189-OR: Food Insecurity and Inability to Obtain Recommended Medications, Diabetes Technology, and Multidisciplinary Services in Youth and Young Adults with Diabetes

Introduction & Objective: Little evidence exists on how household food insecurity (FI) affects youth and young adults (YYA) obtaining medical care related to diabetes. We assessed if FI is cross-sectionally associated with not obtaining recommended diabetes medications, technology, and multidisciplinary services, and explored the most common reasons for not obtaining recommended treatments in YYA with diabetes.

Methods: Using data from 911 YYA with type 1 diabetes (T1D) and 144 YYA with type 2 diabetes (T2D) in the SEARCH Food Security Cohort Study Follow-up 1 (2018-2021) and logistic regression, we evaluated the association of FI and the inability to obtain recommended treatments and tabulated the reasons reported.

Results: Almost 30% of YYA with T1D and FI and 20% of YYA with T2D and FI did not obtain one or more recommended treatment (15.8% and 14.4% in food secure YYA, respectively). YYA with T1D and FI had higher odds of not obtaining insulin (OR 3.2, 95% CI 1.2-8.4), an insulin pump (OR 2.2, 95% CI 1.2-4.4), a continuous glucose monitor (OR 2.5, 95% CI 1.5-4.4), mental health counseling (OR 3.3, 95% CI 1.3-8.2), and diabetes education (OR 3.6, 95% CI 1.4-9.3), adjusted for demographics, household income, food assistance, and diabetes duration. Among YYA with T2D, FI was related to not obtaining dietician services (OR 8.1, 95% CI 1.2-53.8). YYA with T1D mostly reported financial reasons (e.g., unable to afford, insurance issues) for not obtaining diabetes technology and medications, followed by structural reasons (e.g., lack of time, not allowed time off) for not obtaining services such as diabetes education or mental health counseling.

Conclusion: YYA with diabetes and FI face constraints in obtaining medications, diabetes technology, and multidisciplinary services, largely due to financial and structural reasons. New strategies are needed to bridge the gap between medical care required versus obtained by YYA with diabetes.