The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes.
BACKGROUND
Food insecurity- lack of dependable access to adequate food-may play a role in poor diabetes control.


OBJECTIVE
We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control.


METHODS
Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013.


METHODS
Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income < 250 % of the federal poverty level, were 30-70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington.


METHODS
We measured food insecurity determined by the Department of Agriculture's 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample.


RESULTS
The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p < 0.001), report diabetes distress (55.2 % vs. 33.8 %, p < 0.001) and have low medication adherence (52.9 % vs. 37.2 %, p = 0.02). Based on linear regression modeling, those with food insecurity had significantly higher mean A1c levels (β = 0.51; p = 0.02) after adjusting for sex, age, race/ethnicity, language, education, marital status, BMI, insulin use, depression, diabetes distress and low medication adherence.


CONCLUSIONS
Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.
VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, Seattle, WA, USA. Julie.Silverman@va.gov.|VA Puget Sound Healthcare System, General Internal Medicine Service, Seattle, WA, USA. Julie.Silverman@va.gov.|School of Medicine, Department of Medicine, University of Washington, Seattle, WA, USA. Julie.Silverman@va.gov.
Julie
J
Silverman
School of Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.|School of Public Health, University of Washington, Seattle, WA, USA.|Public Health - Seattle & King County, Seattle, WA, USA.
James
J
Krieger
School of Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.
Meghan
M
Kiefer
VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, Seattle, WA, USA.|School of Public Health, University of Washington, Seattle, WA, USA.
Paul
P
Hebert
Public Health - Seattle & King County, Seattle, WA, USA.
June
J
Robinson
VA Puget Sound Healthcare System, Northwest HSR&D Center of Excellence, Seattle, WA, USA.|VA Puget Sound Healthcare System, General Internal Medicine Service, Seattle, WA, USA.|School of Medicine, Department of Medicine, University of Washington, Seattle, WA, USA.|School of Public Health, University of Washington, Seattle, WA, USA.
Karin
K
Nelson
D000328:Adult; D000368:Aged; D003863:Depression / Q000191:economics* / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000453:epidemiology*; D005260:Female; D005523:Food Supply / Q000191:economics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000191:economics / Q000627:therapeutic use; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D011203:Poverty / Q000191:economics*; D014861:Washington / Q000453:epidemiology
D007004:Hypoglycemic Agents
diabetes; food insecurity; glycemic control