University of California - San Francisco
To determine whether healthy food could help low-income people
better control their diabetes, a pilot study by UC San Francisco and Feeding
America tracked nearly 700 people at food banks in California, Texas and Ohio
over two years.
The result: better diabetes control and medication adherence and
an overall improvement in the consumption of healthy food.
The research is the first formal evaluation of a diabetes
intervention for food insecure people involving the actual provision of food.
Food insecurity, a risk factor for poor diabetes control, refers to being at
risk of hunger because of the inability to afford nutritious food.
The observational pilot study is now being followed by a more extensive research trial at food banks in Oakland, Detroit and Houston by UCSF and Feeding America.
The paper will be published in the November issue of Health
Affairs.
"We have not traditionally thought of food pantries as
places to provide diabetes education and diabetes support, but they are in fact
ideal places because they reach so many vulnerable people who suffer from
diabetes and because they have unique expertise in the distribution of
food," said first author Hilary Seligman, MD, an associate professor of
medicine at UCSF and a core faculty member of UCSF's Center for Vulnerable
Populations at San Francisco General Hospital and Trauma Center.
Seligman is also the senior medical advisor and lead scientist
at Feeding America, the nation's largest hunger-relief organization with a
network of 60,000 food pantries and meal programs providing food to more than
46 million people annually.
As one of the nation's foremost experts on the health
implications of food insecurity, Seligman focuses on the intersection between
food insecurity and health, particularly on the prevention and management of
chronic disease.
Feeding America was founded in 1979 in order to meet short-term
emergency needs for food. At the time, the focus was on shelf-stable, often
calorically-rich food.
But over the last two decades, as food insecurity and
poverty persisted, reliance on the food bank system has increased with a
greater imperative to provide nutritious food and promote health. A third of
Feeding America's clients say that a member of their household has diabetes.
The pilot study provided an opportunity for food banks and
pantries to experiment with ways to consistently deliver healthier food, to
educate pantry staff and volunteers about the needs of clients with
diet-sensitive disease, and to study whether vulnerable people with diabetes
were helped in the process.
The intervention was conducted at three food banks: the Redwood
Empire Food Bank in Santa Rosa, California; the Food Bank of Corpus Christi in
Texas; and the Mid-Ohio Foodbank in Grove City, Ohio.
The intervention included four major components:
- Screening for diabetes and monitoring of glycemic control;
- Distributing diabetes-appropriate food once or twice monthly, amounting to enough food to last one or two weeks per distribution depending on household size;
- Referring clients who lacked a usual source of medical care to primary care providers;
- Providing diabetes self-management support and education.
Food-insecure participants with diabetes were enrolled between
February 2012 and March 2014. Excluded were people under age 18, those who were
pregnant or unable to complete surveys in English or Spanish, and people with
impaired cognitive status.
The study contained results on 687 adults who participated in
the intervention. More than half of them were Latino or Hispanic, and 41
percent had less than a high school education. The mean age was 56 years and
the majority (80 percent) were food insecure.
Participants received prepackaged boxes of diabetes-appropriate
food including whole grains, lean meats, beans, low-sodium vegetables, and
shelf-stable dairy products.
The boxes were supplemented with perishable food
-- fresh produce, non-fat or low-fat milk, yogurt, cheese, whole grain bread, and
frozen lean meat. Each box contained recipes and cooking tips to encourage
recipients to eat healthy meals.
Participants in the study highly rated the food boxes: 88
percent said they preferred the diabetes food box to the regular food bank
distribution, and 87 percent reported eating all or most of the contents.
The researchers found significant improvement in glycemic
control, particularly among those with the worst glycemic control when they
started the intervention. Improvements in glycemic control can lower patients'
risk of diabetes complications like kidney disease, eye disease, and nerve
disease.
The researchers also found that participants ate more fruits and
vegetables and better managed their medications, critical factors in diabetes
management.
Policy makers should consider ways to leverage food bank assets,
said the study authors, when designing public health interventions for people
with diet-sensitive chronic diseases such as diabetes.
"The healthy food that a food bank can provide is a cornerstone
of good diabetes management," said Seligman.
"Poor nutrition has a role in the development of so many
diseases of the modern world -- obesity, diabetes, high blood pressure, and
cardiovascular disease, just to name a few," she said.
"One in seven
Americans report that they sometimes don't have adequate money to afford
nutritious foods. Although this study specifically examined the case of
diabetes, it creates a model in which food banks can respond to any of a number
of diseases with education, self-management support, and -- most importantly --
the provision of nutritious food."
