F20C - Relationship of Food-Insecurity with Diabetes Nutrition Self-Efficacy and Behavior Among American Indians and Alaska Natives

Key Takeaways of Your Research: 1. Healthy nutrition habits are key to managing type 2 diabetes (T2D). However, American Indian and Alaska Natives (AI/ANs) often lack access to healthy food and disproportionately experience food insecurity. 2. Food insecurity, defined as lack of consistent access to enough food for an active, healthy life, negatively impacts one’s ability to manage blood sugar and body weight. Our study team developed a culturally responsive diabetes nutrition education curriculum for AI/AN adults with T2D, entitled “ What Can I Eat? Healthy Choices for AI/ANs with T2D” (WCIE). Though WCIE does not include a specific food insecurity intervention, we included a household food insecurity measure at all data collection timepoints. 3. Findings suggest potential significant associations between food insecurity and program outcomes that warrant further investigation with a larger sample.

Background/Purpose: “What Can I Eat? (WCIE) Healthy Choices for American Indians and Alaska Natives (AI/ANs) with T2D” is a 5-lesson diabetes nutrition education program culturally adapted for AI/ANs with T2D. WCIE classes were taught via Zoom at 5 reservation-based or urban inter-tribal clinical sites in 2021 with randomized cohorts. Classes 1-4 were taught weekly for 4 weeks with a 5th class 3 months after class #1. Research Hypothesis and/or Research Questions and Specific

Aims: Food insecurity is associated with less optimal diabetes self-management. We hypothesized participants who were food insecure at baseline would show less improvement over time in healthy eating self-efficacy and behavior than would those who were not food insecure. Methods/Methodology: Food insecurity was measured at baseline by the 2-item Hunger Vital Signs scale. Two self-efficacy measures assessed confidence using the diabetes plate and making healthy food choices, respectively. Two behavior measures assessed the frequency of healthy and unhealthy eating behaviors, respectively. T-tests of difference scores examined changes from baseline to week 4 in diabetes nutrition self-efficacy and behavior.

Results: Participants were 58 AI/ANs with T2D (mean age 58.6 +/-11.1 years, 26% male). 34.0% of participants screened positive for food insecurity at baseline. From baseline to week 4, those who were food secure at baseline showed a significantly greater increase in confidence in using the diabetes plate compared to those who were food insecure at baseline (2.8 vs. 0.9; p=0.01) and a greater increase in confidence in making healthy food choices (3.0 vs. 0.6; p=0.05). In contrast, participants who were food secure at baseline showed a significantly smaller increase in healthy food choices compared to those who were food insecure (7.5 vs. 17.1 ; p=0.04). Conclusions (Impact on Diabetes Care and Education): Findings suggest potential significant associations between food insecurity and program outcomes that warrant further investigation with a larger sample. Given the importance of self-efficacy in behavior change, it is concerning that participants who experienced food insecurity made less improvement in their healthy diet confidence. These findings will guide future refinement of the program aimed at enhancing self-efficacy in the face of food insecurity. Source of Funding for this Research: American Diabetes Association 4-18-SMSC-01 (PI: Moore)