Food Insecurity in Relation to Changes in Hemoglobin A1c, Self-Efficacy, and Fruit/Vegetable Intake During a Diabetes Educational Intervention
- Courtney R. Lyles, PHD1⇑,
- Michael S. Wolf, PHD, MPH2,
- Dean Schillinger, MD1,
- Terry C. Davis, PHD3,
- Darren DeWalt, MD, MPH4,
- Allison R. Dahlke, MPH2,
- Laura Curtis, MS2 and
- Hilary K. Seligman, MD, MAS1
- 1University of California San Francisco Center for Vulnerable Populations, Division of General Internal Medicine at San Francisco General Hospital, San Francisco, California
- 2Health Literacy and Learning Program, Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- 3Department of Medicine-Pediatrics, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
- 4Division of General Internal Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, North Carolina
- Corresponding author: Courtney R. Lyles, .
OBJECTIVE Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.
RESEARCH DESIGN AND METHODS We conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A1c (HbA1c) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.
RESULTS Overall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA1c values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA1c over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA1c by food security status at follow-up.
CONCLUSIONS Participants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA1c and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges.
The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH.
- Received September 25, 2012.
- Accepted November 12, 2012.
- © 2013 by the American Diabetes Association.
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