Food Insecurity, Diabetes Self-Management and Support for Self-Management in High-Income Countries: A Qualitative Systematic Review and Synthesis (2008 to 2024)

Abstract

People living with diabetes and food insecurity in high-income countries have poorer health-related outcomes than those who are food secure. Diabetes is a significant global health challenge. At the same time, the prevalence of household food insecurity continues to increase. This qualitative systematic review and synthesis explored the lived experience of diabetes self-management and support for self-management for people living with diabetes and food insecurity in high-income countries. Keywords and search terms were developed using the PICo framework with searches conducted between January 2008 and August 2024. Titles and abstracts were screened against inclusion and exclusion criteria, and the methodological quality of included papers was assessed using the Critical Appraisal Checklist for Qualitative Research and CERQual. Findings from 18 articles (detailing 17 studies) identified four interlinked themes: structural challenges, day-to-day challenges, ways of being for people living with food insecurity and diabetes, and self and support for self-management needs. Structural challenges (poverty, sociocultural and discrimination) were identified as the main determinants of the day-to-day challenges for people living with diabetes and food insecurity. Those challenges included the following: (i) limited access to suitable foods and food management resources; (ii) stress, (iii) poverty and diabetes stigma, (iv) limited informal support, (v) perceived lack of appropriate support from healthcare practitioners, and limited knowledge, confidence and understanding and access to information. The resulting ways of being for people affected were characterised by experiences of subsisting, avoiding, balancing and prioritising. Self and support for self-management needs were characterised by two themes improve[ing] clinical conversations and, support beyond health services. People living with diabetes and food insecurity are adopting methods of self-management, due to economic necessity, which may not be appropriate from a healthcare perspective, and which may be impacting their short and long-term health. There is an urgent need to address these issues in the post COVID-19 pandemic context for effective diabetes prevention and management.