title: Food insecurity in relation to changes in hemoglobin A1c, self-efficacy, and fruit/vegetable intake during a diabetes educational intervention.
abstract: OBJECTIVE
  Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.
  
  
  METHODS
  We conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A1c (HbA1c) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.
  
  
  RESULTS
  Overall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA1c values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA1c over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA1c by food security status at follow-up.
  
  
  CONCLUSIONS
  Participants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA1c and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges.
authors.affiliation: University of California San Francisco Center for Vulnerable Populations, Division of General Internal Medicine at San Francisco General Hospital, San Francisco, California, USA. lylesc@medsfgh.ucsf.edu
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.forename: Michael S
authors.initials: MS
authors.lastname: Wolf
authors.forename: Dean
authors.initials: D
authors.lastname: Schillinger
authors.forename: Terry C
authors.initials: TC
authors.lastname: Davis
authors.forename: Darren
authors.initials: D
authors.lastname: Dewalt
authors.forename: Allison R
authors.initials: AR
authors.lastname: Dahlke
authors.forename: Laura
authors.initials: L
authors.lastname: Curtis
authors.forename: Hilary K
authors.initials: HK
authors.lastname: Seligman
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005523:Food Supply; D005638:Fruit; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D014675:Vegetables
chemical_list: D006442:Glycated Hemoglobin