189-LB: Household Food Insecurity and Associations with Glycemic Control and Acute Diabetes-Related Complications in Youth and Young Adults with Type 1 Diabetes: The SEARCH for Diabetes in Youth Study

Objectives: To examine, among youth and young adults (YYAs) with type 1 diabetes (T1D), the independent association of household food insecurity (HFI) with: 1) glycemic control and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia.

Methods: This cross-sectional study included SEARCH for Diabetes in Youth participants with T1D examined between 2016-2019. HFI was assessed using the U.S. Household Food Security Survey Module. HbA1c was measured from blood drawn at a research visit; episodes of DKA and severe hypoglycemia were collected by survey. Linear and logistic regression models adjusted for age, sex, race, income, health insurance, diabetes duration, and SEARCH site.

Results: Of 1834 participants (mean age 20.8±5.0 years, 69.9% non-Hispanic white, diabetes duration 11.1±3.2 years), HbA1c was collected for 1029 individuals (mean HbA1c 9.2%±2.0%). The prevalence of HFI was 16.4%. In this sample, 18.7% and 9.9% reported an episode of DKA or severe hypoglycemia in the past 12 months, respectively. Compared to participants who were food secure, HFI was associated with a 0.43% [CI: 0.02%-0.68%] higher HbA1c. In two separate adjusted models, those with HFI had 1.86 [CI: 1.03, 2.34] times the odds of an episode of DKA and 1.64 [CI: 1.03, 2.34] times the odds of an episode of severe hypoglycemia as those without HFI.

Conclusions: HFI is independently associated with poor glycemic control and increased odds of diabetes-related complications in YYAs with T1D. Interventions to reduce HFI and studies to longitudinally examine its impact on glycemic control and complications are warranted.