Emerging trends and the clinical impact of food insecurity in patients with diabetes

Food insecurity is a major public health concern in the United States affecting 15 million households according to data in 2017 from the US Department of Agriculture. Food insecurity, or the inability to consistently obtain nutritious food, disproportionately affects socioeconomically disadvantaged households, as well as those with chronic diseases including diabetes mellitus (DM). This review article explores the literature over the past 10 years pertaining to the complex relationship between food insecurity, social determinants of health, and chronic disease with an emphasis on diabetes and glycemic control. Those with diabetes and food insecurity together have been shown to have worse glycemic control compared to those who are food secure, but it remains unclear exactly how food insecurity affects glycemic control. Prior interventional studies have targeted aspects of food insecurity in patients with diabetes but have reported variable outcomes with respect to improvement in glycemic control despite effectively reducing rates of food insecurity. Additionally, few data exist regarding long‐term outcomes and diabetes‐related complications in this population. It is likely that many factors at both the community and individual levels impact glycemic control outcomes in the setting of food insecurity. Further studies are needed to better understand these factors and to create multifaceted targets for future interventional studies aimed at improving glycemic control in this population. 摘要 食品安全问题是一个重大的公共卫生问题。根据美国农业部2017年的数据, 食品安全问题影响到美国1500万个家庭。食品不安全, 或者不能持续获得有营养的食物, 对社会经济处于不利地位的家庭以及那些患有糖尿病等慢性病的家庭会造成非常不利的影响。这篇综述探讨了过去10年来有关食品安全问题、健康的社会因素和慢性病之间的复杂关系的文献, 以糖尿病和血糖控制为重点。与那些食物安全有保障的人相比, 那些同时有糖尿病和食物安全问题的人, 血糖控制更差, 但目前还不清楚食品不安全到底是如何影响血糖的。以前的干预研究主要针对糖尿病患者的食物安全问题, 虽然干预有效降低了出现食物安全性问题的比例, 但在改善血糖控制方面的结果各不相同的。此外, 关于这一人群的长期结果和糖尿病相关并发症的数据很少。在食品不安全的背景下, 社区和个人层面的许多因素可能都会影响血糖控制结果。需要进一步的研究来更好地了解这些因素, 并为未来改善该人群血糖控制的干预研究创造多方面的靶点。 Highlights Food insecurity is a major public health problem that highlights social disparities and negatively affects those with chronic diseases, including diabetes. Interventions targeting food insecurity in those with diabetes have shown little improvement in glycemic control despite improving food security status. This suggests a complex relationship between glycemic control and food insecurity that is likely mediated by many diverse socioeconomic factors.