title: Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes.
abstract: More than 14% of the American population is food insecure, or at risk of going hungry because of an inability to afford food. Food-insecure (FI) adults often reduce food intake or substitute inexpensive, energy-dense carbohydrates for healthier foods. We hypothesized these behaviors would predispose FI adults with diabetes to hypoglycemia and impaired diabetes self-management. We therefore assessed whether food insecurity was associated with multiple indicators of diabetes self-management (self-efficacy, medication- and glucose-monitoring adherence, hypoglycemia, or glycemic control) among 40 low-income adults with diabetes. Mean self-efficacy score was lower among FI than food-secure (FS) participants (34.4 vs. 41.2, p=.02). Food-insecure participants reported poorer adherence to blood glucose monitoring (RR=3.5, p=.008) and more hypoglycemia-related emergency department visits (RR=2.2, p=.007). Mean hemoglobin A1c was 9.2% among FI and 7.7% among FS participants (p=.08). Food insecurity is a barrier to diabetes self-management and a risk factor for clinically significant hypoglycemia.
authors.affiliation: University of California San Francisco, San Francisco, CA 94142, USA. hseligman@medsfgh.ucsf.edu
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Seligman
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
mesh_terms: D000328:Adult; D015190:Blood Glucose Self-Monitoring / Q000706:statistics & numerical data; D002641:Chicago / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005247:Feeding Behavior / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D005523:Food Supply / Q000191:economics*; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006815:Hunger; D007003:Hypoglycemia / Q000453:epidemiology*; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D011203:Poverty; D012307:Risk Factors; D012648:Self Care / Q000706:statistics & numerical data*; D020377:Self Efficacy; D016903:Drug Monitoring
chemical_list: D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human