Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes  [2012]

Seligman, Hilary K. Jacobs, Elizabeth A. López, Andrea Tschann, Jeanne et al.

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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 A1c ≥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 glycemi
c 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.

Other subjects

  • distress
  • models
  • healthy diet
  • screening
  • risk factors
  • glycemic control
  • patients
  • regression analysis
  • glycohemoglobin
  • noninsulin-dependent diabetes mellitus
  • odds ratio
  • diabetic diet
  • cross-sectional studies
  • food security
  • self-efficacy
  • risk

From the journal

Diabetes care

ISSN : 0149-5992