BOSTON — Clinicians should consider both patients’ socioeconomic status and food availability when discussing diabetes care, as new data show that Latino patients who worry about having enough food to eat, or food insecurity, report having a poorer diet and exhibit worse glycemic control than those who aren’t worried about having enough food to survive.

Researchers reported these findings at the American Diabetes Association (ADA) 75th Scientific Sessions.

The problem of food insecurity is much greater in Latino households compared with the overall American population. Approximately 24% of Latino households in the U.S. were food insecure compared with 14% for Americans overall in 2013, according to the U.S. Department of Agriculture.

Additionally, a 2012 study published in the journal Diabetes Spectrum found that diabetes risk was roughly 2.5% higher in households reporting food insecurity.

“Although prior research has discussed the impact of food insecurity and glycemic control in minority populations, this appears to be the first study that focuses specifically on the Latino population,” said study investigator Britt Rotberg, MS, RDN, who is the assistant director of the Emory Diabetes Education Training Academy, Emory Latino Diabetes Education Program at the Emory School of Medicine in Atlanta.

“For our study, we developed a Modified Plate Method to further explore vegetable consumption and relate it to food security status. We decided to look at food insecurity after our patients repeatedly stated during conversations about healthy eating that that they were unable to obtain the foods recommended, especially towards the end of the month when food budgets became increasingly inadequate.”

Rotberg and her colleagues measured food insecurity by asking patients if they had been worried about having enough food to eat at any point in the past 30 days. They also developed a tool based on the plate method to assess the amount of vegetables patients were eating during their main meal each day (full plate, one-half, one-third, one-fourth of a plate or no vegetables).

The researchers found that those patients who were food insecure had higher HbA1c levels and ate fewer vegetables.

These findings are a wake-up call that clinicians need to consider a patient’s socioeconomic status and food availability when discussing diabetes self-management, according to Rotberg. In addition, she said it is time to find new ways to help food insecure patients obtain nutritionally adequate foods.

The study included 135 patients (mean age, 47 years) and 61% were female. In this cohort, 49% were employed, but only 23% of the cohort had an income of greater than $15,000 a year. When looking at these patients, the researchers discovered that only 24% had access to medical insurance and only 30.9% had been to a diabetes education class.

Overall, the study demonstrated that those who were food insecure had average HbA1c levels of 9.9% compared with 7.6% for those who were food secure. It also showed that those who were food insecure ate fewer vegetables than those who were food secure.

When looking at patients who consumed more than one-third of a plate of non-starchy vegetables at their main meal, 62% were food secure compared with 38% who were food insecure. 

There was no significant difference in BMI between the two groups. Rotberg said this suggests that both groups may consume comparable calories per the individuals’ requirements, but with a difference in nutrient density potentially determining the difference in glycemic control.

“These findings underscore the importance of individualized diabetes management, and the need to consider both patients’ socioeconomic status and food availability when discussing diabetes care,” Rotberg told Endocrinology Advisor

“The key takeaway is that diabetes education is most effective when the patient’s individual circumstances are taken into account. Finding new ways to help our food insecure patients obtain nutritionally adequate foods is essential for improving glycemic control and hopefully reducing diabetes-related complications.”

Reference

  1. Rotberg B et al. Abstract 382-OR: The Impact of Food Insecurity on Glycemic Control and Dietary Habits in Low-Income Latinos with Type 2 Diabetes. Presented at: American Diabetes Association (ADA) 75th Scientific Sessions; June 5-9, 2015; Boston.