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Food insecurity is associated with high risk glycemic control and higher health care utilization among youth and young adults with type 1 diabetes

Published:February 07, 2018DOI:https://doi.org/10.1016/j.diabres.2018.01.035

      Highlights

      • Youth and adults with T1D had higher food insecurity than the national population.
      • Food insecurity was associated with high risk glycemic control.
      • Food insecurity was associated with more emergency department visits.
      • Programs are needed to alleviate food insecurity among youth and adults with T1D.

      Abstract

      Aims

      Household food insecurity (FI), i.e., limited availability of nutritionally adequate foods, is associated with poor glycemic control among adults with type 2 diabetes. We evaluated the association of FI among youth and young adults (YYA) with type 1 diabetes to inform recent clinical recommendations from the American Diabetes Association for providers to screen all patients with diabetes for FI.

      Methods

      Using data from the Washington and South Carolina SEARCH for Diabetes in Youth Study sites, we conducted an observational, cross-sectional evaluation of associations between FI and glycemic control, hospitalizations, and emergency department (ED) visits among YYA with type 1 diabetes. FI was assessed using the Household Food Security Survey Module, which queries conditions and behaviors typical of households unable to meet basic food needs. Participants’ HbA1c were measured from blood drawn at the research visit; socio-demographics and medical history were collected by survey.

      Results

      The prevalence of FI was 19.5%. In adjusted logistic regression analysis, YYAs from food-insecure households had 2.37 higher odds (95% CI: 1.10, 5.09) of high risk glycemic control, i.e., HbA1c >9.0%, vs. peers from food-secure households. In adjusted binomial regression analysis for ED visits, YYAs from food-insecure households had an adjusted prevalence rate that was 2.95 times (95% CI [1.17, 7.45]) as great as those from food secure households.

      Conclusions

      FI was associated with high risk glycemic control and more ED visits. Targeted efforts should be developed and tested to alleviate FI among YYA with type 1 diabetes.

      Keywords

      Abbreviations:

      ADA (American Diabetes Association), ED (Emergency department), HFSSM (Household Food Security Survey Module), FI (Household food insecurity), ISPAD (International Society for Pediatric and Adolescent Diabetes), MDI (Multiple daily injections), PR (Prevalence ratio), SES (Socioeconomic status), SEARCH (SEARCH for Diabetes in Youth Study), SC (South Carolina), USDA (United States Department of Agriculture), WA (Washington State), YYA (Youth and young adults)
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      References

        • American Diabetes Association
        Standards of medical care in diabetes-2017: summary of revisions.
        Diabetes Care. 2017; 40: S4-S5
        • Petitti D.B.
        • Klingensmith G.J.
        • Bell R.A.
        • Andrews J.S.
        • Dabelea D.
        • Imperatore G.
        • et al.
        Glycemic control in youth with diabetes: the SEARCH for diabetes in youth study.
        J Pediat. 2009; 155 (668-72.e3)
        • Mohammad H.A.
        • Farghaly H.S.
        • Metwalley K.A.
        • Monazea E.M.
        • Abd El-Hafeez H.A.
        Predictors of glycemic control in children with Type 1 diabetes mellitus in Assiut-Egypt.
        Ind J Endocrinol Metabol. 2012; 16: 796-802
        • van Esdonk M.J.
        • Tai B.
        • Cotterill A.
        • Charles B.
        • Hennig S.
        Prediction of glycaemic control in young children and adolescents with type 1 diabetes mellitus using mixed-effects logistic regression modelling.
        PLoS ONE. 2017; 12: e0182181
        • Archinkova M.
        • Konstantinova M.
        • Savova R.
        • Iotova V.
        • Petrova C.
        • Kaleva N.
        • et al.
        Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c.
        Biotechnol Biotechnol Equip. 2017; 31: 1198-1203
        • Ngwiri T.
        • Were F.
        • Predieri B.
        • Ngugi P.
        • Iughetti L.
        Glycemic control in Kenyan children and adolescents with type 1 diabetes mellitus.
        Int J Endocrinol. 2015; 2015: 761759
        • Niba L.L.
        • Aulinger B.
        • Mbacham W.F.
        • Parhofer K.G.
        Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon.
        BMC Res Notes. 2017; 10: 207
        • Majaliwa E.S.
        • Munubhi E.
        • Ramaiya K.
        • Mpembeni R.
        • Sanyiwa A.
        • Mohn A.
        • et al.
        Survey on acute and chronic complications in children and adolescents with type 1 diabetes at Muhimbili National Hospital in Dar es Salaam, Tanzania.
        Diabetes Care. 2007; 30: 2187-2192
        • Hall V.
        • Thomsen R.W.
        • Henriksen O.
        • Lohse N.
        Diabetes in Sub Saharan Africa 1999–2011: epidemiology and public health implications. A systematic review.
        BMC Public Health. 2011; 11: 564
        • Borschuk A.P.
        • Everhart R.S.
        Health disparities among youth with type 1 diabetes: a systematic review of the current literature.
        Famil Syst Health: the journal of collaborative family healthcare. 2015; 33: 297-313
        • Apperley L.J.
        • Ng S.M.
        Socioeconomic deprivation, household education, and employment are associated with increased hospital admissions and poor glycemic control in children with type 1 diabetes mellitus. The review of diabetic studies.
        RDS. 2017; 14: 295-300
        • Piechowiak K.
        • Zdunczyk B.
        • Szypowska A.
        Environmental factors affecting management of type 1 diabetes in children below the age of 10.
        Pediat Endocrinol Diabet Metabol. 2017; 23: 23-29
        • Al-Odayani A.N.
        • Alsharqi O.Z.
        • Ahmad A.M.
        • Khalaf Ahmad A.M.
        • Al-Borie H.M.
        • Qattan A.M.
        Children's glycemic control: mother's knowledge and socioeconomic status.
        Glob J Health Sci. 2013; 5: 214-226
        • Zuijdwijk C.S.
        • Cuerden M.
        • Mahmud F.H.
        Social determinants of health on glycemic control in pediatric type 1 diabetes.
        J Pediatr. 2013; 162: 730-735
        • Hatherly K.
        • Smith L.
        • Overland J.
        • Johnston C.
        • Brown-Singh L.
        • Waller D.
        • et al.
        Glycemic control and type 1 diabetes: the differential impact of model of care and income.
        Pediatr Diabetes. 2011; 12: 115-119
        • Bickel G.
        • Nord M.
        • Price C.
        • Hamilton W.
        • Cook J.
        Guide to measuring household food security, Revised 2000.
        US Department of Agriculture, Food and Nutrition Service, Alexandria (VA)2000
      1. Panel to Review the U.S Department of Agriculture's Measurement of Food Insecurity and Hunger. Food Insecurity and Hunger in the United States: an assessment of the measure. Washington, DC: The National Academies Press; 2006.

        • Seligman H.K.
        • Schillinger D.
        Hunger and socioeconomic disparities in chronic disease.
        N Engl J Med. 2010; 363: 6-9
        • Althoff R.R.
        • Ametti M.
        • Bertmann F.
        The role of food insecurity in developmental psychopathology.
        Prev Med. 2016;
        • American Diabetes Association
        Standards of medical care in diabetes-2017: 1. Promoting health and reducing disparities in populations.
        Diabetes Care. 2017; 40: S6-S10
      2. Coleman-Jensen A, Rabbit MP, Gregory C, Singh A. Household Food Security in the United States in 2015. Washington, DC: ERR-215, US Department of Agriculture, Economic Research Service; 2016.

      3. Pinsker JE, Kraus A, Gianferante D, Schoenberg BE, Singh SK, Ortiz H, et al. Techniques for exercise preparation and management in adults with type 1 diabetes. Can J Diabet; 2016.

        • Marjerrison S.
        • Cummings E.A.
        • Glanville N.T.
        • Kirk S.F.L.
        • Ledwell M.
        Prevalence and associations of food insecurity in children with diabetes mellitus.
        J Pediat. 2011; 158: 607-611
        • Seligman H.K.
        • Jacobs E.A.
        • Lopez A.
        • Tschann J.
        • Fernandez A.
        Food insecurity and glycemic control among low-income patients with type 2 diabetes.
        Diabetes Care. 2012; 35: 233-238
      4. Berkowitz SA, Baggett TP, Wexler DJ, Huskey KW, Wee CC. Food Insecurity and Metabolic Control Among U.S. Adults With Diabetes. Diabetes Care; 2013.

        • Gucciardi E.
        • Vahabi M.
        • Norris N.
        • Del Monte J.P.
        • Farnum C.
        The intersection between food insecurity and diabetes: a review.
        Curr Nutr Rep. 2014; 3: 324-332
        • Berkowitz S.A.
        • Meigs J.B.
        • DeWalt D.
        • et al.
        Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the measuring economic insecurity in diabetes study.
        JAMA Internal Med. 2015; 175: 257-265
        • Hamman R.F.
        • Bell R.A.
        • Dabelea D.
        • D’Agostino R.B.
        • Dolan L.
        • Imperatore G.
        • et al.
        The SEARCH for diabetes in youth study: rationale, findings, and future directions.
        Diabetes Care. 2014; 37: 3336-3344
      5. Economic Research Service. U.S. Household Food Security Survey Module: Three-Stage Design with Screeners. September 2012 ed. Washington, DC: U.S. Department of Agriculture, Economic Research Service; 2012.

        • Carlson S.J.
        • Andrews M.S.
        • Bickel G.W.
        Measuring food insecurity and hunger in the United States: development of a national benchmark measure and prevalence estimates.
        J Nutr. 1999; 129: 510S-516S
        • Frongillo E.A.
        Validation of measures of food insecurity and hunger.
        J Nutr. 1999; 129: 506S-509S
        • Chiang J.L.
        • Kirkman M.S.
        • Laffel L.M.B.
        • Peters A.L.
        Type 1 diabetes through the life span: a position statement of the American Diabetes Association.
        Diabetes Care. 2014; 37: 2034-2054
        • Rewers M.J.
        • Pillay K.
        • de Beaufort C.
        • Craig M.E.
        • Hanas R.
        • Acerini C.L.
        • et al.
        Assessment and monitoring of glycemic control in children and adolescents with diabetes.
        Pediatr Diabetes. 2014; 15: 102-114
      6. Grieco EM, Cassidy RC. Overview of race and Hispanic origin, 2000: US Dept. of Commerce, Economics and Statistics Administration, US Census Bureau; 2001.

      7. Centers for Disease Control and Prevention. 2003–2004 Current National Health and Nutrition Examination Survey (NHANES). Hyattsville, MD: National Center for Health Statistics. Available at http://www.cdc.gov/nchs/nhanes/nhanes2003-2004/current_nhanes_03_04.htm. Accessed January 5, 2008.

        • Food and Nutrition Service
        The National School Lunch Program Fact Sheet.
        US Department of Agriculture, Washington, DC2017
        • Pihoker C.
        • Badaru A.
        • Anderson A.
        • Morgan T.
        • Dolan L.
        • Dabelea D.
        • et al.
        Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study.
        Diabetes Care. 2013; 36: 27-33
        • Davis-Kean P.E.
        The influence of parent education and family income on child achievement: the indirect role of parental expectations and the home environment.
        J Fam Psychol. 2005; 19: 294-304
        • Braveman P.A.
        • Cubbin C.
        • Egerter S.
        • Chideya S.
        • Marchi K.S.
        • Metzler M.
        • et al.
        Socioeconomic status in health research: one size does not fit all.
        JAMA. 2005; 294: 2879-2888
      8. U.S. Census Bureau, Current Population Survey. Table H-8. Median Household Income by State. Washington, DC: US Census Bureau; 2015.

        • Shiue I.
        People with diabetes, respiratory, liver or mental disorders, higher urinary antimony, bisphenol A, or pesticides had higher food insecurity: USA NHANES, 2005–2006.
        Environ Sci Pollut Res Int. 2016; 23: 198-205
      9. Cristofar SP, Basiotis PP. Dietary intakes and selected characteristics of women ages 19–50 years and their children ages 1–5 years by reported perception of food sufficiency. J Nutrit Edu 1992;24:53–8.

        • Lyles C.R.
        • Wolf M.S.
        • Schillinger D.
        • Davis T.C.
        • DeWalt D.
        • Dahlke A.R.
        • et al.
        Food insecurity in relation to changes in hemoglobin A1c, self-efficacy, and fruit/vegetable intake during a diabetes educational intervention.
        Diabetes Care. 2013; 36: 1448-1453
        • Berkowitz S.A.
        • Gao X.
        • Tucker K.L.
        Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican Health study.
        Diabetes Care. 2014;
        • Cook J.T.
        • Black M.
        • Chilton M.
        • Cutts D.
        • Ettinger de Cuba S.
        • Heeren T.C.
        • et al.
        Are food insecurity's health impacts underestimated in the U.S. Population? Marginal food security also predicts adverse health outcomes in Young U.S. Children and Mothers.
        Adv Nutri. 2013; 4: 51-61
      10. Alabbood MH, Ho KW, Simons MR. The effect of Ramadan fasting on glycaemic control in insulin dependent diabetic patients: a literature review. Diabet Metabol Syndr; 2016.

      11. Thomas B, Fitzpatrick S, Sidani S, Gucciardi E. Developing and implementing a food insecurity screening initiative for patients living with diabetes. Can J Diabet; 2017.

        • Gitterman B.A.
        • Chilton L.A.
        • Cotton W.H.
        • Duffee J.H.
        • Flanagan P.
        • Keane V.A.
        • et al.
        Promoting food security for all children.
        Pediatrics. 2015; 136: e1431-e1438
        • Alaimo K.
        • Olson C.M.
        • Frongillo Jr., E.A.
        Food insufficiency and American school-aged children's cognitive, academic, and psychosocial development.
        Pediatrics. 2001; 108: 44-53
        • Boris N.W.
        • Brown L.A.
        • Thurman T.R.
        • Rice J.C.
        • Snider L.M.
        • Ntaganira J.
        • et al.
        Depressive symptoms in youth heads of household in Rwanda: correlates and implications for intervention.
        Arch Pediatr Adolesc Med. 2008; 162: 836-843
        • Broughton M.A.
        • Janssen P.S.
        • Hertzman C.
        • Innis S.M.
        • Frankish C.J.
        Predictors and outcomes of household food insecurity among inner city families with preschool children in Vancouver.
        Can J Public Health. 2006; 97: 214-216
        • Casey P.
        • Goolsby S.
        • Berkowitz C.
        • Frank D.
        • Cook J.
        • Cutts D.
        • et al.
        Maternal depression, changing public assistance, food security, and child health status.
        Pediatrics. 2004; 113: 298-304
        • Cook J.T.
        • Frank D.A.
        Food security, poverty, and human development in the United States.
        Ann N Y Acad Sci. 2008; 1136: 193-209
        • Cook J.T.
        • Frank D.A.
        • Berkowitz C.
        • Black M.M.
        • Casey P.H.
        • Cutts D.B.
        • et al.
        Food insecurity is associated with adverse health outcomes among human infants and toddlers.
        J Nutr. 2004; 134: 1432-1438
        • Kleinman R.E.
        • Murphy J.M.
        • Little M.
        • Pagano M.
        • Wehler C.A.
        • Regal K.
        • et al.
        Hunger in children in the United States: potential behavioral and emotional correlates.
        Pediatrics. 1998; 101: E3
        • Murphy J.M.
        • Wehler C.A.
        • Pagano M.E.
        • Little M.
        • Kleinman R.E.
        • Jellinek M.S.
        Relationship between hunger and psychosocial functioning in low-income American children.
        J Am Acad Child Adolesc Psychiatry. 1998; 37: 163-170
        • Rose-Jacobs R.
        • Black M.M.
        • Casey P.H.
        • Cook J.T.
        • Cutts D.B.
        • Chilton M.
        • et al.
        Household food insecurity: associations with at-risk infant and toddler development.
        Pediatrics. 2008; 121: 65-72
        • Whitaker R.C.
        • Phillips S.M.
        • Orzol S.M.
        Food insecurity and the risks of depression and anxiety in mothers and behavior problems in their preschool-aged children.
        Pediatrics. 2006; 118: e859-e868
        • Zaslow M.
        • Bronte-Tinkew J.
        • Capps R.
        • Horowitz A.
        • Moore K.A.
        • Weinstein D.
        Food security during infancy: implications for attachment and mental proficiency in toddlerhood.
        Matern Child Health J. 2009; 13: 66-80