If you’re one of the millions of Americans who tuned in to some Thanksgiving TV programming last week, you probably caught at least a few pharmaceutical ads for drugs to help manage diabetes and its side effects. You may not have realized that November is National Diabetes Awareness Month, but the steady drumbeat of these ads reflects a large and growing demand for diabetes treatment in this country: the Centers for Disease Control report that, in 2015, 30.3 million individuals—nearly 1 in 10 Americans—had diabetes.
And although September is technically Hunger Action Month, the focus on food abundance during the holiday period has also made November into an unofficial national hunger awareness month.
While it was once a coincidence that these two issues converged in November, a growing body of evidence is connecting diabetes and food insecurity in important ways. Research shows that food insecurity is more prevalent among individuals living with diabetes, and similarly, diabetes is more prevalent in households struggling to afford an adequate diet. Food insecurity also increases the likelihood that individuals “stretch” their insulin supply, or delay filling prescriptions or purchasing testing strips. These tradeoffs between food and medical supplies can cause lasting harm.
A recent randomized controlled trial, supported in part by Policies for Action and coordinated by Feeding America and researchers at UCSF and the Urban Institute, revealed that efforts targeted at the intersection of hunger and diabetes can make an important difference in addressing these dual challenges.
In its first phase, the study offered diabetes screening to clients at food pantries affiliated with food banks in Detroit, Houston and Oakland. Those who were identified as having poorly-controlled diabetes were given the opportunity to enroll, and then randomly assigned to a treatment or a control group. The treatment group received:
- HbA1c testing at three and six months (which assessed average blood glucose levels for the prior two to three months);
- referrals to primary care providers as needed;
- twice monthly food pantry packages with diabetes-appropriate foods;
- formal diabetes self-management classes; and,
- one-on-one check-ins with diabetes educators.
The control group was eligible to receive regular food pantry services and then enter a modified version of the intervention after a six-month waiting period.
When compared to the control group, intervention participants experienced statistically significant improvements in food insecurity, food stability, and fruit and vegetable intake. Tradeoffs between purchasing food and diabetes supplies were also mitigated. However, the intervention did not have an impact on glycemic control, hypoglycemia or other measures related to diabetes management, suggesting that improving food resources is an important but not sufficient strategy for achieving overall improvements in diabetes outcomes.
Building on this work, the research team is now examining the sustainability of the intervention by tracking outcomes for individuals six months after completing the trial. The team is also assessing the results of the scaled-down intervention offered to the control group participants.
Focused efforts to improve food security can knock down critical barriers to accessing a more healthful diet for low-income individuals living with diabetes. To amplify the trial’s positive effects, clinicians and other health providers could be encouraged to partner with charitable feeding programs to tailor resources for patients with diabetes, and also refer patients for enrollment in SNAP. In addition to serving as a first line of defense for food resources among low-income patients, a recent study found that SNAP participation may also reduce the incidence of cost-related medication nonadherence among diabetes patients, perhaps by freeing income that would have been spent on food to support compliance with medication regimens.
The next frontier of work at the intersection of these two major public health challenges may require a focus on more fully embedding strategies for addressing food insecurity in clinical diabetes management. And the lessons we’re learning from this trial illuminate bigger, cross-system solutions to our national struggle with chronic conditions.
Photo by Miriam Doerr Martin Frommherz/Shutterstock