Abstract
IntroductionDiabetes, characterized by elevated blood glucose levels, affects 13% of US adults, 95% of whom have type 2 diabetes (T2D). Social determinants of health (SDoH), such as food insecurity, are integral to glycemic control. The Supplemental Nutrition Assistance Program (SNAP) aims to reduce food insecurity, but it is not clear how this affects glycemic control in T2D. This study investigated the associations between food insecurity and other SDoH and glycemic control and the role of SNAP participation in a national socioeconomically disadvantaged sample.Research design and methodsAdults with likely T2D and income<185% of the federal poverty level (FPL) were identified using cross-sectional National Health and Nutrition Examination Survey (NHANES) data (2007–2018). Multivariable logistic regression assessed the association between food insecurity, SNAP participation and glycemic control (defined by HbA1c7.0%–8.5% depending on age and comorbidities). Covariates included demographic factors, clinical comorbidities, diabetes management strategies, and healthcare access and utilization.ResultsThe study population included 2084 individuals (90%>40 years of age, 55% female, 18% non-Hispanic black, 25% Hispanic, 41% SNAP participants, 36% low or very low food security). Food insecurity was not associated with glycemic control in the adjusted model (adjusted OR (aOR) 1.181 (0.877–1.589)), and SNAP participation did not modify the effect of food insecurity on glycemic control. Insulin use, lack of health insurance, and Hispanic or another race and ethnicity were among the strongest associations with poor glycemic control in the adjusted model.ConclusionsFor low-income individuals with T2D in the USA, health insurance may be among the most critical predictors of glycemic control. Additionally, SDoH associated with race and ethnicity plays an important role. SNAP participation may not affect glycemic control because of inadequate benefit amounts or lack of incentives for healthy purchases. These findings have implications for community engaged interventions and healthcare and food policy.
Funder
Siteman Cancer Center
National Institutes of Diabetes, Digestive and Kidney Diseases
Barnes Jewish Hospital
National Institute for Child Health and Development
Subject
Endocrinology, Diabetes and Metabolism
Reference52 articles.
1. Centers for Disease Control and Prevention . National diabetes Statistics report. 2020. Available: https://www.cdc.gov/diabetes/pdfs/data/statistics/national-diabetes-statistics-report.pdf [Accessed 23 Feb 2021].
2. Economic Costs of Diabetes in the U.S. in 2017
3. Centers for Disease Control and Prevention ,. Social determinants of health: Know what affects health. Available: https://www.cdc.gov/socialdeterminants/about.html [Accessed 23 Feb 2021].
4. Social determinants of health and diabetes: A scientific review;Hill-Briggs;Diabetes Care,2020
5. Prevention and management of type 2 diabetes: dietary components and nutritional strategies
Cited by
2 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献