Journal Article

The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes

Hebert, Paul, Silverman, Julie, Nelson, Karin, Krieger, James, Kiefer, Meghan, Robinson, June

2015

Overview

ABSTRACT BACKGROUND Food insecurity— lack of dependable access to adequate food—may play a role in poor diabetes control. OBJECTIVE We aimed to determine the relationship between food security status and depression, diabetes distress, medication adherence and glycemic control. DESIGN Secondary analysis of baseline data from Peer Support for Achieving Independence in Diabetes, a randomized controlled trial that enrolled patients from November 2011 to October 2013. PARTICIPANTS Participants had poorly controlled type 2 diabetes (A1c ≥ 8.0 % on eligibility screen), household income < 250 % of the federal poverty level, were 30–70 years old, and were recruited from a large public hospital, a VA medical center and a community-health center in King County, Washington. MAIN MEASURES We measured food insecurity determined by the Department of Agriculture’s 6-Item Food Security Module. Depression, diabetes distress and medication adherence measured by PHQ-8, Diabetes Distress Scale and Morisky Medication Adherence Scale, respectively. Diet was assessed through Summary of Diabetes Self-Care Activities and Starting the Conversation tool. Incidence of hypoglycemic episodes was by patient report. Glycemic control was assessed with glycosylated hemoglobin (A1c) values from fingerstick blood sample. KEY RESULTS The prevalence of food insecurity was 47.4 %. Chi-square tests revealed participants with food insecurity were more likely to be depressed (40.7 % vs. 15.4 %, p < 0.001), report diabetes distress (55.2 % vs. 33.8 %, p < 0.001) and have low medication adherence (52.9 % vs. 37.2 %, p = 0.02). Based on linear regression modeling, those with food insecurity had significantly higher mean A1c levels (β = 0.51; p = 0.02) after adjusting for sex, age, race/ethnicity, language, education, marital status, BMI, insulin use, depression, diabetes distress and low medication adherence. CONCLUSIONS Almost half of participants had food insecurity. Food insecurity was associated with depression, diabetes distress, low medication adherence and worse glycemic control. Even with adjustment, people with food insecurity had higher mean A1c levels than their food-secure counterparts, suggesting there may be other mediating factors, such as diet, that explain the relationship between food security status and diabetes control.

• Publisher: Springer US,Springer Nature B.V
• Subject: Adult / Aged / Agricultural economics / Body mass / Data processing / Depression - economics / Depression - epidemiology / Diabetes / Diabetes mellitus / Diabetes mellitus (non-insulin dependent) / Diabetes Mellitus, Type 2 - drug therapy / Diabetes Mellitus, Type 2 - economics / Diabetes Mellitus, Type 2 - epidemiology / Diet / Drugs / Female / Food / Food security / Food supply / Food Supply - economics / Government agencies / Health care facilities / Hemoglobin / Humans / Hunger / Hypoglycemic Agents - economics / Hypoglycemic Agents - therapeutic use / Income / Insulin / Internal Medicine / Low income groups / Male / Medication Adherence / Medicine / Medicine & Public Health / Mental depression / Middle Aged / Minority & ethnic groups / Original Research / Patient compliance / Patients / Poverty / Poverty - economics / Regression analysis / Secondary analysis / Washington - epidemiology