141st APHA Annual Meeting and Exposition

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281210
Severe food insecurity among adults with diabetes seeking food assistance at food pantries


Monday, November 4, 2013

Matt Ippolito, MD, UCSF, San Francisco, CA
Courtney Lyles, PhD, Center for Vulnerable Populations, UCSF, San Francisco, CA
Kim Prendergast, RD, MPP, Feeding America
Michelle Berger Marshall, MS, RD, Feeding America
Elaine Waxman, PhD, Feeding America
Hilary Seligman, MD, MAS, Division of General Internal Medicine, University of California San Francisco, San Francisco, CA
Background: In clinical populations of adults with diabetes, food insecurity (FI) independently increases risk for poor diabetes self-management and poor glycemic (HbA1c) control. Previous studies of diabetes self-management have been conducted in clinical-based samples and have been unable to examine severe FI.

Methods: We surveyed adults queuing at food pantries in Texas, California, and Ohio (n=550). Eligible participants self-reported diabetes or had a point-of-care HbA1C test <6.5%. Participants were stratified by FI: “no FI”, “mild FI”, or “severe FI.” We investigated unadjusted associations between FI and potential mediators of poor glycemic control: depressive symptoms (prevalence), diabetes self-efficacy (scored 1-10), diabetes distress (1-6), medication non-adherence (0-4), and financial tradeoffs between food and medicine (yes/no). We also examined HbA1c (%).

Results: The sample was 70% female, 54% Latino, and 8% African-American with a mean age of 58. The prevalence of mild FI was 41% and severe FI, 44%. FI was strongly associated with mediators of poor glycemic control (p<0.05 for all compared to no FI group): higher depression (52% no FI, 64% mild FI, and 84% severe FI), poorer diabetes self-efficacy (means scores of 7.5, 6.9, and 6.5, respectively), greater diabetes distress (2.1, 2.9, and 3.3), greater medication non-adherence (0.8, 1.1, and 1.4), and more food-medicine tradeoffs (15%, 40%, and 57%). Mean HbA1c did not significantly differ (7.9%, 8.0%, and 8.1%, respectively).

Conclusion: Severely food insecure adults with diabetes demonstrate substantial barriers to effective self-management. Efforts to disseminate diabetes self-management programs into low-income, community-based settings must address food affordability challenges.

Learning Areas:

Administer health education strategies, interventions and programs
Chronic disease management and prevention
Implementation of health education strategies, interventions and programs
Public health or related research

Learning Objectives:
Assess the prevalence of severe food insecurity among adults with diabetes seeking food assistance at food pantries in three states Evaluate the extent to which severe food insecurity increases difficulty with diabetes self-management

Keyword(s): Diabetes, Food Security

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Under the mentorship of Dr. Hilary Seligman, I am leading this conceptualization and analysis of this study examining food insecurity among food bank clients.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3190.0: Nutrition Disparities, Food Insecurity & Nutrition Assistance Programs