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Randomized Controlled Trial
. 2019 Mar;34(3):396-404.
doi: 10.1007/s11606-018-4716-z. Epub 2018 Nov 12.

Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial

Seth A Berkowitz  1   2   3   4 , Linda M Delahanty  5   6 , Jean Terranova  7 , Barbara Steiner  5 , Melanie P Ruazol  5 , Roshni Singh  5 , Naysha N Shahid  8 , Deborah J Wexler  5   6
Affiliations
Randomized Controlled Trial

Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial

Seth A Berkowitz et al. J Gen Intern Med. 2019 Mar.

Abstract

Background: Food insecurity, defined as inconsistent food access owing to cost, leads to poor health.

Objective: To test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.

Design: Randomized cross-over clinical trial.

Participants: Forty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign").

Intervention: In the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.

Main measures: The primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.

Key results: Mean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).

Conclusions: For food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).

Keywords: dietary quality; food insecurity; hypoglycemia; type 2 diabetes mellitus.

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Conflict of interest statement

Jean Terranova is an employee of Community Servings. All other authors declare they have nothing to disclose.

Figures

Fig. 1
Fig. 1
CONSORT diagram.
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References

    1. Centers for Disease Control and Prevention. Diabetes Fact Sheets. https://www.cdc.gov/diabetes/library/factsheets.html. Published December 26, 2017. Accessed 17 Sep 2018.
    1. Association AD 1. Improving Care and Promoting Health in Populations: Standards of Medical Care in Diabetes—2018. Diabetes Care. 2018;41(Supplement 1):S7–S12. doi: 10.2337/dc18-S001. - DOI - PubMed
    1. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security, Revised 2000. March 2000. https://fns-prod.azureedge.net/sites/default/files/FSGuide.pdf. Accessed 17 Sep 2018.
    1. Berkowitz SA, Baggett TP, Wexler DJ, Huskey KW, Wee CC. Food insecurity and metabolic control among U.S. adults with diabetes. Diabetes Care. 2013;36(10):3093–3099. doi: 10.2337/dc13-0570. - DOI - PMC - PubMed
    1. Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low-income NHANES participants. J Nutr. 2010;140(2):304–310. doi: 10.3945/jn.109.112573. - DOI - PMC - PubMed

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