The Intersection between Food Insecurity and Diabetes: A Review

Gucciardi, Enza; Vahabi, Mandana; Norris, Nicole; Monte, John Paul Del; Farnum, Cecile

doi:10.1007/s13668-014-0104-4

Cited by 206 publications

(194 citation statements)

References 58 publications

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“…Food insecurity is not only a risk factor for developing diabetes, but it also contributes to diabetes complications when coping behaviors stray from clinical recommendations. 25 Individuals with diabetes who experience food insecurity have also been shown to use more urgent care services. 26 While we were able to examine a series of behaviors that suggest food insecurity, the NHIS lacks more in-depth information on the causes of these behaviors.…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes

et al. 2016

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Background Cost-related non-adherence (CRN) is prevalent among individuals with diabetes and can have significant negative health consequences. We examined health and non-health-related pressures and the use of cost-reducing strategies among the U.S. adult population with and without diabetes that may impact CRN. Methods Data from the 2013 wave of National Health Interview Survey (n=34,557) were used to identify the independent impact of perceived financial stress, financial insecurity with healthcare, food insecurity, and cost-reducing strategies on CRN. Results 11% (n=4,158) of adults reported diabetes. 14% with diabetes reported CRN, compared to 7% without. Greater perceived financial stress (Prevalence Ratio (PR)=1.07 [95% CI: 1.05 to 1.09]), financial insecurity with healthcare (PR=1.6 [95% CI: 1.5 to 1.67]), and food insecurity (PR=1.30 [95% CI: 1.2 to 1.4]) were all associated with a greater likelihood of CRN. Asking the doctor for a lower cost medication was associated with a lower likelihood of CRN (PR=0.2 [95% CI: 0.2 to 0.3]), and 27% with CRN reported this. Other cost-reducing behavioral strategies (using alternative therapies, buying prescriptions overseas) were associated with a greater likelihood of CRN. Conclusions Half of adults with diabetes perceived financial stress, and one-fifth reported financial insecurity with healthcare and food insecurity. Talking to a health care provider about low-cost options may be protective against CRN in some situations. Improving screening and communication to identify CRN and increase transparency of low-cost options patients are pursuing may help safeguard from the health consequences of cutting back on treatment.

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Section: Discussionmentioning

confidence: 99%

Social Determinants of Health, Cost-related Nonadherence, and Cost-reducing Behaviors Among Adults With Diabetes

et al. 2016

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“…3 Food insecurity is defined by the USDA as an inability to or limitation in accessing nutritionally adequate foods, or dependence on emergency food supplies. 4 The overall age-standardized rate of food insecurity in the US population increased from 9.1% in 2005 to 18.3% in 2012, and is shown to be particularly prevalent for those with cardiometabolic diseases.…”

Section: Introductionmentioning

confidence: 99%

“…5 For example, food insecure adults are 2–3 times more likely to have diabetes than those who are food secure, after adjustment for income, employment, and lifestyle. 3,6 …”

Section: Introductionmentioning

confidence: 99%

“…7–10 Overall, reliance on lower quality, energy-dense foods increases due to the higher cost of healthy alternatives. 3,11 However, it has also been hypothesized that food insecurity impacts an individual’s ability to make decisions regarding self-management of the disease. 8,12 For example, those with diabetes have noted diabetes specific diet behaviors such as counting carbohydrates and tracking servings were unrealistic, and meal planning became difficult with inconsistent income.…”

Section: Introductionmentioning

confidence: 99%

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Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes

Walker

Williams

Egede

2018

Public Health Nutr.

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Introduction Food insecurity is reported in approximately 28% of individuals with diabetes in the US, and is associated with poor glycemic and lipid control. The aim of this study was to understand the direct and indirect pathways through which food insecurity impacts glycemic control in individuals with diabetes. Methods 615 adults with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modeling (SEM) was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviors and glycemic control, including investigation into possible direct and indirect effects of perceived stress and social support. Results The final model showed that higher food insecurity was directly significantly related to increased stress (r= 0.14, p<0.001) and increased HbA1c (r= 0.66, p=0.03). Higher stress was significantly related to poorer self-care (r= −0.54, p<0.001), and lower social support (r= −0.41, p<0.001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycemic control. Conclusions Food insecurity had both a direct effect on glycemic control, and an indirect effect on self-care through stress. The indirect pathway suggests efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviors. The direct effect on glycemic control suggests pathways independent of self-care behaviors may also be necessary to improve diabetes outcomes. Results from this study suggest a multi-pronged approach is necessary to address food insecurity in individuals with diabetes.

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“…However, research also indicates that reliance on low-quality, energyrich foods can result in overweight or obesity [28], particularly when combined with other socioeconomic or geographic obstacles prevalent in food-insecure areas. For example, people living in these areas often have limited agency over their environments and face barriers to safe outdoor physical activity and the opportunity to purchase and prepare healthful foods [29].…”

Section: Food Securitymentioning

confidence: 99%