2284-PUB: Food Insecurity and Autonomic Dysfunction among Latinos with Type 2 Diabetes

Abstract

Aims: Food insecurity (FI) is higher among Latinos than non-Hispanic Whites and associated with risk for type 2 diabetes (T2D). Autonomic nervous system (ANS) dysfunction increases mortality in diabetes. We examined FI and ANS function among Low-income Latinos with T2D enrolled in a parent stress management trial. Methods: Inclusion: age > 18 years, Latino or Hispanic, Spanish speaking, ambulatory status, T2D > 6 months, A1c>7.0%. Exclusion: medical or psychiatric instability; pain or dysfunction in hands precluding handgrip testing. Measures: FI was assessed with the 6-item U.S. household food security survey module; affirmative responses to >=1 question was coded as FI. Six autonomic measures were scored 0=normal or 1=abnormal based on published cutoffs and then summed for a total ANS dysfunction index. ANS measures and their normal cutoffs were: 1) metanephrine <350 ug/day; 2) normetanephrine <600 ug/day; 3) cortisol 50-190 ug/day, all from 24-hour urine specimens; 4) 24-hour heart rate variability as reflected in standard deviation of the normal-to-normal (SDNN) heart rate acquired with 3-channel, 7-lead ambulatory electrocardiogram (holter) monitors, 149 +/-39; 5) difference between the highest diastolic blood pressure (DBP) during sustained handgrip and the average DBP at rest, >15 mmHg; and, 6) difference between baseline supine and the minimal BP after standing up, normal = decline in SBP <= 20 mmHg and DBP <= 10 mmHg. Results: N=35 participated, n=23 (65.7%) were women, age M=61.6 (SD=11.2) years, A1c M=8.5% (SD=1.6) and n=20 (57.1%) used insulin. N=22 (62.9%) reported FI and n=25 (71.4%) had at least one abnormal ANS measure. In t-tests, participants with FI had a higher ANS dysfunction index (M=1.5, SD=0.9) than patients who were food secure (M=0.7, SD=0.8), p=0.02. Total ANS index was not related to A1c or insulin use. Discussion: In this Latino sample with T2D, FI was associated with greater ANS dysfunction. Increasing food security may confer autonomic benefits. Disclosure K. Seng: None. R. Feinn: None. A. Bermudez-Millan: None. R. Perez-Escamilla: None. J. Wagner: None. Funding American Diabetes Association (7-13-TS-31 to J.W.); National Institute on Minority Health and Health Disparities (R01MD005879)