Pathways between food insecurity and glycaemic control in individuals with type 2 diabetes. Public Health Nutr 2018 Dec;21(17):3237-3244
Date
08/09/2018Pubmed ID
30088467Pubmed Central ID
PMC6258341DOI
10.1017/S1368980018001908Scopus ID
2-s2.0-85052695790 (requires institutional sign-in at Scopus site) 18 CitationsAbstract
OBJECTIVE: Food insecurity is reported in approximately 28 % of individuals with diabetes in the USA and is associated with poor glycaemic and lipid control. The present study aimed to understand the direct and indirect pathways through which food insecurity impacts glycaemic control in individuals with diabetes.Design/Setting/SubjectsAdults (n 615) with type 2 diabetes completed validated questionnaires after recruitment from two primary care clinics. Structural equation modelling was used to investigate mechanisms through which food insecurity influences diabetes self-care behaviours and glycaemic control, including investigation into possible direct and indirect effects of perceived stress and social support.
RESULTS: The final model showed that higher food insecurity was directly significantly related to increased stress (r=0·14, P<0·001) and increased glycosylated Hb (r=0·66, P=0·03). Higher stress was significantly related to poorer self-care (r=-0·54, P<0·001) and lower social support (r=-0·41, P<0·001). There was no significant direct association between food insecurity and self-care, or between perceived stress and glycaemic control.
CONCLUSIONS: Food insecurity had both a direct effect on glycaemic control and an indirect effect on self-care through stress. The indirect pathway suggests that efforts to address stress may influence the ability of individuals to perform diabetes self-care behaviours. The direct effect on glycaemic control suggests that pathways independent of self-care behaviours may also be necessary to improve diabetes outcomes. Results from the study suggest a multipronged approach is necessary to address food insecurity in individuals with diabetes.
Author List
Walker RJ, Williams JS, Egede LEAuthors
Leonard E. Egede MD Center Director, Chief, Professor in the Medicine department at Medical College of WisconsinRebekah Walker PhD Associate Professor in the Medicine department at Medical College of Wisconsin
Joni Williams MD, MPH Associate Professor in the Medicine department at Medical College of Wisconsin
MESH terms used to index this publication - Major topics in bold
AgedBlood Glucose
Diabetes Mellitus, Type 2
Female
Food Supply
Humans
Male
Middle Aged
Self Care
Social Support
Stress, Psychological
Surveys and Questionnaires