Lowering HbA1c in Food Insecure Type 2 Diabetics Through a Fruit and Vegetable Prescription Program

Abstract

Background: Type 2 Diabetes is a costly and cumbersome disease afflicting millions of Americans. While the disease can be managed through diet and exercise, it seems to affect some populations more than others.The specific aim of this study is to examine the effect of a six-month Fruit and Vegetable Prescription (FVRx) program on the HbA1c levels of food insecure diabetics in rural Washington. Methods: Participants were screened and recruited by their Primary Care Provider and referred to the FVRx program coordinator. Participants met with a diabetes health educator monthly for nutritional education as well as SMART goal setting towards improving their diet. Food vouchers for local farmers’ markets valued at $1 per day per household member were dispersed during these visits. The number of food vouchers redeemed were tracked for each participant for data analysis. HbA1c levels were measured before (May) and after (November) the program. Findings: The average HbA1c change was -1.85% (p = 0.0004; 95% CI: -2.69, -1.01) after the six-month program was completed. After adjusting for participants’ pre-program HbA1c level, a $10 increase in the average amount redeemed per month was associated with a 1.4% (p-value: 0.006; 95% CI: 0.5, 2.4) decrease in HbA1c. Interpretation: The Skagit County FVRx program’s participants showed significant improvements in their HbA1c levels. The results reveal a strong relationship between improving food security and improving diabetes management. A study with a larger number of participants as well as additional HbA1c measurements is needed for a clearer picture of this relationship. Funding Statement: PeaceHealth Medical System was the sole source of funding for this study. PeaceHealth facilities were also used as the site of the patient visits and the participants were all PeaceHealth Primary Care patients. PeaceHealth had no other involvement in this study. Declaration of Interests: The authors of this study declare a potential conflict of interest regarding the $750 travel grant to cover the costs of traveling to and from the PeaceHealth Primary Care Facilities for this study. There are no other conflicts of interest to declare. Ethics Approval Statement: This study design was approved by the University of Washington Human Subjects Division Institutional Review Board.