In people with diagnosed diabetes (DM), pathways between income, diet, and glycated hemoglobin levels (A1c) are unclear. Performing mediation analysis using structural equation modeling, we investigated cross-sectional total effects (direct + indirect effects), shown as standardized coefficients in this conceptual model of household poverty-to-income ratio (PIR), household food insecurity (FI), and individual consumer-related dietary behavior [# of meals prepared away from home (#meals) and % of #meals from fast food/pizza place (%FFpizza) in last 7 days] associated with A1c (Figure). Data from 2,343 participants aged ≥21 years with DM in 2007-2014 National Health and Nutrition Examination Survey were used. Among U.S. adults with DM; 43% had PIR<200%, 16% were FI, and 42% and 37%, respectively, reported ≥3 #meals and more than 50% %FFpizza. Greatest absolute magnitude of association was PIR with FI (-0.41), which was more than 1.5 times greater than next largest, PIR with #meals (0.25). Only FI (0.11) and #meals (0.07) had significant total effect with A1c. Though #meals had a positive total effect on %FFpizza, %FFpizza had no significant total effect on A1c. Complex relationships between PIR, FI, #meals, and %FFpizza in adults with DM suggest the need for a better understanding of dietary behaviors that can influence healthier options for better DM management.


C. Mercado: None. S. Saydah: None. K.M. Bullard: None. K.R. Siegel: None. G. Imperatore: None.

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