Household food insecurity is associated with higher insulin resistance and blood glucose levels in Latinos with type 2 diabetes

Abstract

INTRODUCTIONHousehold food insecurity (HFI) is associated with chronic diseases, including diabetes, among lower income Latinos. We examined the associations between HFI and blood glucose levels and insulin resistance in this population.APPROACHWe studied a sample of 120 Latinos with type 2 diabetes who completed baseline assessments for the CALMS‐D stress management trial. HFI was measured with a 5‐item version of the US Household Food Security Survey Module (Cronbach alpha=0.87). Households were classified as either food secure, mild/moderate food insecure, or severe food insecure. We also categorized individuals as food secure versus food insecure. Fasting glucose and insulin levels were measured and the log‐transformed HOMA‐IR values were used for analyses.RESULTSMean age was 61 years, 74% were female and mean HbA1c was 8.6%. Analysis of variance showed a significant (p<0.001) dose‐response association between fasting blood glucose levels and HFI severity before and after adjusting for gender, education, household income, body mass index and insulin use. The adjusted blood glucose means (SE) across HFI categories were: food secure, 144.8 (8.5); mild/moderate food insecure, 175.8 (7.2); severe food insecure, 200.5 (10.9) mg/dl. When HFI was dichotomized as food secure vs insecure, a significant relationship (p<.05) was found for logHOMA‐IR before and after adjusting for covariates. The untransformed HOMA‐IR adjusted means (SE) were: food secure, 8.9 (2.0); food insecure, 15.0 (1.4).CONCLUSIONSFasting blood glucose and insulin resistance are associated with HFI among Latinos with diabetes. Food insecure individuals had higher fasting glucose and more severe insulin resistance than food secure individuals. Providers that serve disadvantaged populations with type 2 diabetes should consider routinely screening for HFI.Support or Funding InformationThis work is supported by: Stress Management Among Latinos With Type 2 Diabetes (CALMS‐D) (NIMHD R01MD005879‐01).