Food insecurity and metabolic control among U.S. adults with diabetes

We sought to determine whether food insecurity is associated with worse glycemic, cholesterol, and blood pressure control in adults with diabetes.

We conducted a cross-sectional analysis of data from participants of the 1999-2008 National Health and Nutrition Examination Survey. All adults with diabetes (type 1 or type 2) by self-report or diabetes medication use were included. Food insecurity was measured by the Adult Food Security Survey Module. The outcomes of interest were proportion of patients with HbA1c>9.0% (75 mmol/mol), LDL cholesterol>100 mg/dL, and systolic blood pressure>140 mmHg or diastolic blood pressure>90 mmHg. We used multivariable logistic regression for analysis.

Among the 2,557 adults with diabetes in our sample, a higher proportion of those with food insecurity (27.0 vs. 13.3%, P<0.001) had an HbA1c>9.0% (75 mmol/mol). After adjustment for age, sex, educational attainment, household income, insurance status and type, smoking status, BMI, duration of diabetes, diabetes medication use and type, and presence of a usual source of care, food insecurity remained significantly associated with poor glycemic control (odds ratio [OR] 1.53 [95% CI 1.07-2.19]). Food insecurity was also associated with poor LDL control before (68.8 vs. 49.8, P=0.002) and after (1.86 [1.01-3.44]) adjustment. Food insecurity was not associated with blood pressure control.

Food insecurity is significantly associated with poor metabolic control in adults with diabetes. Interventions that address food security as well as clinical factors may be needed to successfully manage chronic disease in vulnerable adults.