Food Insecurity Linked to Diabetes

Food insecurity is defined as “the limited or uncertain availability of nutritionally adequate and safe foods or the inability to acquire foods in socially accepted ways.”² Food insecurity and diabetes have a bi-directional relationship. Insecurity can lead to poor health, and poor health can reduce food access through loss of work/time at work, increased cost of medical care, and increased burden of disease. 

Dietary intake and food access is strongly linked to health outcomes, and adults who experience food insecurity are two to three times more likely to develop type 2 diabetes.³ Reduced consumption of fruits, vegetables, and nutrient-dense foods increases the risk of insulin resistance and type 2 diabetes. For low-income individuals, studies³ have shown increased hospital ER visits and admissions for hypoglycemia during the last week of the month compared to earlier weeks. Financial constraints often force individuals to choose between purchasing medications and buying food. 

The co-occurrence of diabetes and food insecurity is influenced by nutritional, mental health, and behavioral factors, according to the Weiser et al.² conceptual framework. At the individual level, interventions targeting food security and diabetes should focus on these interconnected pathways, especially considering the impact of competing demands on self-care prioritization. People living with diabetes and food insecurity often experience increased diabetes distress, depression, and higher A1c levels. Additional challenges such as cost-of-living, transportation, and medication costs further exacerbate these outcomes. Addressing behavioral barriers may involve providing transportation assistance, social work case management, and comprehensive medical care, and ensuring a review of medication costs. Mental health interventions could involve integrating food access programs with mental health screening and referral services in addition to problem-solving and coping strategies to reduce diabetes distress. The most helpful nutrition interventions aim to improve food accessibility, offer person-centered and budget-friendly nutrition counseling, and address policies and programs that reduce diabetes risk and complications.

Food Is Medicine Programs – Medically Tailored Meals

In 2023, the Department of Health and Human Services (HHS) developed the Food Is Medicine initiative, understanding that “access to nutritious food is critical to health and resilience.”³ The initiative focuses on developing strategies to reduce nutrition-related chronic disease and food insecurity while improving health and racial equity in the US.³ Food is Medicine can encompass many different programs, such as medically tailored meals, groceries, or produce prescription programs. Although A1C reduction results are mixed, each of these programs has shown an increase in fruit and vegetable consumption, food security, and quality of life measures.⁴

For individuals with diabetes, medically tailored meals result in the most evidence for improved diet quality, increased food security, improved diabetes self-management, and reduced hypoglycemic events.⁴ The programs are associated with lower health care utilization and cost for individuals with complex care needs. Medically tailored meals are designed by an RDN to meet the needs of the individual, are delivered directly to the home, and maybe a covered benefit if medical criteria are met. Seniors may access medically tailored and delivered programs through Medicare Advantage, Medicaid, or Area on Aging programs. Individuals who have chronic conditions and are post-hospital discharge have the highest likelihood of coverage. In California, Medi-Cal may provide up to three meals per day for twelve weeks for individuals with chronic health conditions (such as diabetes) who were recently discharged from a hospital or nursing home or require extensive care coordination. The Food is Medicine Coalition is a resource for additional information regarding Food is Medicine programs and can link individuals and providers to local participating agencies.  

Food Insecurity on the Rise

Interventions begin with screening and knowing that more individuals with diabetes will experience food insecurity compared to just one year ago. We can utilize risk assessment tools, including the hunger vital signs, at least annually during our visits and, with patient collaboration, provide referrals to assistance programs. The most extensive federal food assistance programs include the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). These programs are effective in increasing food security while also improving health outcomes. Reviewing eligibility and assisting in the coordination of services for Food Is Medicine programs, Nutrition Assistance Programs, and resources such as local food pantries, Meals on Wheels, or Area on Aging Agencies programs. www.Findhelp.org is a tool that can help individuals and providers find free or reduced- resources, from food to housing and more. Through assessment, understanding patient priority needs, and linking to resources, we can create a more supportive and therapeutic environment for individuals managing diabetes while experiencing food insecurity.

Links to Listed Resources: 

• Food is Medicine Coalition: https://fimcoalition.org
• Hunger Vital Sign: https://fimcoalition.org
• Supplemental Nutrition Assistance Program (SNAP): https://www.fns.usda.gov/snap/supplemental-nutrition-assistance-program
• WIC: https://www.fns.usda.gov/wic
• Local Food Pantries: https://www.feedingamerica.org/our-work/nutrition-health
• Meals on Wheels: https://www.mealsonwheelsamerica.org/find-meals
• Area on Aging Agencies: https://eldercare.acl.gov/Public/About/Aging_Network/AAA.aspx
• Find Help: www.findhelp.org

References: 

1. Food Security and Nutrition Assistance downloaded on June 19th, 2024 from: https://www.ers.usda.gov/data-products/ag-and-food-statistics-charting-the-essentials/food-security-and-nutrition-assistance/#:~:text=In%202022%2C%2012.8%20percent%20of,of%20a%20lack%20of%20resources
2. Weiser, Sheri & Palar, Kartika & Hatcher, Abigail & Young, Sera & Frongillo, Edward & Laraia, Barbara. (2015). Food Insecurity and Health: A Conceptual Framework. 10.1201/b18451-3.
3. Food is Medicine: A Project to Unify and Advance Collective Action. Downloaded on June 19th, 2024 from https://health.gov/our-work/nutrition-physical-activity/food-medicine. 
4. Levi R, Bleich SN, Seligman HK. Food Insecurity and Diabetes: Overview of Intersections and Potential Dual Solutions. Diabetes Care. 2023 Sep 1;46(9):1599-1608. doi: 10.2337/dci23-0002. PMID: 37354336; PMCID: PMC10465985.
5. Wylie-Rosett J, DiMeglio LA. Strategies to Reduce Food Insecurity for People With Diabetes: A Call to Action. Diabetes Care. 2023 Feb 1;46(2):245-248. doi: 10.2337/dci22-0058. PMID: 36701599; PMCID: PMC9887607.