Diabetes Self-Management Blog

In a country like the United States, it can be easy to forget that not everyone has access to an abundance of food and food choices. After all, the media and public health officials continually warn us of the risks of caloric overconsumption — risks that are quite real — while usually not discussing how food scarcity can also lead to negative health outcomes. But studies in the last couple of years have examined this issue in the context of people with diabetes, while a recent study confirms that food insecurity — lack of consistent access to an adequate amount of nutritious food — remains a significant problem.

The report, issued by the United States Department of Agriculture (USDA), lays out the results of the department’s annual survey on food security, which uses a nationally representative sample. According to its executive summary, the study found that in 2011, 14.9% of US households experienced food insecurity at some point during the year. This represents a slight but statistically insignificant rise from 14.5% in 2010. In contrast, the level in 2007 — before the current economic slump — was 11.1%. In 2011, 5.7% of households experienced very low food security, in which food intake was reduced and eating patterns were disrupted among some household members — up from 5.4% in 2010.

There is certainly a strong argument that food insecurity, by itself, represents a terrible scourge — a “humanitarian crisis,” in the words of a leader whose organization fights childhood hunger. But it also has well documented health effects, including in people with diabetes. According to a study published last year in the Journal of Pediatrics, food insecurity appeared related to worse health outcomes in children with diabetes who required insulin. Among 183 families with such children in Nova Scotia (Canada), 21.9% of households experienced food insecurity — well above the Nova Scotian and Canadian averages. Food insecurity was linked with a slightly higher HbA1c level, although this effect disappeared when other factors such as age and parental education level were considered. But food insecurity was more strongly linked to a higher rate of hospitalization; in fact, it was the only factor examined in the study that, by itself, was associated with more hospitalization.

Another study, published earlier this year in the journal Diabetes Care, examined the effects of food insecurity in adults with Type 2 diabetes. Participants were visitors of clinics that serve mainly a low-income clientele. After adjusting for other factors, food-insecure participants were found to have an HbA1c level of 8.55%, compared with 8.10% among food-secure participants. In addition, food-insecure participants were 46% more likely to have an HbA1c level greater than 8.5%. As the researchers noted, this effect on HbA1c may be explained by a shift towards cheaper foods caused by food insecurity. It may also occur because participants skipped meals, making it more difficult for them to maintain steady control of their blood glucose levels.

Are you worried about the current level of food insecurity in the United States? Have you, or has a member of your family, ever experienced food insecurity? If so, how did this affect your or their health? Do you believe that the current system of “food stamps” is an adequate response to the problem? Are there other ways for low-income individuals and families to achieve greater food security? Leave a comment below!

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