Estimating the impact of addressing food needs on diabetes outcomes

Seth A Berkowitz; Aileen Ochoa; Jenna M Donovan; Jenine Dankovchik; Myklynn LaPoint; Marlena L Kuhn; Suzanne Morrissey; Mufeng Gao; Michael G Hudgens; Sanjay Basu; Rachel Gold

doi:10.1016/j.ssmph.2024.101709

Estimating the impact of addressing food needs on diabetes outcomes

SSM Popul Health. 2024 Sep 3:27:101709. doi: 10.1016/j.ssmph.2024.101709. eCollection 2024 Sep.

Authors

Seth A Berkowitz^{1

2

3}, Aileen Ochoa⁴, Jenna M Donovan⁴, Jenine Dankovchik⁴, Myklynn LaPoint^{2

3}, Marlena L Kuhn⁵, Suzanne Morrissey⁴, Mufeng Gao⁶, Michael G Hudgens⁶, Sanjay Basu⁷, Rachel Gold^{4

8}

Affiliations

¹ Division of General Medicine and Clinical Epidemiology, Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
² Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
³ Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁴ Department of Research, OCHIN, Portland, OR, USA.
⁵ Department of Social Medicine, Center for Health Equity Research, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁶ Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
⁷ Clinical Product Development, Waymark Care, San Francisco, CA, USA.
⁸ Kaiser Permanente Northwest Center for Health Research, Portland, OR, USA.

Abstract

Objective: To estimate the association between food needs and diabetes outcomes.

Research design and methods: Longitudinal cohort study, using a target trial emulation approach. 96,792 adults with type 2 diabetes mellitus who underwent food need assessment in a network of community-based health centers were followed up to 36 months after initial assessment. We used targeted minimum loss estimation to estimate the association between not experiencing food needs, compared with experiencing food needs, and hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. The study period was June 24th, 2016 to April 30th, 2023.

Results: We estimated that not experiencing food needs, compared with experiencing food needs, would be associated with 0.12 percentage points lower (95% Confidence Interval [CI] -0.16% to -0.09%, p = < 0.0001) mean HbA1c at 12 months. We further estimated that not experiencing food needs would be associated with a 12-month SBP that was 0.67 mm Hg lower (95%CI -0.97 to -0.38 mm Hg, p < .0001), DBP 0.21 mm Hg lower (95%CI -0.38 to -0.04 mm Hg, p = .01). There was no association with lower LDL cholesterol. Results were similar at other timepoints, with associations for HbA1c, SBP, and DBP of similar magnitude, and no difference in LDL cholesterol.

Conclusions: We estimated that not experiencing food needs may be associated with modestly better diabetes outcomes. These findings support testing interventions that address food needs as part of their mechanism of action.

Keywords: Diabetes mellitus; Food insecurity; Health equity; Population health; Social determinants of health; Socioeconomic factors.