Estimating the impact of addressing food needs on diabetes outcomes

To estimate the association between food needs and diabetes outcomes.

Longitudinal cohort study, using a target trial emulation approach. 96,792 adults with type 2 diabetes mellitus who underwent food need assessment in a network of community-based health centers were followed up to 36 months after initial assessment. We used targeted minimum loss estimation to estimate the association between not experiencing food needs, compared with experiencing food needs, and hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. The study period was June 24th, 2016 to April 30th, 2023.

We estimated that not experiencing food needs, compared with experiencing food needs, would be associated with 0.12 percentage points lower (95% Confidence Interval [CI] -0.16% to -0.09%, p = < 0.0001) mean HbA1c at 12 months. We further estimated that not experiencing food needs would be associated with a 12-month SBP that was 0.67 mm Hg lower (95%CI -0.97 to -0.38 mm Hg, p < .0001), DBP 0.21 mm Hg lower (95%CI -0.38 to -0.04 mm Hg, p = .01). There was no association with lower LDL cholesterol. Results were similar at other timepoints, with associations for HbA1c, SBP, and DBP of similar magnitude, and no difference in LDL cholesterol.

We estimated that not experiencing food needs may be associated with modestly better diabetes outcomes. These findings support testing interventions that address food needs as part of their mechanism of action.