0% [95% CI, 2.2%-3.9%]; Black, 14.9% [95% CI, 11.6%-19.1%]; Mexican American, 18.8% [95% CI, 15.4%-22.9%]; Other Hispanic, 8.1% [95% CI, 6.5%-10.1%]; White, 49.1% [95% CI, 43.2%-55.0%]; and &gt;1 or other race, 6.1% [95% CI, 4.6%-8.0%]). Food insecurity (4.1% [95% CI, 0.7%-7.5%]), public insurance (5.3% [95% CI, 1.6%-9.1%]), and low income (5.7% [95% CI, 3.0%-8.3%]) were each independently associated with higher prediabetes prevalence after adjustment for race, ethnicity, and BMI z score. While Asian, Black, and Hispanic youths had higher prediabetes prevalence overall, increasing number of adverse SDOH was associated with higher prevalence among White youths (8.3% [95% CI, 4.9%-11.8%] for 3 vs 0.6% [95% CI, −0.7% to 2.0%] for 0 adverse SDOH).Conclusions and RelevanceAdverse SDOH were associated with higher prediabetes prevalence, across and within racial and ethnic categories. Consideration of adverse SDOH may offer a more actionable alternative to race- and ethnicity-based screening to evaluate T2D risk in youth.

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“…Type 2 diabetes (T2D) is one of the most frequent chronic comorbid conditions in pregnancy 1–3. Every year in the USA more than 100 000 pregnancies are complicated by T2D, which is anticipated to double in the next 10 years, affecting 1 in 20 pregnancies 4–6. T2D increases the risk of adverse pregnancy outcomes for the pregnant individual, including severe maternal morbidity, caesarean delivery, preeclampsia and severe maternal morbidity, and infant, including large for gestational age at birth, preterm birth and neonatal hypoglycaemia 7–9.…”

Section: Introductionmentioning

confidence: 99%

Multicomponent provider–patient intervention to improve glycaemic control in Medicaid-insured pregnant individuals with type 2 diabetes: clinical trial protocol for the ACHIEVE study

Venkatesh,

Joseph,

Swoboda

et al. 2023

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Introduction Type 2 diabetes (T2D) is one of the most frequent comorbid medical conditions in pregnancy. Glycaemic control decreases the risk of adverse pregnancy outcomes for the pregnant individual and infant. Achieving glycaemic control can be challenging for Medicaid-insured pregnant individuals who experience a high burden of unmet social needs. Multifaceted provider–patient-based approaches are needed to improve glycaemic control in this high-risk pregnant population. Mobile health (mHealth) applications (app), provider dashboards, continuous glucose monitoring (CGM) and addressing social needs have been independently associated with improved glycaemic control in non-pregnant individuals living with diabetes. The combined effect of these interventions on glycaemic control among pregnant individuals with T2D remains to be evaluated. Methods and analysis In a two-arm randomised controlled trial, we will examine the combined effects of a multicomponent provider–patient intervention, including a patient mHealth app, provider dashboard, CGM, a community health worker to address non-medical health-related social needs and team-based care versus the current standard of diabetes and prenatal care. We will recruit 124 Medicaid-insured pregnant individuals living with T2D, who are ≤20 weeks of gestation with poor glycaemic control measured as a haemoglobin A1c ≥ 6.5% assessed within 12 weeks of trial randomisation or within 12 weeks of enrolling in prenatal care from an integrated diabetes and prenatal care programme at a tertiary care academic health system located in the Midwestern USA. We will measure how many individuals achieve the primary outcome of glycaemic control measured as an A1c<6.5% by the time of delivery, and secondarily, adverse pregnancy outcomes; patient-reported outcomes (eg, health and technology engagement, literacy and comprehension; provider–patient communication; diabetes self-efficacy; distress, knowledge and beliefs; social needs referrals and utilisation; medication adherence) and CGM measures of glycaemic control (in the intervention group). Ethics and dissemination The Institutional Review Board at The Ohio State University approved this study (IRB: 2022H0399; date: 3 June 2023). We plan to submit manuscripts describing the user-designed methods and will submit the results of the trial for publication in peer-reviewed journals and presentations at international scientific meetings. Trial registration number NCT05662462

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“…OBJECTIVE: Food and nutrition insecurity affects 1 in 4 pregnant individuals and increases the risk for adverse pregnancy outcomes. 1 , 2 Despite increasing calls to action to address food and nutrition insecurity in pregnancy, 2 there remains limited evidence that describe the use of prenatal clinic–based referrals to community-based food pantries to improve food security for pregnant individuals. 3 …”

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confidence: 99%