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

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.