Associations of Food Security Status with Diet Quality and Glycemic Control over Two Years in Adults with Type 2 Diabetes on Medicaid

Background: Little is known about the association of food insecurity (FI) with changes in diet quality and hemoglobin A1c (HbA1c) over time in people with type 2 diabetes (T2D). Methods: In an analysis of adults with Medicaid and T2D enrolled in a longitudinal cohort study in 2020, demographics, depression (Patient Health Questionnaire-8 [PHQ-8]), food security status (USDA Food Security Module), Healthy Eating Index-2015 (HEI-15) diet quality scores, and other social determinants of health were assessed with annual surveys. Primary outcomes were HEI-15 and HbA1c, obtained from electronic health records. Separate propensity-score adjusted linear mixed models with a random intercept were used to test associations of baseline FI with changes in HEI-15 and A1c over 2 years. Results: Of 846 participants, 133 (16%) had T2D at baseline; 79 (59.4%) of those with T2D had FI. Those with baseline FI vs. food security had higher PHQ-8 scores and prevalence of housing instability, financial stress, and cost-related barriers to care (p<0.05). Over 2 years, changes in HEI-15 (p=0.45) and HbA1c (p=0.86) did not differ by baseline food security status (Table 1). Conclusion: In adults with T2D on Medicaid, diet quality remained low and HbA1c high over 2 years regardless of food security status, highlighting the importance of addressing nutrition when managing T2D in Medicaid patients. Disclosure K.D.Gu: None. J.Cheng: None. S.H.Mcgovern: None. J.L.Mccurley: None. D.E.Levy: None. V.Fung: Other Relationship; Vertex Pharmaceuticals Incorporated, Stock/Shareholder; Vertex Pharmaceuticals Incorporated. C.Clark: None. A.N.Thorndike: None. Funding National Institutes of Health (T32DK007028, 5T32HL098048, R01DK124145)