scholarly journals Food Prescriptions for Management of Prediabetes and Type 2 Diabetes among Food Insecure Youth: A Pilot Protocol

2020 ◽  
Vol 3 ◽  
Author(s):  
Jonathan Oswald ◽  
Lisa Yazel ◽  
Tamara Hannon
Keyword(s):  
Type 2 Diabetes ◽  
Health Outcomes ◽  
Food Insecurity ◽  
Low Income ◽  
Vegetable Consumption ◽  
The Past ◽  
Early Results ◽  
Food And Beverage ◽  
Participant Outcomes

Introduction: Food access and food insecurity represent significant barriers to healthy eating in low-income communities. Food prescription programs have attempted to address these barriers by providing subsidized access to fresh produce through a physician-community collaboration. However, little is known about the health outcomes associated with food prescriptions, especially among youth with diabetes. To address this, we report data from the past two years of the Veggie Box program, a free produce distribution program of Indy Urban Acres. Additionally, we propose a feasibility study to 1) establish a food prescription program for food insecure youth with prediabetes and type 2 diabetes through the Veggie Box program and 2) assess health outcomes of youth who receive a prescription for Veggie Box.   Methods: Through 2018 and 2019, the Veggie Box has been distributed weekly to a low-income community on the eastside of Indianapolis. Participant outcomes have been measured through survey assessment of food and beverage consumption, food insecurity, quality of life indicators, and program satisfaction. The proposed study aims to recruit 70 food insecure families with children aged 10-16 who have prediabetes or type 2 diabetes. Participants will receive a Veggie Box once every two weeks for a total of 12 weeks and will be provided access to a dietitian, health coach, and monthly group diabetes prevention sessions. Participant outcomes will be assessed at baseline and 12 weeks using the same surveys from the past two years with the addition of BMI and HbA1c measurements.  Results: The past two years of Veggie Box distribution led to a statistically significant increase in fruit (p=0.009) and vegetable (p=0.001) consumption among Veggie Box recipients. There was not a significant change in reported food security.  Discussion/Conclusion: Early results from the Veggie Box program showed that it increased fruit and vegetable consumption, indicating its potential use as a food prescription for food insecure youth with prediabetes and type 2 diabetes. This study will begin to fill the gap in knowledge related to health outcomes of food insecure youth with diabetes who are provided a food prescription. 

Addressing Food Insecurity and Overweight/Obesity in Hospitalized Low-Income Latino Patients

2019 ◽  
Vol 25 (3) ◽  
pp. 241-248
Author(s):  
Trina Lorraine Gipson-Jones ◽  
Bertha L. Davis ◽  
Ché Matthew Harris
Keyword(s):  
Public Health ◽  
Type 2 Diabetes ◽  
Food Insecurity ◽  
Low Income ◽  
Adverse Outcomes ◽  
Hospital Utilization ◽  
Health Concern ◽  
Public Health Concern ◽  
Disease Risks

Food insecurity (FI), the limited or unreliable availability of safe and nutritious food, is a pressing public health concern affecting millions of U.S. citizens. Unfortunately, FI tends to impact those who are most vulnerable (e.g., low-income minorities) and potentially increases obesity risks, diet-sensitive disease risks (e.g., hypertension and type 2 diabetes), and hospital utilization. Low-income Latino patients may be particularly sensitive to adverse outcomes based on unaddressed socioeconomic needs. Nurses are in a prime position to assess and address FI in these patients. Our article will discuss how nurses can be advocates in combating FI in Latino patients with overweight/obesity.

798-P: The Prevalence and Impact of Food Insecurity on Glycemic Control in Low-Income Latinos with Type 2 Diabetes

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 798-P
Author(s):  
INA CECILIA FLORES ◽  
DENISSE CRISTINA PORRAS FIMBRES ◽  
J. SONYA HAW ◽  
ALEXANDRA MIGDAL ◽  
BRITT ROTBERG ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Glycemic Control ◽  
Food Insecurity ◽  
Low Income

Designing Healthier Built Environments

2018 ◽  
Author(s):  
Pedro Gullón ◽  
Gina S. Lovasi
Keyword(s):  
Mental Health ◽  
Physical Activity ◽  
Type 2 Diabetes ◽  
Built Environment ◽  
Health Outcomes ◽  
Low Income ◽  
Built Environments ◽  
Street Connectivity ◽  
Research Challenges

The “built environment” is comprised of human-made structures and systems, and aspects include access to and attractiveness of walkable destinations (e.g., retail stores, parks) and community design features (e.g., street connectivity, sidewalk access). A variety of built environment characteristics can influence health outcomes and behaviors, including physical activity, obesity, type 2 diabetes, hypertension, and mental health, as well as sleep and use of tobacco and alcohol. This chapter discusses the large and complex accumulated research on the built environment as well as the methods used to study it, research challenges, policy implication, and how to bring together partnerships for policy change. This chapter also discusses the research conducted across populations (e.g., children, low-income individuals) and geographies (e.g., urban and rural geographies).

scholarly journals Race and Sex Differences in the Association between Food Insecurity and Type 2 Diabetes

2016 ◽  
Vol 26 (3) ◽  
pp. 427 ◽  
Author(s):  
Sabrina Strings ◽  
Yamini K. Ranchod ◽  
Barbara Laraia ◽  
Amani Nuru-Jeter
Keyword(s):  
Type 2 Diabetes ◽  
Food Security ◽  
Food Insecurity ◽  
African American Women ◽  
Low Income ◽  
White Women ◽  
California Health Interview Survey ◽  
Latino Men ◽  
The Relationship

<p><strong>Objective: </strong>To examine whether the relationship between food insecurity (FI) and type 2 diabetes (T2D) varies by race/ethnicity and sex. <strong></strong></p><p><strong>Methods: </strong>We analyzed data from low-income adults participating in the 2009 and 2011 waves of the California Health Interview Survey (CHIS) (N=22,596). We used logistic regression models to estimate the sex and race-specific associations between FI and T2D. </p><p><strong>Results</strong><em>: </em>We observed positive associations between low food security and T2D for White men (AOR: 1.9, 95% CI: 1.2, 3.2), and between very low food security and T2D for White women (AOR: 1.6 95% CI: 1.1, 2.5). In Latinas, we observed positive associations between both low food security (AOR: 1.7, 95% CI: 1.3, 2.2) and very low food security (AOR: 1.8, 95% CI: 1.2, 2.6) and T2D. We did not observe any associations between FI and T2D in Latino men, or African American women and men. <strong></strong></p><p><strong>Conclusion</strong><em>: </em>The relationship between FI and T2D may be moderated by race and sex. For African Americans and Latino men, other distal factors may modify the effect of FI on rates of T2D. <em>Ethn Dis. </em>2016;26(3):427-434; doi:10.18865/ ed.26.3.427 </p>

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study (Preprint)

2020 ◽  
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

BACKGROUND Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. OBJECTIVE The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. METHODS Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare &amp; Medicaid Services database. RESULTS In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. CONCLUSIONS This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. INTERNATIONAL REGISTERED REPORT DERR1-10.2196/20788

scholarly journals Continuity of Care for Patients with Obesity-Associated Chronic Conditions: Protocol for a Multisite Retrospective Cohort Study

10.2196/20788 ◽  
2020 ◽  
Vol 9 (9) ◽  
pp. e20788
Author(s):  
Yilu Lin ◽  
James E Bailey ◽  
Satya Surbhi ◽  
Sohul A Shuvo ◽  
Christopher D Jackson ◽  
...  
Keyword(s):  
United States ◽  
Type 2 Diabetes ◽  
Health Care ◽  
Health Outcomes ◽  
Health Systems ◽  
Continuity Of Care ◽  
Low Income ◽  
Chronic Conditions ◽  
Obesity And Diabetes

Background Obesity affects nearly half of adults in the United States and is contributing substantially to a pandemic of obesity-associated chronic conditions such as type 2 diabetes, hypertension, and arthritis. The obesity-associated chronic condition pandemic is particularly severe in low-income, medically underserved, predominantly African-American areas in the southern United States. Little is known regarding the impact of geographic, income, and racial disparities in continuity of care on major health outcomes for patients with obesity-associated chronic conditions. Objective The aim of this study is to assess, among patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes, (1) whether continuity of care is associated with lower overall and potentially preventable emergency department and hospital utilization, (2) the effect of geographic, income, and racial disparities on continuity of care and on health care utilization, (3) whether continuity of care particularly protects individuals at risk for disparities from adverse health outcomes, and (4) whether characteristics of health systems are associated with higher continuity of care and better outcomes. Methods Using 2015-2018 data from 4 practice-based research networks participating in the Southern Obesity and Diabetes Coalition, we will conduct a retrospective cohort analysis and distributed meta-analysis. Patients with obesity-associated chronic conditions and with type 2 diabetes will be assessed within each health system, following a standardized study protocol. The primary study outcomes are overall and preventable emergency department visits and hospitalizations. Continuity of care will be calculated at the facility level using a modified version of the Bice-Boxerman continuity of care index. Race will be assessed using electronic medical record data. Residence in a low-income area or a health professional shortage area respectively will be assessed by linking patient residence ZIP codes to the Centers for Medicare & Medicaid Services database. Results In 4 regional health systems across Tennessee, Mississippi, Louisiana, and Arkansas, a total of 53 adult hospitals were included in the study. A total of 147,889 patients with obesity-associated chronic conditions who met study criteria were identified in these health systems, of which 45,453 patients met the type 2 diabetes criteria for inclusion. Results are expected by the end of 2020. Conclusions This study should reveal whether health system efforts to increase continuity of care for patients with obesity and diabetes have potential to improve outcomes and reduce costs. Analyzing disparities in continuity of care and their effect on major health outcomes can help demonstrate how to improve care and use of health care resources for vulnerable patients with obesity-associated chronic conditions, and within this group, patients with type 2 diabetes. Better understanding of the association between continuity and health care utilization for these vulnerable populations will contribute to the development of higher-value health systems in the southern United States. International Registered Report Identifier (IRRID) DERR1-10.2196/20788

Self-Management as a Mediator of the Relationship between Social Support Dimensions and Health Outcomes of African American Adults with Type 2 Diabetes

2019 ◽  
Vol 42 (7) ◽  
pp. 485-494
Author(s):  
Tariq N. Al-Dwaikat ◽  
Diane Orr Chlebowy ◽  
Lynne A. Hall ◽  
Timothy N. Crawford ◽  
Pamela A. Yankeelov
Keyword(s):  
Social Support ◽  
Type 2 Diabetes ◽  
African Americans ◽  
Health Outcomes ◽  
Low Income ◽  
Self Management ◽  
Cross Sectional ◽  
The Relationship ◽  
Functional Support

Social support promotes behavior change and self-management that leads to improved health outcomes. The purpose of this study was to evaluate the role of self-management in mediating the relationship between social support dimensions and health outcomes of African Americans with type 2 diabetes (T2D). Cross-sectional data were collected from 102 African Americans with T2D at an outpatient clinic. The majority of the participants were female, single, unemployed, and having low income. Functional support, the quality of the primary intimate relationship, and the number of support persons were negatively correlated with depression. Functional support and satisfaction with support explained a significant small amount of the variance in self-management. However, self-management did not mediate the relationships between social support dimensions and the health outcomes. The results of this study shed the light on the unique relationships of social support dimensions with health outcomes of African Americans with T2D.

scholarly journals Inflammation and Stress Biomarkers Mediate the Relationship Between Household Food Insecurity and Insulin Resistance Among Latinos with Type 2 Diabetes (OR02-02-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Angela Bermudez-Millan ◽  
Julie Wagner ◽  
Richard Feinn ◽  
Sofia Segura-Pérez ◽  
Grace Damio ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Type 2 Diabetes ◽  
Food Insecurity ◽  
Direct Effect ◽  
Low Income ◽  
Stress Hormones ◽  
Household Food Security ◽  
Household Food Insecurity ◽  
Household Food

Abstract Objectives Household food insecurity (HFI) is a stressor that is associated with hyperglycemia type 2 diabetes (T2D). However, little is known about HFI and the insulin resistance underlying hyperglycemia and T2D, and mechanisms involved have not been elucidated. We examined HFI and insulin resistance among low-income Latinos with T2D and tested whether inflammation and stress hormones mediated this relationship. Methods This study is cross-sectional. HFI was measured with the Spanish and English versions of the 6-item US Household Food Security Survey Module. Insulin resistance was calculated from fasting blood glucose and insulin. Inflammation was indicated by high-sensitivity C-reactive protein, and stress hormones included cortisol, metanephrine and normetanephrine. Results The 121 participants were primarily Puerto Rican (85.8%), aged mean = 60.7 years and 74% were female. Eighty-two (68%) were classified as food insecure. Compared to food secure individuals, food insecure individuals had a significantly higher hsCRP (P = .008), cortisol (P = .045), insulin (P = .019), glucose (P < .001), insulin resistance (P = 001), and total cholesterol (P = .004). Groups did not differ on other lipids, metanephrine, normetanephrine, or A1c. A parallel multiple mediation model showed a significant direct effect of HFI on hsCRP (P = .020) and on cortisol (P = .011). There was a direct effect of cortisol (P = .013), hsCRP (P = .044) and HFI on insulin resistance (P = .015). The total combined indirect effect of food insecurity through cortisol and hsCRP was indicated partial mediation. Conclusions Among Latinos with T2D, HFI is associated with insulin resistance partially through inflammation and stress hormones. Interventions to ameliorate HFI and mitigate its effects on inflammation, stress, and insulin resistance is warranted. Funding Sources Supported by the National Institute of Minority Health and Health Disparities (R01MD005879) to Drs. Rafael Pérez-Escamilla and Julie Wagner and the American Diabetes Association (7–13-TS-31) to Dr. Julie Wagner.

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