Food insecurity and diabetes self-management among food pantry clients

Public Health Nutr. 2017 Jan;20(1):183-189. doi: 10.1017/S1368980016001786. Epub 2016 Jul 13.

Abstract

Objective: To examine the association between level of food security and diabetes self-management among food pantry clients, which is largely not possible using clinic-based sampling methods.

Design: Cross-sectional descriptive study.

Setting: Community-based food pantries in California, Ohio and Texas, USA, from March 2012 through March 2014.

Subjects: Convenience sample of adults with diabetes queuing at pantries (n 1237; 83 % response). Sampled adults were stratified as food secure, low food secure or very low food secure. We used point-of-care glycated Hb (HbA1c) testing to determine glycaemic control and captured diabetes self-management using validated survey items.

Results: The sample was 70 % female, 55 % Latino/Hispanic, 25 % white and 10 % black/African American, with a mean age of 56 years. Eighty-four per cent were food insecure, one-half of whom had very low food security. Mean HbA1c was 8·1 % and did not vary significantly by food security status. In adjusted models, very-low-food-secure participants, compared with both low-food-secure and food-secure participants, had poorer diabetes self-efficacy, greater diabetes distress, greater medication non-adherence, higher prevalence of severe hypoglycaemic episodes, higher prevalence of depressive symptoms, more medication affordability challenges, and more food and medicine or health supply trade-offs.

Conclusions: Few studies of the health impact of food security have been able to examine very low food security. In a food pantry sample with high rates of food insecurity, we found that diabetes self-management becomes increasingly difficult as food security worsens. The efficacy of interventions to improve diabetes self-management may increase if food security is simultaneously addressed.

Keywords: Diabetes self-management; Food pantries; Food security.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Aged
  • Blood Glucose / metabolism
  • California / epidemiology
  • Cross-Sectional Studies
  • Depression / blood
  • Depression / epidemiology*
  • Diabetes Mellitus / blood
  • Diabetes Mellitus / epidemiology*
  • Diabetes Mellitus / therapy*
  • Female
  • Food Assistance*
  • Food Supply*
  • Glycated Hemoglobin A / metabolism
  • Humans
  • Hypoglycemia / blood
  • Hypoglycemia / epidemiology*
  • Male
  • Middle Aged
  • Ohio / epidemiology
  • Prevalence
  • Self-Management
  • Socioeconomic Factors
  • Texas / epidemiology

Substances

  • Blood Glucose
  • Glycated Hemoglobin A