Food Insecurity in Relation to Changes in Hemoglobin Aleuro, Self-Efficacy, and Fruit/ Vegetable Intake During a Diabetes Educational Intervention

• Autores: Courtney R. Lyles, Michael S. Wolf, Dean Schillinger, Terry C. Davis, Darren A DeWalt
• Localización: Diabetes care, ISSN-e 0149-5992, Vol. 36, Nº. 6, 2013, págs. 1448-1453
• Idioma: inglés
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• Resumen

  • OBJECTIVE- Food insecurity is hypothesized to make diabetes self-management more difficult. We conducted a longitudinal assessment of food insecurity with several diabetes self-care measures.

    RESEARCH DESIGN AND METHODS-We conducted a secondary, observational analysis of 665 low-income patients with diabetes, all of whom received self-management support as part of a larger diabetes educational intervention. We analyzed baseline food insecurity (measured by the U.S. Department of Agriculture Food Security module) in relation to changes in hemoglobin A^sub 1c^ (HbA^sub 1c^) as well as self-reported diabetes self-efficacy and daily fruit and vegetable intake. We examined longitudinal differences using generalized estimating equation linear regression models, controlling for time, age, sex, race, income, and intervention arm.

    RESULTS-Overall, 57% of the sample had an income <$15,000. Participants who were food insecure (33%) were younger, had less income, and were more likely to be unemployed compared with participants who were food secure. At baseline, those who were food insecure had higher mean HbA^sub 1c^ values (8.4% vs. 8.0%) and lower self-efficacy and fruit and vegetable intake than those who were food secure (all P < 0.05). Compared with food-secure individuals, participants who were food insecure had significantly greater improvements in HbA^sub 1c^ over time (0.38% decrease compared with 0.01% decrease; P value for interaction <0.05) as well as in self-efficacy (P value for interaction <0.01). There was no significant difference in HbA^sub 1c^ by food security status at follow-up.

    CONCLUSIONS-Participants experiencing food insecurity had poorer diabetes-related measures at baseline but made significant improvements in HbA^sub 1c^ and self-efficacy. Low-income patients who were food insecure may be particularly receptive to diabetes self-management support, even if interventions are not explicitly structured to address finances or food security challenges