Patients with type 2 diabetes who face food insecurity (limited access to nutritious food owing to cost) are at increased risk for diabetes complications. Intensive lifestyle interventions (ILI) are recommended for treatment of diabetes and obesity but it is unclear if these interventions are effective in patients with food insecurity, which can be a barrier to weight loss. We conducted a pre-planned subgroup analysis of the REAL HEALTH RCT, which compared a pragmatic group ILI (delivered in-person or by telephone) to medical nutrition therapy (MNT) in adults with type 2 diabetes. The analysis compared whether intervention effects differed by food security status, using mixed effects models to account for repeated measurements. The primary and secondary analyses examined percentage weight change from baseline at 6 and 12 months, respectively. Of 211 participants, those with food insecurity (n=28) were more likely to be racial/ethnic minorities (p<0.001), have lower education (p<0.001), and have lower income (p<0.001) than those who were food secure (n=183). The intervention led to greater reduction in weight at 6 months (mean: 5.1% reduction, SD: 5.3%) than MNT (mean: 1.1% reduction, SD: 3.7%), p <0.001. The ILI was similarly effective in those with versus without food insecurity (5.1% vs. 5.1% reduction, p for interaction 0.92). The ILI remained more effective at 12 months (4.7% reduction vs. 2.0% reduction for MNT), p=0.001, and remained similarly effective in those with versus without food insecurity (4.5% vs. 4.7% reduction, p for interaction 0.67). Adjusting for demographic differences in those who were and were not food insecure did not change the results at 6 (p for interaction 0.67) or 12 (p for interaction 0.88) months. The REAL HEALTH intensive lifestyle intervention yielded clinically significant weight loss at 6 and 12 months with similar effectiveness regardless of food security status.


S. Berkowitz: None. D.J. Wexler: Other Relationship; Spouse/Partner; APOLO1BIO. Y. Chang: None. B.C. Porneala: None. L.M. Delahanty: Advisory Panel; Self; Jana Care Inc., Omada Health, Inc., Weight Watchers International, Inc.


National Institute of Diabetes and Digestive and Kidney Diseases (R18DK102737, K23DK109200)

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