Food insecurity is a condition that results from the poor access to nutritionally adequate and safe foods, or the inability of an individual to acquire such food in socially acceptable ways. This is a critical social determinant of health, affecting a significant proportion of the world population, and varying greatly by region, socioeconomic status, and presence of chronic diseases within households. In 2021, more than 10% of all households and 12% of all households with children, were estimated to be food-insecure in the United States. Households dealing with chronic medical conditions, especially those that require a stringent dietary regime, have been found to be at higher risk of food insecurity since medical expenses coupled with rising dietary needs become a significant financial burden. The SEARCH for Diabetes in Youth Study (SEARCH) showed that food insecurity was reported in nearly a fifth of youth and young adults with type 1 diabetes (T1D), thus calling for an urgent intervention in such vulnerable groups. In youth and young adults, T1D demands a very meticulous management diet and insulin therapy to maintain stable blood sugar to prevent complications. Consistent access to such food in food-insecure homes, on the other hand, complicate efforts towards disease management and greatly increase risk for acute diabetes-related complications. In a recently published study in Diabetes Research and Clinical Practice, Drs. Faisal Malik, Jason Mendoza, and colleagues explored the relationship of Household Food Insecurity (HFI) with diabetes management in youth and young adults from the SEARCH for Diabetes in Youth study.
In this analysis, data was sourced from the SEARCH study, which is a multi-center observatory study focusing on youths diagnosed with diabetes before 20 years of age in United States. The fourth phase of this study was conducted between 2016 and 2019, and covered assessments using the U.S. Household Food Security Survey Module (HFSSM), which refers to food security status over the past year. This included a total of 18 questions thematically designed to include various aspects of concern regarding food insecurity, ranging from worry that food would run out before getting money to buy more, to having to change types of food because of lack of money, and actually eating less than one felt he/she should because there was not enough money for food. Additionally, glycemic control was assessed by measuring the level of glycated hemoglobin A1c, while episodes from diabetic ketoacidosis (DKA) and severe hypoglycemia were accessed through survey responses. DKA is an extremely serious complication of diabetes that happens when the body begins to run out of insulin. Since this important hormone is required for glucose to enter cells for energy, insufficient levels of insulin lead to the body breaking down fat as an alternative supply of energy, which produces acidic chemicals known as ketones. If these ketones accumulate in the blood, the blood becomes more acidic, which can be lethal. On the other hand, severe hypoglycemia, where the blood glucose falls to critically low levels can lead to cognitive dysfunction, and in acute conditions, it may lead to loss of consciousness, seizures, and death. Therefore, the monitoring of both DKA and severe hypoglycemia is essential in diabetes care.
The findings pointed out some of the critical associations between HFI and poor management of diabetes. Out of the 1830 participants, 16.4% reported to have been subjected to HFI. Amongst those with HFI, on average, 0.33% demonstrated higher hemoglobin A1c than their food-secure counterparts. Furthermore, people in the food-insecure group were 58% more likely to have DKA. The study found an increased association between HFI and severe hypoglycemia, though it was not statistically significant.
The insights from the SEARCH data emphasize that food insecurity is associated with poor glycemic control and a high prevalence of acute complications, such as DKA. From the clinical perspective, this food security assessment must be integrated into patient assessment, with necessary individual adjustments made to diabetes management plans. In the bigger view, the public health policies should aim to seek synergy between food assistance programs and chronic disease management strategies, pointing to those who are most vulnerable, like the youth with T1D. This further highlights the need for additional research to understand the mechanisms through which food insecurity impacts diabetes management and offers intervention to ameliorate food insecurity among the diabetic population and evaluates the impact of such interventions. In conclusion, addressing food insecurity is not just a matter of improving nutritional status but also a critical component of managing chronic diseases effectively.
This study received support through grants from the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases.
Fred Hutch/University of Washington/Seattle Children’s Cancer Consortium Member Dr. Jason Mendoza contributed to this study.
Malik, F. S., Liese, A. D., Ellyson, A., Reid, L. A., Reboussin, B. A., Sauder, K. A., Frongillo, E. A., Pihoker, C., Dabelea, D., Reynolds, K., Jensen, E. T., Marcovina, S., Bowlby, D. A., Mendoza, J. A., & SEARCH for Diabetes in Youth Study Group (2024). Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for diabetes in youth study. Diabetes research and clinical practice, 111608. Advance online publication.