Food Insecurity and Glycemic Control Among Low-Income Patients With Type 2 Diabetes
Hilary K. Seligman, MD, MAS1,2⇓, Elizabeth A. Jacobs, MD, MPP3, Andrea López, BS1,2, Jeanne Tschann, PHD4 and Alicia Fernandez, MD1
+ Author Affiliations
1Division of General Internal Medicine, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
2Center for Vulnerable Populations, San Francisco General Hospital, University of California, San Francisco, San Francisco, California
3Division of General Medicine and Health Innovation Program, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
4Department of Psychiatry, University of California, San Francisco, San Francisco, California
Corresponding author: Hilary K. Seligman, firstname.lastname@example.org.
OBJECTIVE To determine whether food insecurity—the inability to reliably afford safe and nutritious food—is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes.
RESEARCH DESIGN AND METHODS We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control.
RESULTS The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A1c ≥8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07–2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control.
CONCLUSIONS Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.
This article contains Supplementary Data online at http://care.diabetesjournals.org/lookup/suppl/doi:10.2337/dc11-1627/-/DC1.