Abstract
Type 2 diabetes mellitus (DM-2) remains a significant public health concern, particularly in low-income neighborhoods where healthy foods may be scarcer. Despite the well-known relationship between diet and diabetes, little evidence exists on the connections among the objectively measured community and consumer food environment, perception of food access, and diabetes management or outcomes. This cross-sectional, ecological study represents the first example of combining a GIS-based, objectively measured food store audit considering quality, variety, and price of foods in stores with a clinical survey of patients with DM-2 (n = 126). In this way, we offer evidence on the relationship between healthy food access—measured more robustly than proximity to or density of certain store types—and diabetes management knowledge, medication adherence, and glycemic control. Better glycemic control was not correlated with better overall food store score, meaning that people in neighborhoods with better access to healthy foods are not necessarily more likely to manage their diabetes. While perceived healthy food access was not correlated with glycemic control, it was strongly correlated with objective healthy food access at shorter distances from home. These results have great importance both for clinical understanding of the persistence of poor diabetes management outcomes and for the understanding of the influence of the food environment on health behaviors.
Highlights
Research exists on community food environments and their presumed association with health outcomes [1]—including type 2 diabetes mellitus (DM-2) [2]—limitations in data quality or spatial analytical approaches have led researchers to question which relationships are merely artifacts of study design.The relationship between food insecurity itself and DM-2 is well-established, but research has not yet provided rigorous approaches to objectively measuring food environments that can be linked via GIS to individual health outcomes, such as DM-2
To illustrate how individual characteristics were combined with GIS-based food store scores, Figure 1 highlights anonymized participant location colored by perception of food in their neighborhood overlaid on a kernel density estimation (KDE) surface of objective healthy food access
Self-identified demographics revealed that 60% of the sample were female, 85% were African American, and all lived within the 2-mile buffer zone of the City of Flint
Summary
Research exists on community food environments and their presumed association with health outcomes [1]—including type 2 diabetes mellitus (DM-2) [2]—. The relationship between food insecurity itself and DM-2 is well-established, but research has not yet provided rigorous approaches to objectively measuring food environments that can be linked via GIS to individual health outcomes, such as DM-2. Only a few papers (such as [3]) collect objective measures of the food environment, but such studies have not linked GIS-based measures to health outcomes. Type 2 diabetes mellitus (DM-2) remains the 7th leading cause of death in the US [4]. It is responsible for a range of morbidities, such as renal disease, amputations, and cancers [5], Int. J.
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