title: Food insecurity and diabetes self-management among food pantry clients.
abstract: To examine the association between level of food security and diabetes self-management among food pantry clients, which is largely not possible using clinic-based sampling methods.
  
  
  
  Cross-sectional descriptive study.
  
  
  
  Community-based food pantries in California, Ohio and Texas, USA, from March 2012 through March 2014.
  
  
  
  Convenience sample of adults with diabetes queuing at pantries (n 1237; 83 % response). Sampled adults were stratified as food secure, low food secure or very low food secure. We used point-of-care glycated Hb (HbA1c) testing to determine glycaemic control and captured diabetes self-management using validated survey items.
  
  
  
  The sample was 70 % female, 55 % Latino/Hispanic, 25 % white and 10 % black/African American, with a mean age of 56 years. Eighty-four per cent were food insecure, one-half of whom had very low food security. Mean HbA1c was 8·1 % and did not vary significantly by food security status. In adjusted models, very-low-food-secure participants, compared with both low-food-secure and food-secure participants, had poorer diabetes self-efficacy, greater diabetes distress, greater medication non-adherence, higher prevalence of severe hypoglycaemic episodes, higher prevalence of depressive symptoms, more medication affordability challenges, and more food and medicine or health supply trade-offs.
  
  
  
  Few studies of the health impact of food security have been able to examine very low food security. In a food pantry sample with high rates of food insecurity, we found that diabetes self-management becomes increasingly difficult as food security worsens. The efficacy of interventions to improve diabetes self-management may increase if food security is simultaneously addressed.
authors.affiliation: 1Johns Hopkins University School of Medicine,Department of Medicine,1830 East Monument Street,Room 450B,Baltimore,MD 21287,USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Ippolito
authors.affiliation: 2University of California San Francisco,Department of Medicine,San Francisco,CA,USA.
authors.forename: Courtney R
authors.initials: CR
authors.lastname: Lyles
authors.affiliation: 4Feeding America,Chicago,IL,USA.
authors.forename: Kimberly
authors.initials: K
authors.lastname: Prendergast
authors.affiliation: 4Feeding America,Chicago,IL,USA.
authors.forename: Michelle Berger
authors.initials: MB
authors.lastname: Marshall
authors.affiliation: 5Urban Institute,Washington,DC,USA.
authors.forename: Elaine
authors.initials: E
authors.lastname: Waxman
authors.affiliation: 2University of California San Francisco,Department of Medicine,San Francisco,CA,USA.
authors.forename: Hilary Kessler
authors.initials: HK
authors.lastname: Seligman
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D002140:California / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003863:Depression / Q000097:blood / Q000453:epidemiology*; D003920:Diabetes Mellitus / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D005260:Female; D063105:Food Assistance; D005523:Food Supply; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000453:epidemiology*; D008297:Male; D008875:Middle Aged; D009820:Ohio / Q000453:epidemiology; D015995:Prevalence; D000073278:Self-Management; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Diabetes self-management; Food pantries; Food security