Relevance of Food Insecurity to the Cdc's Diabetes Agenda

Objective: Food insecurity, the inability to reliably afford food, affects >11% of Americans.  We sought to determine whether food insecurity is related to the development or clinical management of diabetes; understand mechanisms by which food insecurity may affect diabetes risk and self-management; and explore the relevance of food insecurity interventions for preventing progression to diabetes.

Methods: We reviewed existing epidemiologic studies and interventions addressing food insecurity and its implications for diabetes risk, dietary intake, and self-management.

Results: Food insecure (FI) adults are more than twice as likely as food secure (FS) adults to have diabetes.  They are also at elevated risk of poor glycemic control and severe hypoglycemia.   Food insecurity may impact the development or progression of diabetes in numerous ways.  To maintain caloric intake, FI adults shift their diets toward energy-dense, nutritionally-poor, but inexpensive foods (refined carbohydrates, added sugars, and added fats) that patients with diabetes are counseled to avoid.  Daily caloric and carbohydrate intake fluctuate in response to food availability, making blood glucose unpredictable and complicating treatment regimens.  Constrained resources force purchasing trade-offs between food and diabetes medication/supplies.  Interventions to reduce food insecurity may reduce progression from pre-diabetes to diabetes, but to be effective they must shift dietary intake toward healthier alternatives.  Such interventions might include fruit/vegetable vouchers, or incentives/zoning regulations which encourage new grocery stores to locate in “food deserts” or existing stores to improve infrastructure.

Conclusion: Translation of diabetes interventions into low-income communities must include strategies for helping participants overcome food insecurity.