Food insecurity, or the lack of consistent access to enough food for an active, healthy life, is associated with worse glycemic control and higher mortality in adults with diabetes. However, little is known regarding the burden of food insecurity on health-related quality of life, a global measure that captures physical and mental health over time. Using two years of national data collected through the Medical Expenditure Panel Survey (2016-2017) , we investigated the relationship between food insecurity and physical health related (PCS) and mental health related (MCS) quality of life in adults with diabetes. Ten questions asked about running out of food, affording balanced meals, skipping meals, and losing weight due to not eating. Adults scoring 3 or more were considered food insecure. Unadjusted and adjusted linear regression weighted to represent the US adult population was run with PCS and MCS treated as separate continuous outcomes. Food insecure adults with diabetes reported significantly lower physical and mental health related quality of life (PCS 42.2 vs. 35.9; MCS 51.5 vs. 42.7) . After adjusting for demographics, insurance coverage, and comorbidities, food insecure adults with diabetes maintained significantly lower scores compared to food secure adults with diabetes (PCS: -3.43, 95%CI -4.63,-2.25; MCS: -5.37, 95%CI -6.68,-4.06) . This drop in PCS scores of 3.4 and MCS of 5.4 was similar to or larger than differences between those with comorbidities known to significantly impact quality of life, such as stroke (decrease of 2.6 in PCS and 0.5 in MCS) , joint pain (decrease of 4.5 in PCS and 2.4 in MCS) , and heart disease (decrease of 2.0 in PCS and 3.8 in MCS) . Results highlight the significant burden of food insecurity on both physical and mental health related quality of life in adults with diabetes. Interventions are needed that integrate clinical and social factors impacting health-related quality of life to ensure overall well-being in adults with diabetes.
R.J.Walker: None. A.Thorgerson: None. E.Mosley-johnson: None. L.E.Egede: None.
American Diabetes Association (1-19-JDF-075) ; National Institute for Minority Health and Health Disparities (R01MD013826, PI: Egede/Walker) , National Institute of Diabetes and Digestive Kidney Disease (K24DK093699, R01DK118038, R01DK120861, PI: Egede)