Food Insecurity Is a Major Risk Factor for Clinically Significant Hypoglycemia

Objective: Optimizing glycemic control while preventing hypoglycemia requires a balance of energy intake, energy expenditure, and medication.   Food insecurity, the inability to reliably afford nutritious food, affects 11% of Americans and alters energy intake unpredictably.  We evaluated food insecurity as a risk factor for hypoglycemia.

Methods: We administered the Food Security Survey Module to 711 adults with diabetes receiving care in safety net clinics. Our outcome was self-report of ≥4 severe hypoglycemic episodes (“passing out or needing help to treat”) in the past year.  We compared food insecure (FI) and food secure (FS) participants using t-tests.  In a series of logistic regression models, we controlled for sociodemographic characteristics differing by p<0.2 in univariate analysis, and then additionally controlled for known hypoglycemia risk factors (alcohol, insulin, comorbid illnesses, adherence to blood glucose monitoring, and hypoglycemia knowledge). 

Results: The prevalence of food insecurity was 46%.  FI participants were older than FS participants and more likely to be White, obese, and tobacco smokers (all p<0.02).   In unadjusted analysis, FI participants were significantly more likely to report hypoglycemia (24.3% vs. 14.8%; OR 1.98, p=0.001).  Odds of hypoglycemia remained higher after controlling for sociodemographics alone (OR 1.91, p=0.009) and in combination with other known hypoglycemia risk factors (OR 2.00, p=0.01).

Conclusion: Interventions targeted toward improving glycemic control in this population should pay particular attention to potential adverse events and tailor treatment strategies to accommodate fluctuations in food availability.