期刊
DIABETES CARE
卷 35, 期 2, 页码 233-238出版社
AMER DIABETES ASSOC
DOI: 10.2337/dc11-1627
关键词
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资金
- Russell Sage Foundation
- The Commonwealth Fund
- National Institutes of Health (NIH)/National Center for Research Resources (NCRR)/Office of the Director, University of California, San Francisco (UCSF)-Clinical & Translational Science Institute (CTSI) [KL2 RR024130]
- Arnold P. Gold Foundation
OBJECTIVE-To determine whether food insecurity-the inability to reliably afford safe and nutritious food-is associated with poor glycemic control and whether this association is mediated by difficulty following a healthy diet, diabetes self-efficacy, or emotional distress related to diabetes. RESEARCH DESIGN AND METHODS-We used multivariable regression models to examine the association between food insecurity and poor glycemic control using a cross-sectional survey and chart review of 711 patients with diabetes in safety net health clinics. We then examined whether difficulty following a diabetic diet, self-efficacy, or emotional distress related to diabetes mediated the relationship between food insecurity and glycemic control. RESULTS-The food insecurity prevalence in our sample was 46%. Food-insecure participants were significantly more likely than food-secure participants to have poor glycemic control, as defined by hemoglobin A(1c) >= 8.5% (42 vs. 33%; adjusted odds ratio 1.48 [95% CI 1.07-2.04]). Food-insecure participants were more likely to report difficulty affording a diabetic diet (64 vs. 49%, P < 0.001). They also reported lower diabetes-specific self-efficacy (P < 0.001) and higher emotional distress related to diabetes (P < 0.001). Difficulty following a healthy diet and emotional distress partially mediated the association between food insecurity and glycemic control. CONCLUSIONS-Food insecurity is an independent risk factor for poor glycemic control in the safety net setting. This risk may be partially attributable to increased difficulty following a diabetes-appropriate diet and increased emotional distress regarding capacity for successful diabetes self-management. Screening patients with diabetes for food insecurity may be appropriate, particularly in the safety net setting.
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