Outcomes of Cooking Matters for Diabetes: A 6-week Randomized, Controlled Cooking and Diabetes Self-Management Education Intervention.

Abstract

Diabetes self-management education and support is the cornerstone of diabetes care, yet only 1 in 2 adults with diabetes attain hemoglobin A1c (HbA1c) targets. Food insecurity makes diabetes management and HbA1c control more difficult. Our aim was to test whether a cooking intervention with food provision and diabetes self-management education and support improves HbA1c and diabetes management. This was a waitlist-controlled, randomized trial. Participants were 48 adults with type 1 or type 2 diabetes. Cooking Matters for Diabetes was adapted from Cooking Matters and the American Diabetes Association diabetes self-management education and support intervention into a 6-week program with weekly food provision (4 servings). Surveys (ie, Summary of Diabetes Self-Care Activities; Medical Outcomes Study Short Form Health Survey, version 1; Diet History Questionnaire III; 10-item US Adult Food Security Survey Module; and Stanford Diabetes Self-Efficacy Scale) were administered and HbA1c was measured at baseline, post intervention, and 3-month follow-up. Mixed-effects linear regression models controlling for sex and study wave were used. Mean (SD) age of participants was 57 (12) years; 65% identified as female, 52% identified as White, 40% identified as Black, and 19 (40%) were food insecure at baseline. Intervention participants improved Summary of Diabetes Self-Care Activities general diet score (0 to 7 scale) immediately post intervention (+1.51; P= .015) and 3 months post intervention (+1.23; P= .05), and improved Medical Outcomes Study Short Form Health Survey, version 1, mental component score (+6.7 points; P= .025) compared with controls. Healthy Eating Index 2015 total vegetable component score improved at 3 months (+0.917; P= .023) compared with controls. At baseline, food insecure participants had lower self-efficacy (5.6 vs 6.9 Stanford Diabetes Self-Efficacy Scale; P= .002) and higher HbA1c (+0.77; P= .025), and demonstrated greater improvements in both post intervention (+1.2 vs+0.4 Stanford Diabetes Self-Efficacy Scale score; P= .002, and -0.12 vs+0.39 HbA1c; P= .25) compared with food secure participants. Cooking Matters for Diabetes may be an effective method of improving diet-related self-care and health-related quality of life, especially among food insecure patients, and should be tested in larger randomized controlled trials.