Introduction: Food insecurity (FI) in youth with type 1 diabetes (T1D) has been associated with high-risk glycemic levels (A1c >9%) and more emergency department utilization (Mendoza et al., Diabetes Res Clin Prac, 2018). At our diabetes center, we routinely assess for FI using the Hunger Vital Sign™, a validated 2-question screening tool. The goal of the present work was to examine the contribution of FI on DKA risk prediction in youth with T1D.
Methods: Multiple logistic regression models were used to predict the probability of severe DKA (pH <7.0 and/or HCO3 <5 mEq/L) and multiple DKA events in the next year based on demographic and glycemic features from the previous two years in youth with T1D screened for FI (n=761, age 12.93.2y, 53%F, A1c 8.92.1%, 49% public health insurance, 9.6% with positive FI screen).
Results: Predictive model performance with and without incorporation of the FI feature is characterized using receiver operating curves in Figure 1. A positive food insecurity screen was a significant covariate in the model for predicting the risk of severe DKA (p=0.003) and multiple DKA events (p=0.025).
Conclusion: Diabetes clinics should incorporate FI screening into clinical care and future studies are needed to assess whether addressing FI with tailored resources such as SNAP benefits, food prescriptions, connection to local food banks, and/or home-delivery of healthy foods reduces future risk of DKA.
D. DeSalvo: Advisory Panel; Insulet Corporation. Consultant; Dexcom, Inc. D.D. Schwartz: None. M. Erraguntla: None. R.Y. Sonabend: None. S. Lyons: None.
The Leona M. and Harry B. Helmsley Charitable Trust (2206-05307)
