Prevalence of food insecurity in patients with diabetes in western Kenya

Aims To determine the characteristics of patients with diabetes who reported food insecurity at three diabetes clinics in western Kenya. Methods This study includes routinely collected demographic data at the first presentation of patients with diabetes at clinics in western Kenya from 1 January 2006 to 24 September 2011. A validated questionnaire was used to assess food insecurity with descriptive and comparative statistics being used to analyse the food‐secure and food‐insecure populations. Results The number of patients presenting to these clinics who were food‐secure and those who were food‐insecure was 1179 (68.0%) and 554 (32.0%), respectively. Comparative analysis shows a statistically significant difference in weight, BMI, the presence of a caretaker, and use of insulin between the two groups. These variables were lower in the food‐insecure group. The overall assessment of the clinic population revealed an abnormally high mean HbA1c concentration of 81 mmol/mol (9.6%). Conclusions Despite the widely recognized contribution of caloric over‐nutrition to the development of diabetes, this study highlights the high prevalence of food insecurity amongst patients with diabetes in rural, resource‐constrained settings. Other factors, such as the lower prevalence of obesity, poor glucose control, challenges in the use of insulin because of the risk of hypoglycaemia, and varying subtypes of diabetes in this population, point to the need for additional research in understanding the aetiology, pathophysiology and optimum management of this condition, as well as understanding the effects of enhancing food security. What's new? The focus on addressing the rising burden of diabetes has largely been on traditional risk factors such as caloric over‐nutrition and a sedentary lifestyle. In the rural resource‐constrained setting analysed in the present study, many potential differences exist in both the presentation and causes of diabetes. This study highlights the unique characteristics seen on initial presentation as approximately one‐third of the patients in this study report food insecurity, with the overall population demonstrating lower BMIs and elevated initial HbA1c concentrations. Contextualized prevention and management approaches need to be further investigated to better understand this population.