Household Food Insecurity and Associations With HbA1c and Acute Diabetes–Related Complications in Youth and Young Adults With Type 1 Diabetes
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersAIMS
To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia.
METHODS
HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use.
RESULTS
Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI.
CONCLUSIONS
HFI is associated with higher HbA1c levels and increased odds of DKA in YYA with T1D.
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Additional Info
Disclosure statements are available on the authors' profiles:
Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for diabetes in youth study
Diabetes Res. Clin. Pract. 2024 Apr 02;[EPub Ahead of Print], FS Malik, AD Liese, A Ellyson, LA Reid, BA Reboussin, KA Sauder, EA Frongillo, C Pihoker, D Dabelea, K Reynolds, ET Jensen, S Marcovina, DA Bowlby, JA MendozaFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
This study sought to examine the association between household food insecurity (HFI) and glycemic control, diabetic ketoacidosis (DKA), and severe hypoglycemia in a cohort of youth and young adults with type 1 diabetes (T1D) from the SEARCH for Diabetes in Youth study (N = 1830), a large US multicenter observational study of diabetes in youth diagnosed before the age 20 years. HFI was assessed with the US Household Food Security Survey Module, an instrument which measures HFI over a period of 12 months. Scores were dichotomized such that participants with high or marginal food security were considered food secure, whereas those with low or very-low food security were considered food insecure. Outcomes of interest were HbA1c obtained at study visits (n = 1060) and self-reported occurrence of DKA or severe hypoglycemia (defined as very low blood sugar requiring assistance). Participants with food insecurity had 0.33% higher HbA1c (95% CI, 0.003–0.657) than those with food security when adjusted for age, sex, race, participant education, parental education, income, health insurance, study site, insulin pump use, CGM use, and diabetes duration. Food insecurity was also associated with increased odds of a DKA episode (adjusted OR, 1.58; 95% CI, 1.13–2.21) compared with food security. When the exposure variable was treated as four categories of HFI, the very-low food security group had the highest adjusted odds of a DKA episode (adjusted OR, 1.87; 95% CI, 1.19–2.92). The odds of severe hypoglycemia were not significantly higher for participants experiencing food insecurity.
The study contributes to the limited body of literature supporting the association between HFI and poor diabetes outcomes in youth and young adult populations. This can serve as a foundation for further exploration into the proposed mechanisms behind this association, such as impaired self-management behaviors and poor diet due to financial constraints and competing demands, as well as adverse mental health associated with both HFI and diabetes.