title: Food insecurity is associated with diabetes self-care behaviours and glycaemic control.
abstract: Food insecurity is the 'limited or uncertain availability of nutritionally adequate and safe foods'. Our objective was to examine the association between food insecurity, diabetes self-care and glycaemic control.
  
  
  
  We conducted a cross-sectional analysis of baseline data from adult patients with Type 2 diabetes who were enrolled in a randomized trial evaluating a health literacy-focused diabetes intervention in safety net primary care clinics in middle Tennessee. Food insecurity was assessed with three items from the U.S. Household Food Security Survey. Diabetes self-care behaviours were assessed with the Summary of Diabetes Self-Care Activities Scale, Personal Diabetes Questionnaire and Adherence to Refills and Medication Scale. Glycaemic control was assessed with HbA1c .
  
  
  
  The sample consisted of 401 participants, 73% of whom reported some level of food insecurity. Food insecurity was significantly associated with self-care behaviours including less adherence to a general diet [Adjusted Odds Ratio (AOR) 0.9, P = 0.02], less physical activity (AOR 0.9, P = 0.04) and with a greater occurrence of medication non-adherence (AOR 1.2, P = 0.002) and calorie restriction (AOR 1.1, P = 0.02). Food insecurity was also associated with worse glycaemic control (adjusted β = 0.1, P = 0.03). None of the self-care behaviours were significantly associated with HbA1c , limiting the ability to test for self-care as a mechanism linking food insecurity to glycaemic control.
  
  
  
  There was a high rate of food insecurity in a sample of patients with Type 2 diabetes who were of low socio-economic status. Food insecurity was associated with less adherence to recommended self-care behaviours and worse glycaemic control.
authors: Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.|Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA.|Vanderbilt Center for Health Services Research, Nashville, TN, USA.
authors: W J
authors: WJ
authors: Heerman
authors: Vanderbilt Center for Health Services Research, Nashville, TN, USA.|School of Nursing, Nashville, TN, USA.
authors: K A
authors: KA
authors: Wallston
authors: Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA.|Vanderbilt Center for Health Services Research, Nashville, TN, USA.|Department of Biomedical Informatics and the Center for Health Behavior and Health Education, Nashville, TN, USA.|Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: C Y
authors: CY
authors: Osborn
authors: Vanderbilt Center for Health Services Research, Nashville, TN, USA.|Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA.
authors: A
authors: A
authors: Bian
authors: Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA.|Vanderbilt Center for Health Services Research, Nashville, TN, USA.|Department of Psychology, Vanderbilt University, Nashville, TN, USA.
authors: D G
authors: DG
authors: Schlundt
authors: Vanderbilt Center for Health Services Research, Nashville, TN, USA.
authors: S D
authors: SD
authors: Barto
authors: Vanderbilt Center for Diabetes Translation Research, Center for Diabetes and Translational Research, Vanderbilt University, Nashville, TN, USA.|Vanderbilt Center for Health Services Research, Nashville, TN, USA.|Department of Biomedical Informatics and the Center for Health Behavior and Health Education, Nashville, TN, USA.
authors: R L
authors: RL
authors: Rothman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000378:metabolism; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology*; D005260:Female; D005523:Food Supply; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D012648:Self Care / Q000523:psychology*; D013714:Tennessee; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin