Evaluating diabetes self-management education and support services delivered alone and in combination with produce packages at a Texas Food Bank

Daniel P Hatfield; Dayna S Alexander; Mary-Esther Gourdin; Georgiana Bradshaw; Oluwayomi Fabayo; Kimberly D Farris; Betsy Rodriguez; Julie Bromberg

doi:10.1080/10852352.2025.2552086

Evaluating diabetes self-management education and support services delivered alone and in combination with produce packages at a Texas Food Bank

J Prev Interv Community. 2025 Sep 3:1-11. doi: 10.1080/10852352.2025.2552086. Online ahead of print.

Authors

Daniel P Hatfield¹, Dayna S Alexander², Mary-Esther Gourdin¹, Georgiana Bradshaw³, Oluwayomi Fabayo², Kimberly D Farris², Betsy Rodriguez², Julie Bromberg¹

Affiliations

¹ Social Marketing & Communication, FHI 360, Washington, District of Columbia, USA.
² Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
³ Diabetes Hands On, Coastal Bend Food Bank, Corpus Christi, Texas, USA.

PMID: 40899975
DOI: 10.1080/10852352.2025.2552086

Abstract

Food banks can successfully deliver diabetes self-management education and support (DSMES) services, which improve glycemic control and reduce adverse outcomes among people with diabetes (PWD). However, consequences of providing produce packages with DSMES in food banks are unknown. This study assessed pre-to-post intervention changes in hemoglobin A1c (HbA1c), food security, and other outcomes among PWD (type 1 or 2) in two 8-week interventions delivered by a Texas food bank, one providing DSMES services alone (Diabetes Hands On [DHO], n = 31) and one providing DSMES services plus fruit/vegetable packages (Diabetes Hands On Plus [DHO+], n = 48). At pre- and post-intervention, HbA1c and body mass index (BMI) were directly measured, and surveys assessed food security, diabetes distress, diabetes self-efficacy, diabetes knowledge, medication-taking, perceived social support, fruit and vegetable intake, and diabetes-specific food security. Post-intervention questionnaires gauged program satisfaction. Participants in both DHO and DHO+ showed significant improvements in HbA1c, BMI, diabetes distress, diabetes self-efficacy, diabetes knowledge, vegetable intake, and some measures of diabetes-specific food security (p < .05 for each outcome). Average decreases in HbA1c were greater among DHO (-0.6%) versus DHO+ participants (-0.2%). Food security improved significantly in DHO participants only (pre: 32% very low; post: 10%, p = .001), as did medication-taking (p = .03). Fruit intake increased significantly in DHO+ participants only (p = .04). When asked to assess DHO/DHO+ overall, over 95% of both programs' participants provided "excellent" ratings. This study suggests that this food bank's DSMES services, with or without produce, may have been effective for improving HbA1c and other clinical, behavioral, and psychosocial outcomes among PWD. Benefits of providing produce alongside DSMES remain unclear. Further research may be needed to explore factors such as dose, duration, and household-level use. Studies in other geographies and non-food-bank settings may increase understanding of the generalizability of findings.

Keywords: Charitable food system; diabetes management; food is medicine; food pantries; food security; type 2 diabetes.