Food insecurity and glycemic control in individuals with diagnosed and undiagnosed diabetes in the United States

  • Rebekah J. Walker
    Affiliations
    Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States

    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
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  • Emma Garacci
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
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  • Mukoso Ozieh
    Affiliations
    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States

    Division of Nephrology, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States

    Division of Nephrology, Clement J. Zablocki VA Medical Center, Milwaukee, WI, United States
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  • Leonard E. Egede
    Correspondence
    Corresponding author at: Medical College of Wisconsin, Division of General Internal Medicine, 8701 Watertown Plank Rd., Milwaukee, WI 53226-3596, United States.
    Affiliations
    Division of General Internal Medicine, Department of Medicine, Froedtert & The Medical College of Wisconsin, Milwaukee, WI, United States

    Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee, WI, United States
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      Highlights

      • Food insecurity had a stronger relationship with HbA1c for undiagnosed diabetes.
      • Adults with food insecurity may be at high risk for having undiagnosed diabetes.
      • Screening for diabetes should be considered in food insecure adults.

      Abstract

      Aims

      Investigate the relationship between food insecurity and glycemic control in adults with diagnosed and undiagnosed diabetes.

      Methods

      Using National Health and Nutrition Examination Survey (NHANES) between 2003–2016, food insecurity was measured using the household food insecurity scale. Glycemic control was measured using glycated hemoglobin (HbA1c) collected during the NHANES examination. Individuals were categorized into undiagnosed diabetes or diagnosed diabetes based on their measured HbA1c and response to whether they were told by a doctor or other health professional they have diabetes or were taking medications for diabetes. Sampling weights and survey procedures were used when conducting univariate and multivariable models using SAS version 9.4.

      Results

      Approximately 13.7% of the population sample (35,216 adults representing 207,271,917 US adults) reported food insecurity. Reporting food insecurity was associated with 0.37 higher HbA1c for diagnosed (95% CI 0.15−0.60) and 0.45 higher HbA1c for undiagnosed diabetes (95% CI 0.05−0.85). In the undiagnosed diabetes population, those reporting food insecurity had 80% higher likelihood of HbA1c above 7% (OR = 1.80, 95% CI 1.06–3.06).

      Conclusions

      Food insecurity had a stronger relationship with HbA1c for those with undiagnosed diabetes. Results suggest the importance of screening for individuals with food insecurity that may be at high risk for having undiagnosed diabetes.

      Keywords

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