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Food insecurity and diabetes self-management among food pantry clients

  • Matthew M Ippolito (a1), Courtney R Lyles (a2) (a3), Kimberly Prendergast (a4), Michelle Berger Marshall (a4), Elaine Waxman (a5) and Hilary Kessler Seligman (a2) (a3)...

To examine the association between level of food security and diabetes self-management among food pantry clients, which is largely not possible using clinic-based sampling methods.


Cross-sectional descriptive study.


Community-based food pantries in California, Ohio and Texas, USA, from March 2012 through March 2014.


Convenience sample of adults with diabetes queuing at pantries (n 1237; 83 % response). Sampled adults were stratified as food secure, low food secure or very low food secure. We used point-of-care glycated Hb (HbA1c) testing to determine glycaemic control and captured diabetes self-management using validated survey items.


The sample was 70 % female, 55 % Latino/Hispanic, 25 % white and 10 % black/African American, with a mean age of 56 years. Eighty-four per cent were food insecure, one-half of whom had very low food security. Mean HbA1c was 8·1 % and did not vary significantly by food security status. In adjusted models, very-low-food-secure participants, compared with both low-food-secure and food-secure participants, had poorer diabetes self-efficacy, greater diabetes distress, greater medication non-adherence, higher prevalence of severe hypoglycaemic episodes, higher prevalence of depressive symptoms, more medication affordability challenges, and more food and medicine or health supply trade-offs.


Few studies of the health impact of food security have been able to examine very low food security. In a food pantry sample with high rates of food insecurity, we found that diabetes self-management becomes increasingly difficult as food security worsens. The efficacy of interventions to improve diabetes self-management may increase if food security is simultaneously addressed.

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Public Health Nutrition
  • ISSN: 1368-9800
  • EISSN: 1475-2727
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