Managing diabetes and food insecurity in times of extreme economic hardship: A qualitative study of low-income diabetic safety net clinic patients

Introduction: Diabetes is one of the most prevalent chronic health conditions in the United States. Few studies have investigated the impact of food insecurity on the self-management practices of patients with diabetes. This study documents the experiences of low-income patients struggling to manage their diabetes in times of economic hardship and food insecurity.

Methods: We conducted semi-structured interviews with English and Spanish speaking Type II diabetes patients (N=20) receiving care at a Safety Net Clinic in Southern California. Data were coded for key themes using ATLAS.ti Qualitative Data Analysis software.

Results: The majority of participants (55% male) were Latino (40%) or African American (25%) and 54 years old, on average. These patients (1) frequently experienced cycles of food scarcity and abundance depending upon receipt of income (i.e. arrival of paycheck, welfare benefits, contract work) (2) were forced to manage competing economic demands such as paying rent or electricity over purchasing healthy food, further exacerbating the health impacts of food insecurity, and (3) employed creative strategies to incorporate clinical recommendations of portion control that often resulted in reducing daily food consumption rather than incorporating more healthy food items.

Discussion: With referral Medicare currently covers three hours annually of medical nutritional therapy for people with diabetes. It is unclear if low-income patients utilize such services. Our findings underscore the urgent need to assess the health impact of food insecurity on diabetes management among low-income patients. Further, policy makers should be aware of the direct health implications of the thinning social safety net.