263592 Food Insecurity in Relation to Changes in Self-Efficacy, Nutrition, and Hemoglobin A1c during a Diabetes Educational Intervention

Monday, October 29, 2012 : 3:30 PM - 3:50 PM

Courtney Lyles, PhD , Center for Vulnerable Populations, UCSF, San Francisco, CA
Michael Wolf, PhD, MPH , Feinberg School of Medicine, Northwestern University, Chicago, IL
Allison Dahlke, MPH , Feinberg School of Medicine, Northwestern University, Chicago, IL
Terry Davis, PhD , Department of Medicine - Pediatrics, Louisiana State University - Shreveport, Shreveport, LA
Laura Curtis, MS , Feinberg School of Medicine, Northwestern University, Chicago, IL
Darren DeWalt, MD, MPH , School of Medicine - Division of General Internal Medicine, University of North Carolina Chapel Hill, Chapel Hill, NC
Dean Schillinger, MD , Department of Medicine, University of California, San Francisco, San Francisco, CA
Hilary Seligman, MD, MAS , Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Background Food insecurity may make it more difficult to self-manage chronic diseases like diabetes. However, there have been no longitudinal studies examining food insecurity and disease self-management.

Methods We conducted a secondary analysis using data from 621 patients with diabetes participating in the Missouri Health Literacy and Diabetes Communication Initiative. We examined baseline food insecurity (6-item scale, dichotomized as secure/insecure) in relation to outcomes over 1 year: diet and diabetes self-efficacy (scored 1-5), fruit and vegetable intake (servings/day), and HbA1c (%). We examined longitudinal differences using GEE linear regressions clustering by individual and controlling for time, age, gender, race, income, intervention arm, and interaction of time by food insecurity.

Results Food insecure participants (n= 214) were younger, had less income, and were more likely to be unemployed. At baseline, food insecure individuals had higher mean HbA1c values, lower diet and diabetes self-efficacy, and lower fruit and vegetable intake (all p≤0.01). Compared to food secure individuals, food insecure participants had significantly greater improvements in HbA1c (reduced on average by 0.39%), diet self-efficacy score (increased by 0.23 points), and diabetes self-efficacy score (increased by 0.26 points) over time (interaction terms: p<0.05). There was no significant HbA1c difference between the groups at follow-up.

Conclusions Participants experiencing food insecurity began the study with poorer measures of self-efficacy, dietary intake, and glycemic control. However, food insecure participants made significant improvements on HbA1c and self-efficacy, whereas food secure participants did not. This finding suggests that food insecure patients may be particularly receptive to diabetes self-management support.

Learning Areas:
Chronic disease management and prevention
Public health or related research

Learning Objectives:
1. Compare changes in diabetes self-efficacy, nutritional intake, and glycemic control between food insecure and food secure individuals over time, within a diabetes self-management intervention conducted in low-income communities.

Keywords: Food Security, Diabetes

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have completed my PhD in health services research and have completed the analyses in this work. I have been working under the mentorship of Dr. Hilary Seligman on this project, an expert in food insecurity in relation to diabetes care and outcomes.
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.