Food security is related to adult type 2 diabetes control over time in a United States safety net primary care clinic population

Abstract

Background/objectives: Successful Type 2 diabetes management requires adopting a high nutrient-density diet made up of food items that both meet dietary needs and preferences and can be feasibly obtained on a regular basis. However, access to affordable, nutrient-dense foods often is lacking in poorer neighbourhoods. Therefore, low food security should directly impair glucose control, even when patients have full access to and utilize comprehensive medical management. The present study sought to determine whether food security is related longitudinally to glucose control, over-and-above ongoing medication management, among Type 2 diabetes patients receiving comprehensive care at a Midwestern multi-site federally qualified health centre (FQHC).

Subjects/methods: In this longitudinal observational study, we completed a baseline assessment of patients' food security (using the US Household Food Security Module), demographics (via Census items), and diabetes history/management (using a structured clinical encounter form) when patients began receiving diabetes care at the health centre. We then recorded those patients' A1C levels several times during a 24-month follow-up period. Three hundred and ninety-nine patients (56% with low food security) had a baseline A1c measurement; a subsample of 336 (median age=52 years; 56% female; 60% Hispanic, 27% African American, and 9% White) also had at least one follow-up A1c measurement.

Results: Patients with lower (vs higher) food security were more likely to be on insulin and have higher A1c levels at baseline. Moreover, the disparity in glucose control by food security status persisted throughout the next 2 years.

Conclusions: Although results were based on one multi-site FQHC, potentially limiting their generalizability, they seem to suggest that among Type 2 diabetes patients, low food security directly impairs glucose control-even when patients receive full access to comprehensive medical management-thereby increasing their long-term risks of high morbidity, early mortality, and high health-care utilization and cost.

Figure 1

Trajectory of A1c Levels over Time by Initial Food Security Status. The solid line represents A1c levels of food insecure patients, whereas the dashed line represents A1c levels of food secure patients.

Figure 2

A1c Levels by Age and Food Security Status at Enrollment. The dark grey line represents A1c levels of food insecure patients, whereas the light grey line represents A1c levels of food secure patients.

Figure 3

A1c Levels by Years since Diagnosis and Obesity. Dark grey bars represent A1c levels of patients who were diagnosed with diabetes less than 15 years ago, whereas light grey bars represent A1c levels of patients diagnosed with diabetes 15 or more years ago. *P <0.05.