Food insecurity is associated with diabetes self-care behaviours and glycaemic control

• Published in: Diabetic medicine 2016-06, Vol.33 (6), p.844-850
• Main Authors: Heerman, W. J., Wallston, K. A., Osborn, C. Y., Bian, A., Schlundt, D. G., Barto, S. D., Rothman, R. L.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Blood Glucose - metabolism; Cross-Sectional Studies; Diabetes; Diabetes Mellitus, Type 2 - psychology; Female; Food; Food Supply; Glycated Hemoglobin A - metabolism; Humans; Hunger; Low income groups; Male; Middle Aged; Self Care - psychology; Tennessee; Young Adult
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/dme.12896

Aims Food insecurity is the ‘limited or uncertain availability of nutritionally adequate and safe foods’. Our objective was to examine the association between food insecurity, diabetes self‐care and glycaemic control. Methods We conducted a cross‐sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial evaluating a health literacy‐focused diabetes intervention in safety net primary care clinics in middle Tennessee. Food insecurity was assessed with three items from the U.S. Household Food Security Survey. Diabetes self‐care behaviours were assessed with the Summary of Diabetes Self‐Care Activities Scale, Personal Diabetes Questionnaire and Adherence to Refills and Medication Scale. Glycaemic control was assessed with HbA1c. Results The sample consisted of 401 participants, 73% of whom reported some level of food insecurity. Food insecurity was significantly associated with self‐care behaviours including less adherence to a general diet [Adjusted Odds Ratio (AOR) 0.9, P = 0.02], less physical activity (AOR 0.9, P = 0.04) and with a greater occurrence of medication non‐adherence (AOR 1.2, P = 0.002) and calorie restriction (AOR 1.1, P = 0.02). Food insecurity was also associated with worse glycaemic control (adjusted β = 0.1, P = 0.03). None of the self‐care behaviours were significantly associated with HbA1c, limiting the ability to test for self‐care as a mechanism linking food insecurity to glycaemic control. Conclusions There was a high rate of food insecurity in a sample of patients with Type 2 diabetes who were of low socio‐economic status. Food insecurity was associated with less adherence to recommended self‐care behaviours and worse glycaemic control. What's new? These data provide the first evidence that food insecurity is associated with diabetes self‐care behaviours, suggesting that further work should focus here to understand the mechanism by which food insecurity is associated with the onset of diabetes. These data show that food insecurity is associated with glycaemic control in a low‐income, under‐served population. The associations between food insecurity and glycaemic control, and food insecurity and diabetes self‐care behaviours point to food insecurity as a modifiable risk factor for improving diabetes control, especially in low‐income populations.