245329 Food insecurity and glycemic control among patients with diabetes

Monday, October 31, 2011

Hilary Seligman, MD, MAS , Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Elizabeth A. Jacobs, MD, MPP , Collaborative Research Unit, John H. Stroger Jr. Hospital of Cook County & Rush Medical College, Madison, WI
Andrea Lopez , Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Alicia Fernandez, MD , Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Little is known about the extent to which food insecurity is associated with clinical health outcomes among adults. We examined the association between food insecurity and glycemic control in a cross-sectional study of English- and Spanish-speaking patients with diabetes receiving care in safety-net health clinics in San Francisco or Chicago (n=710). We assessed food insecurity using the short form of the Food Security Survey Module. Our main outcome measure was most recent hemoglobin A1c (HbA1c) level. We used linear or logistic regression, with multivariate models adjusting for age, race/ethnicity, and gender. The food insecurity (FI) prevalence in our sample was 46%. Mean HbA1c was higher among FI participants compared with food secure (FS) participants (8.54% vs 8.09%, p=0.007). In multivariate models, the difference in HbA1c between FI and FS participants was 0.32% (p=0.05). FI participants were significantly more likely than FS participants to have poor glycemic control (HbA1c≥8.5%; 42% vs 33%, p=0.02), although this relationship was no longer statistically significant after adjusting. FI participants were more likely to report difficulty affording a diabetic diet (68% vs 43%, p<0.001). FI participants also reported lower diabetes-specific self-efficacy (mean 7.22 vs 7.81 on a 10-point scale, p<0.001) and higher diabetes distress (3.88 vs 2.96 on a 5-point scale, p<0.001). Both diabetes-specific self-efficacy and diabetes distress partially mediated the association between FI and HbA1c. We conclude FI is associated with poor glycemic control. FI may contribute to the disproportionate burden of diabetes-related complications associated with low socioeconomic status.

Learning Areas:
Chronic disease management and prevention

Learning Objectives:
1. Discuss food insecurity as a risk factor for hyperglycemia among patients with diabetes 2. Describe three pathways by which food insecurity may be related to the development of hyperglycemia among patients with hyperglycemia

Keywords: Diabetes, Food Security

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I work with Dr. Seligman on a number studies examining food insecurity and diabetes.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.