Screening for household food insecurity (HFI) is recommended because of its impact on diabetes management. While HFI has been shown to be associated with poor glycemic control in adults with type 2 diabetes (T2D) and youth and young adults (YYA) with type 1, the association between HFI and glycemic control in YYA with T2D is not known.
This cross-sectional study included T2D YYA (n=395) from the 2015-2020 SEARCH for Diabetes in Youth Study (14-35 yrs; median age: 25.2 yrs). HFI was defined as affirming ≥3 items on the US Household Food Security Survey Module. HbA1c values were available for 271 participants. It was measured in a sample of whole blood and analyzed as a continuous variable. Glycemic control was dichotomized into optimal/suboptimal (≤9 %) vs. high risk (> 9.0%) based on HbA1c. Survey data on experiencing severe hypoglycemia or diabetic ketoacidosis (DKA) in the last 12 months was available for 292 participants. Logistic and linear regression were used for modeling the association of HFI with binary and continuous outcomes, respectively.
Approximately 34% of YYA with T2D reported HFI in the past 12 months. The mean HbA1c of the YYA with HFI was 9.2%, 54% had HbA1c >9.0%, and 19% reported experiencing DKA or hypoglycemia. YYA who were food secure had a mean HbA1c of 9.5%, 54% had HbA1c >9.0%, and 8% reported acute complications. No associations were observed between HFI and HbA1c or glycemic control. YYA with HFI had 2.3 (CI: 1.1-5.2) times the odds of experiencing DKA or hypoglycemia as those without HFI, after adjusting for age, gender, race, parent education, household income, insurance, clinic, diabetes duration, use of continuous glucose monitoring, and medication regimen. Our data suggests that HFI among YYA with T2D is a quite common, affecting more than a third of our sample and is associated with acute diabetes-related complications. These results warrant longitudinal studies in this particularly vulnerable group to establish if alleviating HFI reduces frequency of DKA and hypoglycemia episodes.
L. A. Reid: None. S. M. Marcovina: None. E. Lustigova: None. A. D. Liese: None. J. A. Mendoza: None. A. Merchant: None. M. Geraci: None. B. A. Reboussin: None. A. M. Ellyson: None. F. Malik: None. D. Dabelea: None. L. Merjaneh: None.
National Institutes of Health (R01DK117461, 1UC4DK108173)