Severe food insecurity among adults with diabetes seeking food assistance at food pantries

Background: In clinical populations of adults with diabetes, food insecurity (FI) independently increases risk for poor diabetes self-management and poor glycemic (HbA1c) control. Previous studies of diabetes self-management have been conducted in clinical-based samples and have been unable to examine severe FI.

Methods: We surveyed adults queuing at food pantries in Texas, California, and Ohio (n=550). Eligible participants self-reported diabetes or had a point-of-care HbA1C test <6.5%. Participants were stratified by FI: “no FI”, “mild FI”, or “severe FI.” We investigated unadjusted associations between FI and potential mediators of poor glycemic control: depressive symptoms (prevalence), diabetes self-efficacy (scored 1-10), diabetes distress (1-6), medication non-adherence (0-4), and financial tradeoffs between food and medicine (yes/no). We also examined HbA1c (%).

Results: The sample was 70% female, 54% Latino, and 8% African-American with a mean age of 58. The prevalence of mild FI was 41% and severe FI, 44%. FI was strongly associated with mediators of poor glycemic control (p<0.05 for all compared to no FI group): higher depression (52% no FI, 64% mild FI, and 84% severe FI), poorer diabetes self-efficacy (means scores of 7.5, 6.9, and 6.5, respectively), greater diabetes distress (2.1, 2.9, and 3.3), greater medication non-adherence (0.8, 1.1, and 1.4), and more food-medicine tradeoffs (15%, 40%, and 57%). Mean HbA1c did not significantly differ (7.9%, 8.0%, and 8.1%, respectively).

Conclusion: Severely food insecure adults with diabetes demonstrate substantial barriers to effective self-management. Efforts to disseminate diabetes self-management programs into low-income, community-based settings must address food affordability challenges.