Lowering the Impact of Food insecurity in African American Adults with Type 2 Diabetes Mellitus (LIFT-DM)

相比之下，糖尿病影响了9.4%的美国人口，并不成比例地影响了非裔美国人 敬白人。在糖尿病患者中，AA和那些生活在联邦贫困线以下的人更贫穷 新陈代谢控制，与白人和那些生活在 最高收入水平。粮食不安全(即无法获得或限制获得营养充足的食物) 与收入相比，更好地预测慢性病，突出了它作为一个可修改因素的重要性。近28%的 患有糖尿病的美国人报告说食物不安全，相比之下，没有糖尿病的人只有12%，而美国人 食物不安全的可能性是白人的3倍。食物不安全的糖尿病患者病情更严重 血糖控制，报告饮食质量较低，与那些坚持健康饮食的人相比更难 并不是粮食不安全。目前经过测试的解决粮食不安全问题的战略包括#年的粮食补充 形式：1)支付食品成本的代金券；2)只能在农贸市场使用的代金券/代金券； 3)将预先包装好的食品(备用盒)运往参与者家庭。然而，重要的是没有得到答复 糖尿病患者的问题包括：1)在食品补充选择中，邮寄存货箱 在实现血糖控制方面优于食品券？2)是邮寄备用盒的组合 食品券比单独的食品补充选项更好吗？3)提供糖尿病教育 与单纯的教育相比，与食物补充相结合可以改善临床结果吗？ 为了解决文献中的这一差距，我们提出了一项随机对照试验，以测试以下药物的单独和联合疗效 每月向农贸市场发放食品代金券，每月邮寄糖尿病食品储存箱 在低收入、食物不安全、AAS合并2型糖尿病(T2 DM)患者中改善血糖控制的教育 2x2析因设计。

Diabetes affects 9.4% of the US population and disproportionately affects African Americans (AAs) compared to whites. Among individuals with diabetes, AAs and those living below the federal poverty level have poorer metabolic control, higher complication rates and higher mortality compared to Whites and those living at the highest income level. Food insecurity (i.e. an inability to or limitation in accessing nutritionally adequate food) better predicts chronic disease than income, highlighting its importance as a modifiable factor. Almost 28% of the US population with diabetes report food insecurity, compared to 12% of those without diabetes, and AAs are 3 times more likely than whites to be food insecure. Food insecure individuals with diabetes have worse glycemic control, report lower dietary quality and more difficulty following a healthy diet compared to those who are not food insecure. Currently tested strategies to address food insecurity include food supplementation in the form of: 1) vouchers to cover cost of food; 2) vouchers/coupons that can only be used at farmer’s markets; and 3) shipments of pre-packaged food (stock boxes) to participants homes. However, important unanswered questions in individuals with diabetes include: 1) Within food supplementation options, are mailed stock boxes superior to food vouchers in terms of achieving glycemic control? 2) Is the combination of mailed stock boxes and food vouchers superior to either food supplementation option alone? 3) Does providing diabetes education in combination with food supplementation lead to improved clinical outcomes compared to education alone? To address this gap in the literature, we propose an RCT to test the separate and combined efficacy of monthly food vouchers to farmers market and monthly mailed food stock boxes layered upon diabetes education in improving glycemic control in low income, food insecure, AAs with Type 2 Diabetes (T2DM) using a 2x2 factorial design.