OCHIN-partnered research looks at the impact of addressing food insecurity on diabetes control

By Anna Crosetti | FEATURED STORY, NEWS, RESEARCH | Comments are Closed | 20 December, 2024 | 0

December 20, 2024

Social risks, such as income, housing stability, and food insecurity—also known as adverse social determinants of health—drive health disparities by limiting individuals’ ability to prevent disease, manage chronic conditions, and support overall health.

Among these risks, food insecurity is strongly associated with poor health outcomes, particularly among low-income people with diabetes. Community-based health centers, which serve a disproportionately high number of patients experiencing food insecurity, need evidence to understand how addressing this social risk could improve diabetes-related outcomes.

To investigate this, researchers from OCHIN partnered with a team at the University of North Carolina, led by Seth Berkowitz, MD, to study the potential impact of food-related interventions within community health centers.

The Social Risk and Diabetes Outcomes Study (SOCRATES) team recently published their findings in Social Science & Medicine – Population Health. Rachel Gold, PhD, MPH, program director of implementation science at OCHIN, answered a few questions about the study, which estimated the effect of addressing patients’ food needs on diabetes-related outcomes.

What did you study and why?

Food insecurity can worsen diabetes-related outcomes by creating barriers to healthy eating, which is essential for diabetes control. Clinic-based interventions—such as providing food directly, helping with food benefit applications, and referring patients to local food pantries—are becoming more common and may help address these needs. However, limited research exists on how such interventions affect diabetes-related outcomes, partly because conducting formal randomized trials in this area is challenging.

To address this gap, OCHIN research scientists partnered on a study that used statistical methods to estimate the impact of a hypothetical intervention addressing food needs on diabetes-related outcomes in adult patients at community health centers.

What did you learn?

We analyzed data from about 97,000 adults with diabetes in the OCHIN network of community health centers to estimate the hypothetical impact of an intervention that prevented food insecurity, specifically examining how addressing this social risk might improve diabetes outcomes. By modeling various scenarios in which food insecurity was eliminated, we were able to efficiently evaluate the potential impact of food insecurity on diabetes control.

Our findings showed that after 12 months, eliminating food insecurity would result in significantly improved hemoglobin A1c (0.12 percentage points lower), systolic blood pressure (0.67 mm Hg lower), and diastolic blood pressure (0.21 mm Hg lower), with no difference in low-density lipoprotein cholesterol. In other words, addressing food needs may modestly improve diabetes outcomes.

Why does it matter?

Addressing food needs is critical for improving health outcomes in people with diabetes. This study advances our understanding of how clinic-led interventions could help mitigate the impacts of diabetes.

The findings show that diabetes control can be improved through interventions targeting food insecurity, such as providing information about local food resources. However, the modest impact suggests the need for further research on optimizing such interventions—potentially by using multiple strategies simultaneously—to maximize the clinical benefits of “food is medicine” approaches.

The results also suggest that clinic-led interventions may have limited ability to fully address the impact of food insecurity on diabetes control, underscoring the potential need for policy-level solutions. Moreover, these findings show that future trials of food-related interventions will need to be large (more than 7,500 patients) to detect clinical impacts. They further show that earlier studies reporting no significant change or effect were likely too small to identify modest improvements in diabetes control.

What was OCHIN’s role in this study?

OCHIN’s collaboration was critical to this study. All the clinics involved were members of the OCHIN network, and a dedicated team of OCHIN scientists worked alongside the UNC team on this paper. This study highlights how OCHIN research seeks to support equitable health outcomes by exploring how community clinics can intervene to address the adverse health impacts of social risks like food insecurity.

This work was supported by the National Institute of Diabetes and Digestive and Kidney Diseases grant award number R01DK125406. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funder. Seth Berkowitz was supported by the National Institutes of Health (Grant Nos. 2P30 DK092924 and R01DK116852) and the Centers for Disease Control and Prevention (Grant No. U18DP006526).

The research reported in this work was powered by PCORnet®. PCORnet has been developed with funding from the Patient-Centered Outcomes Research Institute® (PCORI®) and conducted with the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Research Network (CRN). ADVANCE is a Clinical Research Network in PCORnet® led by OCHIN in partnership with Health Choice Network, Fenway Health, University of Washington, and Oregon Health & Science University. ADVANCE’s participation in PCORnet® is funded through the PCORI Award RI-OCHIN-01-MC.