Food Insecurity, Food "Deserts," and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis
Food Insecurity, Food "Deserts," and Glycemic Control in Patients With Diabetes: A Longitudinal Analysis
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DOI：
10.2337/dc17-1981
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发表时间：
2018-06-01
期刊：
影响因子：
16.2
通讯作者：
Wexler, Deborah J.
中科院分区：
文献类型：
--
作者：
Berkowitz, Seth A.;Karter, Andrew J.;Wexler, Deborah J.
目的食物不安全(由于成本原因食物获取有限)和生活在缺乏营养食物的地区都是公共卫生问题，但人们对它们对糖尿病管理的相对贡献了解很少。2013年，初级保健网络中的糖尿病患者随机抽样完成了食品不安全评估。在人口普查区域一级，物质食物可获得性低的定义是在城市地区1英里内没有超市，在农村地区10英里内没有超市。HBA(1c)测量是从电子健康记录中获得的，截至2016年11月。使用分层线性混合模型分析了食物不安全、低体力食物可获得性和血糖控制(由HBA(1c)定义)之间的关系。20%的受访者报告粮食不安全，31%的受访者居住在实际粮食可获得性较低的地区。在调整后的模型中，食物不安全与较高的HbA(1c)相关(相差0.6%[6.6 mmol/m ol]，95%CI 0.4-0.8[4.4-8.7]，P<；0.0001)，但不会随着时间的推移而改善(P=0.5)。生活在食物缺乏地区与HBA(1c)的差异(差值0.2%[2.2 mmol/mol]，95%CI-20.2~0.5[-22.2~5.6]，P=0.33)或随时间的变化(P=0.07)无关。食品不安全筛查和干预可能有助于改善对脆弱患者的血糖控制。
OBJECTIVEBoth food insecurity (limited food access owing to cost) and living in areas with low physical access to nutritious foods are public health concerns, but their relative contribution to diabetes management is poorly understood.RESEARCH DESIGN AND METHODSThis was a prospective cohort study. A random sample of patients with diabetes in a primary care network completed food insecurity assessment in 2013. Low physical food access at the census tract level was defined as no supermarket within 1 mile in urban areas and 10 miles in rural areas. HbA(1c) measurements were obtained from electronic health records through November 2016. The relationship among food insecurity, low physical food access, and glycemic control (as defined by HbA(1c)) was analyzed using hierarchical linear mixed models.RESULTSThree hundred and ninety-one participants were followed for a mean of 37 months. Twenty percent of respondents reported food insecurity, and 31% resided in an area of low physical food access. In adjusted models, food insecurity was associated with higher HbA(1c)(difference of 0.6%[6.6mmol/mol], 95% CI 0.4-0.8[4.4-8.7], P < 0.0001), which did not improve over time (P = 0.50). Living in an area with low physical food access was not associated with a difference in HbA(1c) (difference 0.2%[2.2mmol/mol], 95% CI-20.2 to 0.5 [-22.2 to 5.6], P = 0.33) or with change over time (P = 0.07).CONCLUSIONSFood insecurity is associated with higher HbA(1c), but living in an area with low physical food access is not. Food insecurity screening and interventions may help improve glycemic control for vulnerable patients.