Food Insecurity and Diabetes: Evidence of Psychosocial Consequences During the COVID-19 Pandemic in the United States

Abstract

Objectives: To analyze the associations between food insecurity (FI) and diabetes distress (DD) related to COVID-19 in adults with pre-diabetes/diabetes in the United States (US). Methods: We fielded a national, web-based survey among low-income adults in the US (N = 1,756). Measures included FI status, using the 18-item USDA Household Food Security Module, and DD, using the 17-item Diabetes Distress Scale. Multinomial logistic regression models examined the relationship between FI and DD among adults with pre-diabetes, type-1, or type-2 diabetes (n = 317). Results: Overall, 58.4% of participants reported little/no distress, 15.7% reported moderate distress and 25.9% reported high distress. Adults with FI had a higher prevalence of high DD (43.3% vs. 13.5%) and moderate DD (23.3% vs. 11.9%) compared to individuals with food security (p < 0.001). Compared to individuals with food security, individuals experiencing FI had clinical levels of distress (moderate or high) for the emotional burden subscale (70.4% vs. 27.7%), regimen-related subscale (71.4% vs. 34.7%), interpersonal subscale (23.6% vs. 58.64% vs. 23.6%) and physician-related subscale (57.4% vs. 17.1%). Conclusions: During the COVID-19 pandemic, FI was associated with higher DD among individuals with pre-diabetes/diabetes in the US. Healthcare providers should screen for DD and connect patients to resources to help manage their food and mental health needs.