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

糖尿病影响着9.4%的美国人口，与其他疾病相比， 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的糖尿病发病率更低。 代谢控制，更高的并发症发生率和死亡率相比，白人和那些生活在 最高收入水平。粮食不安全（即无法获得或在获得营养充足的食物方面受到限制） 更好地预测慢性病比收入，突出其作为一个可修改的因素的重要性。人数将近28%的强调 美国糖尿病患者报告食物不安全，而非糖尿病患者中有12%报告食物不安全， 比白人更容易出现食物不安全。食物不安全的糖尿病患者 血糖控制，报告较低的饮食质量和更多的困难，以下健康饮食相比， 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： 形式：1）支付食品费用的代金券; 2）只能在农贸市场使用的代金券/优惠券; 以及3）将预先包装的食品（储备箱）运送到参与者家中。然而，重要的未答复 糖尿病患者的问题包括：1）在食物补充剂的选择中， 在实现血糖控制方面比食品券更上级？2)是邮寄的股票盒的组合 和食品券上级任何一种单独的食品补充方案？3)提供糖尿病教育 与单独的教育相比，与食物补充剂相结合会导致改善的临床结果吗？ 为了解决文献中的这一空白，我们提出了一项随机对照试验，以测试单独和联合的疗效， 每月向农贸市场提供食品券，每月邮寄食品库存箱，并根据糖尿病分层 在低收入、食物不安全、2型糖尿病（T2 DM）AA患者中， 2 × 2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.