The Intersection of Food Insecurity and Diet Quality in Association with Diabetes ABCs Management among US Adults, 2013-2018

The ADA recommends that people with diabetes (PWD) consume a high-quality diet to achieve diabetes treatment goals, however, food insecurity may prevent consumption of a high-quality diet. Cross-sectional, national data from 2,351 participants aged ≥20 years with self-reported diabetes that completed the National Health and Nutrition Examination Surveys between 2013-2018 were analyzed. Diet quality was assessed using quartiles of the 2015 Healthy Eating Index. Adjusted odds ratios (aOR, 95% CI) were calculated from logistic regression models to determine the association between individual food insecurity/diet quality and A1c, blood pressure (BP) , and cholesterol control (ABCs) while controlling for sociodemographics, health care utilization, smoking, diabetes, BP, and cholesterol medication use, and BMI. Overall, 17.6% of PWD were food insecure/low diet quality; 14.2% were food insecure/high diet quality; 33.1% were food secure/low diet quality; and 35.2% were food secure/high diet quality. PWD who were food insecure/low diet quality were younger, non-Hispanic black race or Hispanic ethnicity, and uninsured vs. those who were food secure/high diet quality (all p<0.001) . In comparison with PWD with full food security/high diet quality, those with food insecurity/low diet quality were significantly more likely to have A1c ≥7.0% (aOR=1.84, 1.23-2.76) , A1c ≥8.0% (aOR=1.76, 1.02-3.02) , low HDL (aOR=1.70, 1.24-2.33) , and high triglycerides (aOR=3.13, 1.71-5.71) ; food insecurity/high diet quality was significantly associated with A1c ≥7.0% (aOR=1.69, 1.14-2.51) , A1c ≥8.0% (aOR=1.83,1.12-2.98) and high triglycerides (aOR=2.44, 1.15-5.16) ; and food security/low diet quality with A1c≥7% (aOR=1.55, 1.07-2.24) . Both food insecurity and low diet quality are associated with both poor glycemic and lipid management. Screening for and interventions that address food insecurity and diet quality may help support PWD in their diabetes management. Disclosure S.Casagrande: None. K.M.Bullard: None. K.R.Siegel: None. J.M.Lawrence: None. Funding National Institutes of Diabetes and Digestive and Kidney Diseases (GS-10F-0381L)