Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes

• Published in: Diabetes research and clinical practice 2018-04, Vol.138, p.128-137
• Main Authors: Mendoza, Jason A., Haaland, Wren, D'Agostino, Ralph B., Martini, Lauren, Pihoker, Catherine, Frongillo, Edward A., Mayer-Davis, Elizabeth J., Liu, Lenna L., Dabelea, Dana, Lawrence, Jean M., Liese, Angela D.
• Format: Article
• Language: English
• Subjects: Adolescent; Cross-Sectional Studies; Diabetes Mellitus, Type 1 - complications; Diabetes Mellitus, Type 1 - pathology; Emergency department; Female; Food Supply - methods; Hospitalizations; Humans; Hyperglycemia - etiology; Hyperglycemia - pathology; Male; Patient Acceptance of Health Care; Pediatric; Risk; Social determinants of health
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2018.01.035

•Youth and adults with T1D had higher food insecurity than the national population.•Food insecurity was associated with high risk glycemic control.•Food insecurity was associated with more emergency department visits.•Programs are needed to alleviate food insecurity among youth and adults with T1D. Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI. Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants’ HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey. The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households. FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.