Food insecurity, defined as difficulty affording an adequate diet owing to cost, affects over 20% of the 29 million Americans with diabetes. Food insecurity is an important socioeconomic barrier to effective diabetes care: it is associated with worse diabetes control and increased emergency department visits and hospitalization. By incentivizing consumption of calorie-dense foods high in simple carbohydrates and saturated fats, instead of more expensive fresh produce and whole grains, food insecurity may undermine healthy diets that are crucial for diabetes management. This project will help advance our knowledge of the relationship between food insecurity and diabetes by identifying how food insecurity affects current diabetes management and examining the clinical effects of using different strategies to overcome it. Fundamental questions regarding the mechanisms underlying potential interventions remain unanswered. To address these gaps in knowledge, the principal investigator (PI) proposes a career development program that blends rigorous methodologic training with an innovative research agenda. This plan has three scientific objectives: 1) To determine the impact of food insecurity on a lifestyle change intervention: the REAL HEALTH Diabetes trial (R18 DK102737 NCT02320253), a pragmatic adaptation of the Look AHEAD lifestyle intervention to community health centers, 2)To estimate the effect of nutrition assistance program use on diabetes control for patients in a primary care network, and 3) To conduct a pilot randomized controlled trial to assess the feasibility of home-delivered medically tailored meals for food insecure diabetes patients with hyperglycemia. This research program complements the National Institute of Diabetes and Digestive and Kidney Diseases' strategic focus on translating clinical research to practice by overcoming barriers faced by patients in real-world settings, reducing disparities in special populations, making care more patient-centered, and innovating within systems of care. The long-term goal of this career development award is to establish the PI as an independent researcher with expertise in understanding how socioeconomic barriers affect diabetes management and pragmatic interventions to overcome them. Career development activities include training in advanced analytic methods and intervention design through formal coursework as well as mentorship by an exceptionally qualified team of senior scientists. Successful completion of this career development proposal will fill important knowledge gaps, and help improve diabetes management and reduce diabetes complications in patients with food insecurity.

Public Health Relevance

Over 29 million Americans have diabetes, and 1 in 5, nearly 6 million, report food insecurity, or difficulty accessing nutritious food owing to cost. The proposed research program will significantly advance our understanding of the role food insecurity plays in diabetes management, and assess 2 strategies to address food insecurity in diabetes patients: 1) improving food access using nutritional assistance programs, and 2) directly providing medically tailored meals. This program has the potential to expand partnerships between healthcare systems and community organizations, and may reduce the impact of food insecurity among vulnerable diabetes patients

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Mentored Patient-Oriented Research Career Development Award (K23)
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Study Section
Kidney, Urologic and Hematologic Diseases D Subcommittee (DDK)
Program Officer
Spain, Lisa M
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Massachusetts General Hospital
United States
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Baggett, Travis P; Berkowitz, Seth A; Fung, Vicki et al. (2018) Prevalence of Housing Problems Among Community Health Center Patients. JAMA 319:717-719
Basu, Sanjay; Sussman, Jeremy B; Berkowitz, Seth A et al. (2018) Validation of Risk Equations for Complications of Type 2 Diabetes (RECODe) Using Individual Participant Data From Diverse Longitudinal Cohorts in the U.S. Diabetes Care 41:586-595
Basu, Sanjay; Yudkin, John S; Berkowitz, Seth A et al. (2018) Reducing chronic disease through changes in food aid: A microsimulation of nutrition and cardiometabolic disease among Palestinian refugees in the Middle East. PLoS Med 15:e1002700
Berkowitz, Seth A (2018) Capsule Commentary on Landon et al., ""Trends in Diabetes Treatment and Monitoring Among Medicare Beneficiaries"". J Gen Intern Med 33:498
Kalkhoran, Sara; Berkowitz, Seth A; Rigotti, Nancy A et al. (2018) Financial Strain, Quit Attempts, and Smoking Abstinence Among U.S. Adult Smokers. Am J Prev Med 55:80-88
Baggett, Travis P; Yaqubi, Awesta; Berkowitz, Seth A et al. (2018) Subsistence difficulties are associated with more barriers to quitting and worse abstinence outcomes among homeless smokers: evidence from two studies in Boston, Massachusetts. BMC Public Health 18:463
James, Aisha; Berkowitz, Seth A; Ashburner, Jeffrey M et al. (2018) Impact of a Population Health Management Intervention on Disparities in Cardiovascular Disease Control. J Gen Intern Med 33:463-470
Berkowitz, Seth A; Terranova, Jean; Hill, Caterina et al. (2018) Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries. Health Aff (Millwood) 37:535-542
Berkowitz, Seth A; Karter, Andrew J; Corbie-Smith, Giselle et al. (2018) Food Insecurity, Food ""Deserts,"" and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis. Diabetes Care 41:1188-1195
Berkowitz, Seth A; Kalkhoran, Sara; Edwards, Samuel T et al. (2018) Unstable Housing and Diabetes-Related Emergency Department Visits and Hospitalization: A Nationally Representative Study of Safety-Net Clinic Patients. Diabetes Care 41:933-939

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