MON-012 Diabetes-Related Healthcare Exposure and Dietary Intake Among Food Pantry Clients

Abstract

Background: Dietary self-management is a demanding aspect of diabetes mellitus (DM) care. To help identify optimal food choices, patients with DM need support from a healthcare team. Studies examining associations between DM-related healthcare utilization and dietary intake are rare, particularly in food insecure (FI) populations where dietary self-management is especially challenging. Purpose: To examine the association between DM healthcare utilization and dietary intake among FI adults with DM. We examined self-reported utilization of (1) a healthcare provider for DM management and (2) DM self-management education (DSME)-related services. Methods: We used baseline data from a randomized trial designed to improve glycemic control in food pantry clients with DM. Participants (A1c ≥ 7.5%, age ≥ 18, English/Spanish speaking) were recruited from pantries affiliated with 3 food banks. We dichotomized DM healthcare into more recent (< 12 months ago) versus less recent (≥ 12 months ago) or no utilization. Our primary outcome was intake frequency of vegetables, fruit, sugar-sweetened beverages (SSBs), and desserts, assessed by the California Health Interview Survey dietary screener. We used t-tests to examine unadjusted associations between DM healthcare utilization and dietary intake and multiple linear regression to determine if sociodemographic characteristics modified the relationships. Results: Among 523 participants (mean A1c 9.8%; BMI 34.6 kg/m2; 17.0% uninsured), recent utilization of a provider for DM management and/or DSME-related services were associated with increased vegetable intake frequency in unadjusted analyses and after adjusting for DM duration, race/ethnicity, education, health insurance status, and medication adherence (additional 0.4 times/day for all comparisons; p < 0.01). Recent utilization of a provider for DM management was associated with increased fruit consumption frequency in adjusted analyses (additional 0.2 times/day; p = 0.03). Neither healthcare utilization variable was associated with decreased SSB or dessert intake. Conclusions: Among food pantry users, messaging from traditional healthcare settings to increase healthy intake may be more successful than messaging to decrease unhealthy intake. Environmental cues for sugar intake may supersede messaging from healthcare settings, particularly in low-income areas where cues may be more pervasive and healthier options less available. It may also be that clients with healthcare access are better able to prioritize healthy intake than clients without access are, as access may indicate increased resources overall. Given the negative health consequences added sugar intake has on DM management, approaches that increase access to DM-appropriate foods (including at food pantries) and education efforts focused on reducing sugar intake may be effective in vulnerable populations.