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. 2012 Feb;35(2):233-8.
doi: 10.2337/dc11-1627. Epub 2011 Dec 30.

Food insecurity and glycemic control among low-income patients with type 2 diabetes

Hilary K Seligman  1 , Elizabeth A Jacobs, Andrea López, Jeanne Tschann, Alicia Fernandez
Affiliations

Food insecurity and glycemic control among low-income patients with type 2 diabetes

Hilary K Seligman et al. Diabetes Care. 2012 Feb.

Abstract

Objective: 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.

Research design and methods: 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.

Results: 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.

Conclusions: 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.

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Figures

Figure 1
Figure 1
Association between HbA1c and food security status among patients with diabetes receiving care in safety net clinics (n = 710).
See this image and copyright information in PMC

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