Food-based diabetes self-management and education intervention for food insecure patients with type 2 diabetes: A mixed-methods feasibility study

Authors: SHORT, ELIZA - University Of Arizona; BRYANT, HOLLY - Non ARS Employee; GONZALEZ, RHONDA - Community Food Bank Of Southern Arizona; ROE, DENISE - University Of Arizona; SHEAVA, JESSI - Community Food Bank Of Southern Arizona; TAREN, DOUGLAS - University Of Colorado; Thompson, Deborah - Debbe; HINGLE, MELANIE - University Of Arizona

Submitted to: Meeting Abstract
Publication Type: Abstract Only
Publication Acceptance Date: 3/14/2022
Publication Date: 5/21/2022
Citation: Short, E., Bryant, H., Gonzalez, R., Roe, D.J., Sheava, J., Taren, D., Thompson, D.J., Hingle, M. 2022. Food-based diabetes self-management and education intervention for food insecure patients with type 2 diabetes: A mixed-methods feasibility study [abstract]. International Society of Behavioral Nutrition and Physical Activity (ISBNPA) Annual Meeting. May 18-21, 2022; Phoenix, AZ. Oral Presentation.

Interpretive Summary:

Technical Abstract: The purpose of the study was to determine the feasibility and acceptability of a food-based diabetes self-management and education (DSME) intervention for food insecure individuals. A single arm (pre-post) intervention study was conducted in partnership with a food bank and federally qualified health center (FQHC). Twenty-one food insecure FQHC patients with type 2 diabetes (T2DM) participated in the 3-month intervention: six bimonthly food boxes, recipes, DSME resources, and two, 30-minute virtual dietitian consults. Food security, diabetes self-efficacy, sociodemographic characteristics, and dietary intake (two, 24-hour dietary recall interviews) were assessed during phone interviews; diet quality scores were calculated (Healthy Eating Index (HEI)-2015). Hemoglobin A1c (HbA1c), height, and weight were obtained (FQHC electronic medical record). Wilcoxon signed-rank and Stuart-Maxwell tests evaluated pre-post intervention differences. Participants completed one in-depth interview at follow-up; data were coded to assess feasibility criteria using structured thematic analysis. 247 patients with T2DM and food insecurity were recruited, 71 expressed interest, 25 consented, and 21 completed the study. Participants were median (IQR) 48.0 (38.0-63.0) years, 71% female, 62% Hispanic, and 38% White. Fifteen participants (71%) received all home food deliveries and > 1 dietitian visit. At baseline, (n=15, 71%) participants reported low/very low food security; median (IQR) diabetes self-efficacy score (0-10) was 6.4 (5.9-7.0); HEI-2015 score (0-100) was 55.9 (51.8-63.9); 90% were overweight or obese; HbA1c was 10.4 (7.6-11.0). There were no significant differences in food security, diabetes self-efficacy, diet quality or biometric data (HbA1c, body mass index) between baseline and follow-up. The intervention was feasible - participants were satisfied with resources and reported using most/all foods received. Reported benefits included offsetting food costs, increased consumption of healthy foods, and help with T2DM meal planning. Challenges included time to cook some food items, family support, and securing dietitian appointments. Participants provided suggestions for improvement - more recipes, greater food diversity, T2DM management tools, and tailoring food amount to household size. We concluded the intervention was feasible and acceptable, and participants gave specific suggestions for improvement. Most participants reported moderate diabetes self-efficacy, and low diet quality and food security, suggesting unmet needs. Next steps include a randomized clinical trial to establish intervention efficacy.