Low-income Patients with Type 2 Diabetes: Glycemic Control and Food Insecurity
US researchers set out to determine whether food insecurity is linked to poor glycemic control in patients with type 2 diabetes. They also looked at whether this relationship is mediated by 3 things: difficulty following a diabetic diet; diabetes self-efficacy; or emotional distress related to managing type 2 diabetes.
Their findings appeared in the February 2012 issue of Diabetes Care in the article “Food insecurity and glycemic control among low-income patients with type 2 diabetes.”
The research team used a cross-sectional survey and a chart review of 711 patients with type 2 diabetes who were being seen in safety net health clinics. The researchers used multi-variable regression models to examine the link between food insecurity and poor glycemic control in these patients.
In this study, food insecurity prevalence was 46%.
Researchers found that those study participants who were food insecure were significantly more likely than participants who were food secure to have poor glycemic control as defined by hemoglobin (HbA1c) that was greater than or equal to 8.5% (42% vs 33%; adjusted odds ratio: 1.48; 95% confidence interval [CI]: 1.07 to 2.04).
Study participants who were food insecure were more likely to report difficulty affording a diabetic diet (64% vs 49%; p<0.001). In addition, these participants reported lower diabetes-specific self-efficacy (p<0.001) and higher emotional distress related to diabetes (p<0.001).
At the end of the study, the research team concluded that food insecurity is an independent risk factor for poor glycemic control in patients in the safety net setting who have type 2 diabetes. This risk factor may be partially attributed to an increased difficulty in following a diabetic diet as well as increased emotional distress in regard to a patient’s capacity for successful self-management of diabetes.
The researchers suggest that screening patients who have type 2 diabetes for food insecurity may be particularly appropriate, especially in the safety net setting.