F20B - Food Insecurity Interventions for People with Diabetes: A Systematic Review Using the RE-AIM Framework

Key Takeaways of Your Research: 1. Food insecurity impacts many adults living with diabetes and/or prediabetes. 2. Interventions that address food insecurity can help to improve diabetes outcomes. 3. Addressing food insecurity through partnerships with community organizations is essential for addressing health equity.

Background/Purpose: Approximately 10.5% of households were food insecure at least some of the time during the year 2020 in the United States. Food insecurity has been associated with prediabetes and type 2 diabetes mellitus (T2D). Health inequities are observed in individuals who experience food insecurity. Implementation of interventions that address food insecurity can assist the management of T2D and prediabetes. Research Hypothesis and/or Research Questions and Specific

Aims: Our aim was to evaluate interventions that address food insecurity in persons with prediabetes or T2D utilizing the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Methods/Methodology: We searched 5 electronic databases from inception to January 2022. After title and abstract screening (n=2,745), we examined the full-text of 48 articles to identify interventions that addressed food insecurity for adult patients with prediabetes or T2D. Four reviewers independently screened studies, extracted data, and assessed risk of bias. The resulting articles were coded using a RE-AIM data collection tool.

Results: Thirteen articles met eligibility criteria (three RCTs, nine pilots, and one observational study). Interventions included home-delivered meals, food/meal prescriptions, vouchers, financial incentives, and diabetes education. Reach and effectiveness were the highest reported RE-AIM elements. Interventions reached a high-risk population via food banks, community-based outreach, and federally qualified health centers. A majority of participants identified as female, Black or Latinx, and were living below the federal poverty level. Most studies (n=11, 84.6%) reported at least one diabetes measure (i.e., A1C, hypoglycemia, diabetes distress, diabetes self-management). A significant decrease in A1C was reported in 4/10 studies and a significant improvement in food insecurity in 5/5 studies that measured these outcomes. Conclusions (Impact on Diabetes Care and Education): Food insecurity interventions exhibit a positive impact for persons living with prediabetes or diabetes. Interventions delivered in the community setting reached food insecure adults and demonstrated improvements in food insecurity and A1C levels across most studies that measured these outcomes. Developing partnerships between federally qualified health centers and community resources providing food assistance programs has the potential to improve both food security and diabetes-related outcomes. Source of Funding for this Research: None