Foods for Health: An Integrated Social Medical Approach to Food Insecurity Among Patients With Diabetes

Abstract

Purpose: Examine a clinic-based approach to improve food security and glycemic control among patients with diabetes. Design: One-group repeated-measures design. Setting: Federally Qualified Health Centers in a large Midwest city. Sample: Of the 933 patients with diabetes who consented at baseline, 398 (42.66%) returned during the follow-up period for a visit that included Hemoglobin A1c (HbA1c) results. Intervention: Integrated social medicine approach that includes food insecurity screening, nutrition education, and assistance accessing food resources as a standard-of-care practice designed to minimize disruptions in how patients and providers experience medical care. Measures: HbA1c collected as part of a standard blood panel. Analysis: Repeated-measure, mixed-effect linear regression models. Results: There was a decrease in mean HbA1c (Δ = −0.22, P = 0.01) over the study period. The model examining change over time, glycemic control (GC), and food security status (F1, 352 = 5.80, P = 0.02) indicated that among participants with poor GC (33.12%), food secure (FS) participants exhibited significantly greater levels of improvement than food insecure (FI) participants (Δ = −0.55, P = 0.04). Among participants with good GC, changes in HbA1c were not significantly different between FS and FI participants (Δ = 0.23, P = 0.21). Conclusion: Providing nutrition education and food assistance improved HbA1c profiles among FS and FI participants, but FI participants may face social and structural challenges that require additional support from health care teams.