'Food Insecurity' in Low-Income Latinos Thwarts Diabetes Control

Marlene Busko

June 10, 2015

BOSTON — In low-income Latino patients with type 2 diabetes who took part in a diabetes education program that was specifically designed for them, those with "food insecurity" — a belief that they could not access adequate food to feed their families — reported eating fewer healthy vegetables at their main meal and had worse initial glycemic control than their peers.

Strikingly, in this patient population, HbA1c levels were 9.9% in those with food insecurity vs 7.6 % in those without food insecurity (P < .001) at the beginning of the educational program.

Thus, "food insecurity" is another factor that diabetes educators and clinicians should be aware of when they advise low-income patients from minority groups about managing their diabetes, Britt Rotberg, MS, RDN, assistant director of the Emory Latino Diabetes Education Program, from Emory School of Medicine, Atlanta, Georgia, said, reporting results of this study at a press conference at the American Diabetes Association (ADA) 2015 Scientific Sessions. The study was also presented at the ADA Presidents' Oral Session.

The findings would probably be similar in other minority groups, she speculated, since about one in four Latinos, African Americans, and American Indians have food insecurity, which is higher than the national average of 14%, she told Medscape Medical News.

Clinicians with low-income patients with diabetes could refer patients to community-based support programs, since group support has been very helpful in their patient population, she said.

Dr Guillermo Umpierrez, the director of Emory Latino Diabetes Education Program, told Medscape Medical News: "There's no question that [in general] the Latino population is poorly educated and has significant language barriers and that most of the first generation have very low incomes, [but] if you educate them and provide enough support, they do fairly well — like everybody else. "

Ability to Buy Healthy Foods

According to the United States Department of Agriculture, "food insecurity" is defined as "limited or uncertain availability of nutritionally adequate and safe foods or limited or uncertain ability to acquire acceptable foods in socially acceptable ways." Diabetes is 2.5 times more prevalent in households where people feel that they cannot afford to buy healthy foods, Ms Rotberg reported.

The researchers investigated the relationship between food insecurity and glycemic control in 304 patients who participated in the Emory Latino Diabetes Education Program. Three-quarters of the patients had a yearly household income below $15,000, and 66% had no health insurance.

The patients replied to questions about food insecurity and a question about vegetable consumption at the main meal of the day (full plate of vegetables, half plate, third plate, quarter plate, or none).

The questionnaire revealed that more than half — 167 patients (55%) — had food insecurity.

Furthermore, 62% of patients who reported eating more than a third of a plate of vegetables at their main meal had no food insecurity, but only 38% of patients with food insecurity reported this level of vegetable consumption.

Interestingly, patients with or without food insecurity were similarly obese, with a mean body mass index (BMI) of 31.7 kg/m2 and 31.2 kg/m2, respectively, "suggesting that both groups may consume comparable calories, with a difference in nutrient density," the researchers report.

This study did not identify what the patients were eating instead of vegetables, but from observation, it is likely to be "more fast food, a lot of high-carbohydrate food such as beans, rice, and tortillas — especially in Georgia," the fast-food capital of the United States, Ms Rotberg said.

Latino patients have a 1.8 times higher rate of obesity than the general population, and those with unsure or limited income or limited education may choose to eat more high-calories foods associated with poor glycemic control, a high rate of obesity, and potential worse long-term cardiovascular outcomes, according to Dr Umpierrez.

It is difficult to tease out the true lack of access to healthy food from a perception of lack of access to this food, he agreed. For example, when the diabetes educators gave participants a $10 gift card along with a list of recommended foods and then accompanied them on a shopping trip, the patients learned about buying frozen vegetables and purchasing fresh vegetables on sale and "that their money can go way further than they thought," Ms Rotberg said.

The diabetes education program, which included information aimed at overcoming food insecurity, was successful: 234 of the 304 participants in this study lowered their baseline HbA1c levels from 8.8% to 7.7% at 3 months.

Thus, "if you can, through education, overcome the psychological barrier [of food insecurity], you can teach [these patients] that it's not as hard" to eat healthily on a tight budget as they may think, Dr Umpierrez said.

"Exploring avenues to assist food-insecure patients in obtaining nutritionally adequate food may improve the overall health of Latinos with diabetes," the group concludes.

The study was supported by Sanofi. Ms Rotberg and Dr Umpierrez report research support from Sanofi. Disclosures for the coauthors are listed in the abstract.

American Diabetes Association 2015 Scientific Sessions; June 9, 2015: Boston, Massachusetts. Abstract 382-OR

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