Food Insecurity and Diabetes: An Integrated Social Medical Approach

Food insecurity—a lack of consistent access to sufficient, safe, and nutritious food—is a daily struggle for millions of Americans. It is one of the many social, economic, and environmental factors that influence individuals’ health and well-being that are collectively referred to as Social Determinants of Health.

Food insecurity can also compound the effects of chronic diseases and intensifying economic woes as patients choose between buying food and paying for medicine. This is especially problematic for people with diabetes. For these individuals, a healthy diet is a crucial part of their diabetes self-management. People with diabetes who don’t have access to fresh healthful food on a consistent basis—either because of proximity or because of affordability—may be unable to maintain healthy blood-sugar levels over time. This leads patients with diabetes to experience five times more physician encounters than patients who do not have diabetes. At the national level, diabetes accounts for an additional $77 billion in annual health care spending.

Many players in the health care system, from individual providers to the federal Centers for Medicare and Medicaid Services, recognize food insecurity’s role in health promotion and are investing in ways to tackle this persistent problem that has been exacerbated by the economic challenges of the COVID pandemic. 

Researchers at RTI partnered with Access Community Health Network (ACCESS), a federally qualified health center network in Chicago, to learn more about how to improve the health of the population by addressing food insecurity through an innovative, high-impact approach for low-resource communities.  

With support from Robert Wood Johnson Foundation, the RTI team created and executed an evaluation of the standard of practice model developed and implemented by the team at ACCESS. The model represents a social medicine approach that considers the whole person and was designed to help low-income patients with diabetes maintain healthy blood sugar levels. It involved screening patients at intake for food insecurity, offering education on healthy eating, and providing help with access to healthy foods. Providers using this approach do more than check in with patients and discuss their lab results—they actively promote a culture of health.

At the start of the study, patients were screened for food insecurity and offered additional resources, such as referrals to food pantries, access to a mobile produce truck, and enrollment in SNAP, the federal food stamp program. The study team collected data on more than 900 patients, including HbA1C, a common measure for a person’s average blood sugar levels. After five months, patients were sent a postcard reminding them about their next visit. Nearly 400 returned for a follow-up visit that included an HbA1C check.

Our study led to important findings on who was able to improve their HbA1C levels. Across all participants, HbA1C levels dropped by .22 percentage points from baseline to follow-up, a statistically significant difference. This shows the overall impact of the integrated social medicine approach.

Taking a closer look at the participants’ food security status reveals other important factors. Not unexpectedly, patients whose diabetes was well controlled at baseline experienced less of a change over the study than those whose diabetes was not well controlled. However, among the group with poor control, we found that food-secure patients’ HbA1C levels improved significantly more than did food-insecure patients.

Based on our results, we concluded that food insecurity is not likely to exist separate from other disparities. While all patients can benefit from the standard of care practice we examined, food-secure patients are better able to translate the information and resources into positive health outcomes. This leads us to recommend that physicians and other members of the health care community look closely at their patients who identify as food insecure and play an active role in identifying the support and resources they need.  

What keeps people food-insecure, even if they are given assistance to access to the foods they need? Are the food pantries inaccessible? Are people cut off from the foods they prefer, culturally speaking? Sometimes economics are not the only barrier.

Our study is part of a growing area of research on social determinants of health. These findings, along with those from future studies, can help inform policymakers addressing food insecurity and the many overlapping factors that prevent individuals and the nation from reaching their full potential.