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Food Insecurity and Diabetes, A Dangerous Combination

By Rosalind Lucier, Marie Tetsu, and Matthew Garza

Food insecurity affects many people in the US, particularly people with diabetes. Resources exist to help those without access to enough, nutritious food, and Dr. Seth Berkowitz encourages healthcare teams to address this problem specifically and creatively

At a webinar hosted by the American Diabetes Association, Dr. Seth Berkowitz (from the University of North Carolina at Chapel Hill) addressed the issue of food insecurity for people with diabetes. Food insecurity describes when a person does not have consistent access to food (or enough food) to support an active and healthy life. Some characteristics of food insecurity include:

  • Low quality of food

  • Limited variety of food

  • Disrupted eating patterns – not eating balanced meals throughout the day

  • A decrease in the amount of food eaten

In 2018, 11.1% of Americans were found to be food insecure at some point during the year. For people with diabetes, the rate is almost double, at 20%. 

Food insecurity and diabetes can be a particularly dangerous combination. Dr. Hilary Seligman pioneered this field and has helped bring attention to this very issue. When individuals face financial stress, it can lead to the difficult decision of paying for medicine or paying for food. If that person prioritizes food over medication, their threat of hyperglycemia increases. However, if medication is prioritized, then they are at a higher risk of severe hypoglycemia. People who experience food insecurity have higher A1C levels. Food insecurity also adds psychological challenges, which can lead to stress and depression.

Dr. Seligman has highlighted how few resources exist for people who can’t afford healthy food, and she founded EatSF as a way to address this issue in San Francisco. Unfortunately, in absence of these programs, people facing food insecurity often end up prioritizing the immediate need for food above the chronic care of their diabetes – a decision that can lead to long-term health complications.

During the seminar, Dr. Berkowitz stressed the importance of routine screening for food insecurity at visits with healthcare professionals. Tools for screening include brief questionnaires like the Hunger Vital Sign tool or the Health-Related Social Needs (HRSN) tool developed by Centers for Medicare and Medicaid Services (CMS). When asked how often screenings should occur, Dr. Berkowitz reminded the audience that food insecurity is community-dependent. Healthcare professionals may need to screen people anywhere from once a month to once a year, depending on the needs of the community and the individual. He also recommended that screenings be increased now due to COVID-19, as estimates show that food insecurity may have tripled as a result of the pandemic. Moreover, healthcare professionals must be mindful that food insecurity can be a sign that a person is struggling to meet other important needs (such as medicine, access to healthcare, or diabetes supplies), making it that much harder to manage their diabetes.

However, screening is not enough to solve the problem of food insecurity. Once food insecurity is identified, it is important that interventions follow to address the issue. Dr. Berkowitz urged healthcare professionals to partner with local resources such as food banks and other community-based organizations. He listed a few of the national organizations that are working to help relieve food insecurity, including: Feeding America, No Kid Hungry, the American Hospital Association, and AARP. For people with diabetes, Dr. Berkowitz praised the nutritional education services provided by the Diabetes Prevention Program (DPP) study, as well as Diabetes Self-Management Education and Support (DSMES) programs. Read about the program in Pennsylvania that is providing healthy food and dramatically improving diabetes outcomes.

If you or someone you know is experiencing food insecurity, here are some resources to help you:

  • SNAP (Supplemental Nutrition Assistance Program, formerly known as food stamps)

  • NSLP (National School Lunch Program)

  • WIC (the Special Supplemental Program for Women, Infants, and Children)

All of these programs are funded by the federal government and are the main forms of assistance for people experiencing food insecurity. Reach out to these national programs to see if you qualify for help, and talk to your healthcare team about any additional resources it may have.

In addition to these national programs, here are two online resources that can help you locate affordable food and other local health services in your area: 

  • Aunt Bertha is a free, online database that has helped almost four million people find free or reduced-cost food and other essential services in their area. You can browse ten categories – including food, housing, health, legal, and education – by zip code or by state. The food section can help you find local options for emergency food, free meals, nutrition education, and assistance with paying for food. To find out if you qualify for these services, a filter allows you to input personal information such as income level or citizenship status. Aunt Bertha’s “translate” option even allows you to change the page into any language, reducing barriers for people who don’t speak English.

  • NowPow helps healthcare professionals, social workers, and community caregivers provide individualized, “hyper-local” support resources to patients. The platform delivers resource referrals to people at community centers, clinics, and hospitals – including referrals to local food access and nutrition services. If you are a healthcare provider or social worker and would like to use NowPow’s services, click here to request a demo. If you work at a community organization and would like to add your organization to NowPow’s local resource directory, click here. If you or someone you know faces food insecurity, contact your healthcare team to see if NowPow could help you.

While more healthcare professionals are asking people screening questions to be able to identify food insecurity, many people are not yet being connected to the resources they need. To start a conversation with your healthcare professional about nutrition resources for you or others, feel free to send them this article.

Whether you are a person with diabetes, a care-partner, or a healthcare professional, COVID-19 has affected every aspect of daily life, including access to food. Understanding food insecurity and working to relieve it is important for creating and maintaining a healthy society. Many studies have found that federal food programs can lead to dietary changes and help reduce food insecurity. In the seminar, Dr. Berkowitz recommended that healthcare professionals and community health workers think creatively. Helping people with food insecurity is not limited to just providing food; rather, systemic changes and community partnerships are necessary so that people don’t have to make a decision between eating a meal and buying their medication. We hope that increased screenings for food insecurity and the use of intervention pathways will help educate and support people with diabetes.

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