Diabetes affects 9.4% of the US population and disproportionately affects African Americans (AAs) compared to whites. Among individuals with diabetes, AAs and those living below the federal poverty level have poorer metabolic control, higher complication rates and higher mortality compared to Whites and those living at the highest income level. Food insecurity (i.e. an inability to or limitation in accessing nutritionally adequate food) better predicts chronic disease than income, highlighting its importance as a modifiable factor. Almost 28% of the US population with diabetes report food insecurity, compared to 12% of those without diabetes, and AAs are 3 times more likely than whites to be food insecure. Food insecure individuals with diabetes have worse glycemic control, report lower dietary quality and more difficulty following a healthy diet compared to those who are not food insecure. Currently tested strategies to address food insecurity include food supplementation in the form of: 1) vouchers to cover cost of food; 2) vouchers/coupons that can only be used at farmer?s markets; and 3) shipments of pre-packaged food (stock boxes) to participants homes. However, important unanswered questions in individuals with diabetes include: 1) Within food supplementation options, are mailed stock boxes superior to food vouchers in terms of achieving glycemic control? 2) Is the combination of mailed stock boxes and food vouchers superior to either food supplementation option alone? 3) Does providing diabetes education in combination with food supplementation lead to improved clinical outcomes compared to education alone? To address this gap in the literature, we propose an RCT to test the separate and combined efficacy of monthly food vouchers to farmers market and monthly mailed food stock boxes layered upon diabetes education in improving glycemic control in low income, food insecure, AAs with Type 2 Diabetes (T2DM) using a 2x2 factorial design.
Almost 28% of the US population with diabetes report food insecurity and African Americans are 3 times more likely than whites to be food insecure. Currently tested strategies to address food insecurity include food supplementation in the form of: 1) vouchers to cover cost of food; 2) vouchers/coupons that can only be used at farmer?s markets; and 3) shipments of pre-packaged food (stock boxes), however little evidence exists testing the effectiveness of these components on diabetes outcomes. To address this gap in knowledge, we propose to test whether monthly food vouchers to farmers market or monthly mailed food stock boxes or the combination of both, layered upon diabetes education will lead to improvements in glycemic control in low income, food insecure, African Americans with type 2 diabetes.
