Affiliation:
1. University of North Carolina at Chapel Hill
Abstract
Background Little is known about the differing impacts of food insecurity on HbA1c by race in type 2 diabetes (T2D). Predictions around increased food insecurity from COVID-19 exacerbating racial disparities led us to estimate its prevalence and associations with HbA1c by race during the COVID-19 pandemic. Methods Data came from medical records and surveys among a clinic-based sample of T2D patients. Linear regression models estimated associations between food insecurity and HbA1c and between change in food insecurity and change in HbA1c. Likelihood ratio tests and examination of stratum-specific estimates assessed effect modification by race. Results Our sample was 59% White, 59% female, and mean age was 60.8 ± 12.6. During the pandemic, food insecurity prevalence and HbA1c were significantly (p < .05) higher among non-Whites (39%, 8.4% ± 2.1) compared to Whites (15%, 7.8% ±1.6). HbA1c among those who were very food insecure was 1.00% (95% CI: 0.222, 1.762, p = .01) higher than those who were food secure. Those with increased food insecurity had a 0.58% (95% CI: 0.024, 1.128, p = .04) higher HbA1c increase than among those experiencing no change. No effect modification was detected. Limitations Convenience sampling in an endocrinology clinic, recall bias, and inadequate power may underlie null effect modification results. Conclusion Although effect modification was not detected, racial disparities in HbA1c and food insecurity warrant further investigation. These disparities, combined with the significant impact of food insecurity on HbA1c, suggest that prioritization of resources to high-risk populations should be considered early during public emergencies to minimize short- and long-term health consequences.
Publisher
North Carolina Institute of Medicine
Reference26 articles.
1. Food insecurity, food “deserts,” and glycemic control in patients with diabetes: A longitudinal analysis;Seth A. Berkowitz;Diabetes Care,2018
2. The longitudinal relationship between food insecurity in older adults with diabetes and emergency department visits, hospitalizations, hemoglobin A1c, and medication adherence;Emily B. Schroeder;Journal of Diabetes and its Complications,2019
3. Significance of hba1c test in diagnosis and prognosis of diabetic patients;Shariq I. Sherwani;Biomarker Insights,2016
4. Diabetes health disparities: a systematic review of health care interventions;Monica E. Peek;Medical Care Research and Review,2007
5. Food insecurity and diabetes: the role of federally qualified health centers as pillars of community health;Anne Daly;Cureus,2021