Linking education, produce provision, and community referrals to improve diabetes care (LINK)

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Project Summary The combined impacts of type 2 diabetes mellitus (T2D) and food insecurity can be devastating. According to recent NHANES data, 19% of adults with T2D are food-insecure, and T2D prevalence is higher among those with food insecurity. Individuals with T2D and food insecurity have worse diabetes self-management and glycemic control compared to food-secure peers. While addressing food insecurity is important in T2D care, individuals with food insecurity may also have other non-medical, health-related social needs (e.g., transportation barriers, housing instability, job insecurity) that may decrease their ability to attain glucose targets and impact other diabetes-related health outcomes. Partnerships between healthcare systems and community-based organizations have emerged as a promising approach to improve diabetes control in food- insecure populations. Given the design limitations of prior studies, there remains a critical need for randomized controlled trials (RCTs) to test the combined impact of diabetes education, food provision, and addressing unmet social needs on glycemic control in people with T2D experiencing food insecurity. Leveraging existing programs and relationships, we propose to test the combined effects of a food referral program, social needs screening and referral, and diabetes education intervention on hemoglobin A1c in a population of racially/ethnically diverse participants with food insecurity and T2D with A1c ≥7.5% identified at OSUWMC. We plan to use a community-engaged research approach with community members and stakeholders informing the design and focus of the interventions. Aim 1: Using a pragmatic randomized controlled trial (pRCT), to test the effect of produce provision, diabetes education, and community referrals on A1c levels in individuals with T2D experiencing food insecurity. Aim 2: To assess the cost-effectiveness of each of the interventions that comprise the pRCT. Aim 3: To utilize a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. Impact: Our proposed study aligns with the NIDDK’s interest in clinical studies addressing T2D treatment, complications, and health equity, as our project directly examines health system-based approaches to address non-medical, health-related social needs to improve health outcomes. Innovative solutions are warranted to combat the long-term sequelae of uncontrolled T2D combined with food insecurity that contribute to the two-fold higher all-cause mortality in T2D that disproportionality impacts lower socio-economic status and racial/ethnic minority populations. Food insecurity, unmet social needs, and diabetes education are critical issues that must be addressed to improve T2D treatment, care, and equity. Our study will provide essential evidence that will support both scalable and sustainable partnerships to address these conditions.