Cardiometabolic Impact of a Produce Prescription Program in Patients With Type 2 Diabetes and Food Insecurity (GARDEN-CARDIO)

A Randomized Crossover Trial Evaluating the Cardiometabolic Impact of a Produce Prescription Program in Patients With Type 2 Diabetes and Food Insecurity

This study is testing whether providing monthly vouchers to buy fruits and vegetables can help improve blood sugar control in adults with type 2 diabetes. People receiving care at WVU clinics who recently had an HbA1c level above 8% will be invited to participate in the study. Those who are interested will speak with a study coordinator, be screened for eligibility, and, if eligible, will provide written consent to join the study. Participants will be randomly assigned to one of two groups. One group will receive $100 per month in produce-only grocery vouchers and standardized dietary education for 5 months, followed by 5 months of usual diabetes care. The second group will receive usual diabetes care first for 5 months, followed by 5 months of produce-only grocery vouchers and standardized dietary education. This crossover design allows all participants to experience both approaches during the study. Researchers will measure changes in blood sugar (HbA1c) as the main outcome. Other outcomes include blood pressure, cholesterol levels, body weight, diet quality, food security, anxiety symptoms, depressive symptoms, and physical activity. These will be assessed through lab tests, clinic measurements, and surveys at certain time points during the 10 month study period. The study team will also track how often participants use the vouchers and any challenges they face. The risks of participating are expected to be minimal and similar to routine diabetes care. The total study duration, including enrollment, participation, and analysis, is expected to be about 18 months.

Study Overview

• Status: Not yet recruiting
• Conditions: Type 2 Diabetes
• Intervention / Treatment: Behavioral: Produce Gift Card and Dietary Education; Other: Usual Care

• Study Type: Interventional
• Enrollment (Estimated): 88
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Syed Ahmad, MD; Phone Number: 304-598-4850; Email: syed.ahmad@hsc.wvu.edu

Study Locations

• United States
  • West Virginia
    • Morgantown, West Virginia, United States, 26506
      • West Virginia University Heart and Vascular Institute
      • Contact: Syed Ahmad, MD; Phone Number: 304-598-4850; Email: syed.ahmad@hsc.wvu.edu
      • Principal Investigator: George Sokos, DO, FACC

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Diagnosis of type 2 diabetes mellitus
• Most recent HbA1c >8% within the prior 6 months
• Must have had a clinic visit within the past 6 months
• Positive screening for food insecurity based on the USDA 6-item food security survey
• Receiving care through WVU cardiometabolic, endocrinology, or primary care clinics
• Able and willing to provide written informed consent

Exclusion Criteria:

• End-stage renal disease
• Advanced heart failure
• Severe cognitive impairment
• Chronic pancreatitis
• Pancreatic malignancy
• Pregnancy at time of enrollment
• Anticipated inability to utilize intervention vouchers (e.g., lack of access to Walmart)

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Crossover Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Produce Gift Card to Usual Care; Participants are randomized to receive the produce prescription intervention, consisting of fruit and vegetable vouchers and standardized dietary education, for 5 months, followed by crossover to usual care for an additional 5 months.	Behavioral: Produce Gift Card and Dietary Education; Participants receive $100 per month in Walmart gift cards restricted to the purchase of fruits and vegetables. Gift cards are provided monthly during the intervention period and usage is tracked using participant-specific access codes. Participants also receive standardized dietary education consistent with current clinical guidelines, delivered by study personnel during the intervention period only.; Other: Usual Care; Participants receive standard clinical care for management of type 2 diabetes. No study-provided produce vouchers or study-provided dietary education are provided during this period.
Experimental: Usual Care to Produce Gift Card; Participants are randomized to receive usual care for 5 months, followed by crossover to the produce prescription intervention, consisting of fruit and vegetable vouchers and standardized dietary education, for an additional 5 months.	Behavioral: Produce Gift Card and Dietary Education; Participants receive $100 per month in Walmart gift cards restricted to the purchase of fruits and vegetables. Gift cards are provided monthly during the intervention period and usage is tracked using participant-specific access codes. Participants also receive standardized dietary education consistent with current clinical guidelines, delivered by study personnel during the intervention period only.; Other: Usual Care; Participants receive standard clinical care for management of type 2 diabetes. No study-provided produce vouchers or study-provided dietary education are provided during this period.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Hemoglobin A1c from Baseline to 5 Months	Change in hemoglobin A1c (%) measured using a standard laboratory test at baseline and at the 5-month study visit. Hemoglobin A1c reflects average blood glucose over the prior 2 to 3 months. The outcome measure is the change in hemoglobin A1c from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Hemoglobin A1c from Baseline to 10 Months	Change in hemoglobin A1c (%) measured using a standard laboratory test at baseline and at the 10-month study visit. Hemoglobin A1c reflects average blood glucose over the prior 2 to 3 months. The outcome measure is the change in hemoglobin A1c from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period	Baseline and 10 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Change in Food Insecurity Score (USDA 6-Item Survey) from Baseline to 5 Months	Change in food insecurity score measured using the USDA 6-item Food Security Survey at baseline and at the 5 month study visit. Scores range from 0 to 6, with higher scores indicating greater food insecurity. The outcome measure is the change in food insecurity score from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Food Insecurity Score (USDA 6-Item Survey) from Baseline to 10 Months	Change in food insecurity score measured using the USDA 6-item Food Security Survey at baseline and at the 10 month study visit. Scores range from 0 to 6, with higher scores indicating greater food insecurity. The outcome measure is the change in food insecurity score from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Sitting Systolic Blood Pressure from Baseline to 5 Months	Change in sitting systolic blood pressure (mmHg), measured using an automated device at baseline and at the 5 month study visit. Three readings are obtained and averaged at each visit. The outcome measure is the change in systolic blood pressure from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Sitting Systolic Blood Pressure from Baseline to 10 Months	Change in sitting systolic blood pressure (mmHg), measured using an automated device at baseline and at the 10 month study visit. Three readings are obtained and averaged at each visit. The outcome measure is the change in systolic blood pressure from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Body Weight from Baseline to 5 Months	Change in body weight (kg), measured at baseline and at the 5 month study visit. Weight is measured using a calibrated scale. The outcome is the mean change in body weight between baseline and 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Body Weight from Baseline to 10 Months	Change in body weight (kg), measured at baseline and at the 10 month study visit. Weight is measured using a calibrated scale. The outcome is the mean change in body weight between baseline and 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Body Mass Index (BMI) from Baseline to 5 Months	Change in body mass index (kg/m²), measured at baseline and at the 5 month study visit. BMI is calculated as weight in kilograms divided by height in meters squared using measurements obtained at each visit. The outcome is the mean change in BMI between baseline and 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Body Mass Index (BMI) from Baseline to 10 Months	Change in body mass index (kg/m²), measured at baseline and at the 10 month study visit. BMI is calculated as weight in kilograms divided by height in meters squared using measurements obtained at each visit. The outcome is the mean change in BMI between baseline and 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Waist Circumference from Baseline to 5 Months	Change in waist circumference (cm), measured at baseline and at the 5 month study visit using a standardized measuring tape. The outcome is the mean change in waist circumference between baseline and 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Waist Circumference from Baseline to 10 Months	Change in waist circumference (cm), measured at baseline and at the 10 month study visit using a standardized measuring tape. The outcome is the mean change in waist circumference between baseline and 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in PREVENT Cardiovascular Risk Score from Baseline to 5 Months	Change in estimated 10-year cardiovascular risk (%) calculated using the American Heart Association PREVENT cardiovascular risk equation at baseline and at the 5-month study visit. Higher values indicate greater cardiovascular risk. The outcome measure is the change in estimated cardiovascular risk from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in PREVENT Cardiovascular Risk Score from Baseline to 10 Months	hange in estimated 10-year cardiovascular risk (%) calculated using the American Heart Association PREVENT cardiovascular risk equation at baseline and at the 5-month study visit. Higher values indicate greater cardiovascular risk. The outcome measure is the change in estimated cardiovascular risk from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Healthy Eating Index (HEI) Score from Baseline to 5 Months	The Healthy Eating Index (HEI) score will be measured at baseline and at 5 months using a 24-hour recall of everything the participant ate and drank the previous day, collected by trained study staff. The HEI-2015 scoring method will be used, which compares the participant's diet to national dietary guidelines. The total score ranges from 0 to 100, where higher scores indicate a healthier overall diet. The outcome measure is the change in Healthy Eating Index score from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Healthy Eating Index (HEI) Score from Baseline to 10 Months	The Healthy Eating Index (HEI) score will be measured at baseline and at 10 months using a 24-hour recall of everything the participant ate and drank the previous day, collected by trained study staff. The HEI-2015 scoring method will be used, which compares the participant's diet to national dietary guidelines. The total score ranges from 0 to 100, where higher scores indicate a healthier overall diet. The outcome measure is the change in Healthy Eating Index score from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Daily Fruit and Vegetable Intake from Baseline to 5 Months	Change in mean daily fruit and vegetable intake (cups/day) from baseline and 5 months. Intake is assessed using a 24-hour dietary recall administered by a trained study team member or clinical research coordinator. The outcome measure is the change in average daily fruit and vegetable intake from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Daily Fruit and Vegetable Intake from Baseline to 10 Months	Change in mean daily fruit and vegetable intake (cups/day) from baseline and 10 months. Intake is assessed using a 24-hour dietary recall administered by a trained study team member or clinical research coordinator. The outcome measure is the change in average daily fruit and vegetable intake from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Anxiety Score (HADS-A) from Baseline to 5 Months	Change in anxiety score, measured using the HADS Anxiety subscale (0 to 21) at baseline and at the 5 month study visit. Higher scores indicate greater anxiety symptoms. The outcome measure is the change from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Anxiety Score (HADS-A) from Baseline to 10 Months	Change in anxiety score, measured using the HADS Anxiety subscale (0 to 21) at baseline and at the 10 month study visit. Higher scores indicate greater anxiety symptoms. The outcome measure is the change from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Depression Score (HADS-D) from Baseline to 5 Months	Change in depression score, measured using the HADS Depression subscale (0 to 21) at baseline and at the 5 month study visit. Higher scores indicate greater depressive symptoms. The outcome measure is the change from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Depression Score (HADS-D) from Baseline to 10 Months	Change in depression score, measured using the HADS Depression subscale (0 to 21) at baseline and at the 10 month study visit. Higher scores indicate greater depressive symptoms. The outcome measure is the change from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Physical Activity (IPAQ) from Baseline to 5 Months	Change in physical activity measured using the International Physical Activity Questionnaire (IPAQ), reported as total metabolic equivalent (MET) minutes per week. The IPAQ assesses physical activity over the past 7 days. Measurements are obtained at baseline and at the 5 month study visit. The outcome measure is the change from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Physical Activity (IPAQ) from Baseline to 10 Months	Change in physical activity measured using the International Physical Activity Questionnaire (IPAQ), reported as total metabolic equivalent (MET) minutes per week. The IPAQ assesses physical activity over the past 7 days. Measurements are obtained at baseline and at the 10 month study visit. The outcome measure is the change from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Total Cholesterol from Baseline to 5 Months	Change in total cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 5 month study visit. Total cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in total cholesterol from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Total Cholesterol from Baseline to 10 Months	Change in total cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 10 month study visit. Total cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in total cholesterol from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Low-Density Lipoprotein (LDL) Cholesterol from Baseline to 5 Months	Change in low-density lipoprotein (LDL) cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 5 month study visit. LDL cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in LDL from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Low-Density Lipoprotein (LDL) Cholesterol Baseline to 10 months	Change in low-density lipoprotein (LDL) cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 10 month study visit. LDL cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in LDL from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in High-Density Lipoprotein (HDL) Cholesterol from Baseline to 5 Months	Change in high-density lipoprotein (HDL) cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 5 month study visit. HDL cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in HDL from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in High-Density Lipoprotein (HDL) Cholesterol Baseline to 10 months	Change in high-density lipoprotein (HDL) cholesterol (mg/dL), measured via fasting blood sample at baseline and at the 10 month study visit. HDL cholesterol is quantified using standard clinical laboratory methods. The outcome measure is the change in HDL from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months
Change in Triglycerides from Baseline to 5 Months	Change in triglycerides (mg/dL), measured via fasting blood sample at baseline and at the 5 month study visit. Triglycerides are quantified using standard clinical laboratory methods. The outcome measure is the change in triglycerides from baseline to 5 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 5 months
Change in Triglycerides Baseline to 10 months	Change in triglycerides (mg/dL), measured via fasting blood sample at baseline and at the 10 month study visit. Triglycerides are quantified using standard clinical laboratory methods. The outcome measure is the change in triglycerides from baseline to 10 months and will be evaluated according to randomized treatment sequence and study period.	Baseline and 10 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Average Monthly Produce Voucher Spending per Participant	Average monthly amount spent (USD) per participant during the produce prescription intervention period, calculated from gift card redemption records.	10 months
Protocol Retention at 5 Months (Proportion of Participants)	Proportion of enrolled participants who remain actively enrolled in the study and have not withdrawn consent or been lost to follow-up at the 5-month assessment. Retention is calculated as the number of active participants divided by the total number of enrolled participants.	5 months
Protocol Retention at 10 Months (Proportion of Participants)	Proportion of enrolled participants who remain actively enrolled in the study and have not withdrawn consent or been lost to follow-up at the 10-month assessment. Retention is calculated as the number of active participants divided by the total number of enrolled participants.	10 months
Protocol adherence (Proportion of Participants)	Proportion of enrolled participants who complete all required study procedures during the 10-month study period, including attendance at scheduled study visits, completion of required laboratory assessments, and completion of required study questionnaires. Adherence is calculated as the number of participants who complete all required study procedures divided by the total number of enrolled participants.	10 months

Collaborators and Investigators

• Sponsor: West Virginia University
• Investigators: Principal Investigator: George Sokos, DO, FACC, West Virginia University Heart and Vascular Institute

Publications and helpful links

General Publications

• Bjelland I, Dahl AA, Haug TT, Neckelmann D. The validity of the Hospital Anxiety and Depression Scale. An updated literature review. J Psychosom Res. 2002 Feb;52(2):69-77. doi: 10.1016/s0022-3999(01)00296-3.
• Panizza CE, Shvetsov YB, Harmon BE, Wilkens LR, Le Marchand L, Haiman C, Reedy J, Boushey CJ. Testing the Predictive Validity of the Healthy Eating Index-2015 in the Multiethnic Cohort: Is the Score Associated with a Reduced Risk of All-Cause and Cause-Specific Mortality? Nutrients. 2018 Apr 5;10(4):452. doi: 10.3390/nu10040452.
• Seligman HK, Angell SY, Berkowitz SA, Elkind MSV, Hager K, Moise N, Posner H, Muse J, Odoms-Young A, Ridberg R, Troxel AB, Yaroch AL, Volpp KG. A Systematic Review of "Food Is Medicine" Randomized Controlled Trials for Noncommunicable Disease in the United States: A Scientific Statement From the American Heart Association. Circulation. 2025 Jul 29;152(4):e32-e46. doi: 10.1161/CIR.0000000000001343. Epub 2025 Jun 18.
• Mozaffarian D, Aspry KE, Garfield K, Kris-Etherton P, Seligman H, Velarde GP, Williams K, Yang E; ACC Prevention of Cardiovascular Disease Section Nutrition and Lifestyle Working Group and Disparities of Care Working Group. "Food Is Medicine" Strategies for Nutrition Security and Cardiometabolic Health Equity: JACC State-of-the-Art Review. J Am Coll Cardiol. 2024 Feb 27;83(8):843-864. doi: 10.1016/j.jacc.2023.12.023.

Helpful Links

• USDA 6-item food insecurity survey
• International Physical Activity Questionnaire scoring

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): June 1, 2027
• Study Completion (Estimated): June 1, 2027

Study Registration Dates

• First Submitted: June 24, 2026
• First Submitted That Met QC Criteria: June 24, 2026
• First Posted (Actual): June 30, 2026

Study Record Updates

• Last Update Posted (Actual): June 30, 2026
• Last Update Submitted That Met QC Criteria: June 24, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Food Insecurity
• Additional Relevant MeSH Terms: Endocrine System Diseases; Metabolic Diseases; Glucose Metabolism Disorders; Diabetes Mellitus; Nutritional and Metabolic Diseases; Diabetes Mellitus, Type 2; Health Care Quality, Access, and Evaluation; Investigative Techniques; Epidemiologic Methods; Data Collection; Health Care Evaluation Mechanisms; Quality of Health Care; Public Health; Environment and Public Health; Epidemiologic Measurements; Nutrition Assessment
• Other Study ID Numbers: STUDY00000327

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: YES
• IPD Plan Description: Upon reasonable request, prospectively collected data points (lab values, vital signs, survey results) will be shared. All shared data will be completely anonymous.
• IPD Sharing Time Frame: Data will be available, upon reasonable request, starting 6 months after the manuscript is published in a scientific peer-reviewed journal. This will be available for other researchers for up to one year.
• IPD Sharing Access Criteria: Criteria include ethical use of data, appropriate citation of source of data (such as study team, grant, etc.), clear plan for use of data, and transparency in use of data. Those requesting access must provide proof of affiliation to United States-based academic institution or clinical facility.
• IPD Sharing Supporting Information Type: STUDY_PROTOCOL

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No