Comprehensive Diabetes Self-Management Support From Food Banks: A Randomized Controlled Trial

Abstract

Objectives: To determine whether food bank provision of self-management support and diabetes-appropriate food improves glycemic control among clients with diabetes.

Methods: We screened 5329 adults for diabetes at food pantries (n = 27) affiliated with food banks in Oakland, California; Detroit, Michigan; and Houston, Texas, between October 2015 and September 2016. We individually randomized 568 participants with hemoglobin A1c (HbA1c) 7.5% or greater to waitlist control or 6-month intervention including food, diabetes education, health care referral, and glucose monitoring. The primary outcome was HbA1c at 6 months.

Results: Food security (relative risk [RR] = 0.85; 95% confidence interval [CI] = 0.73, 0.98), food stability (RR = 0.77; 95% CI = 0.64, 0.93), and fruit and vegetable intake (risk difference [RD] = 0.34; 95% CI = 0.34, 0.34) significantly improved among intervention participants. There were no differences in self-management (depressive symptoms, diabetes distress, self-care, hypoglycemia, self-efficacy) or HbA1c (RD = 0.24; 95% CI = -0.09, 0.58).

Conclusions: Food banks are ideally situated to provide diabetes-appropriate food to food-insecure households. Effective strategies for food banks to support improvements in diabetes clinical outcomes require additional study. Public Health Implications. Moving chronic disease support from clinics into communities expands reach into vulnerable populations. However, it is unclear how community interventions should be integrated with clinical care to improve disease outcomes.

Trial registration number: NCT02569060.

Figures

FIGURE 1—

Flow of Participants Through Trial of Diabetes Self-Management Support in Food Banks: Detroit, MI; Houston, TX; and Oakland, CA, 2015–2016 Note. DM = diabetes mellitus; RBG = random blood glucose. aSpecific exclusion criteria for participants with 2 or more exclusion criteria: no contact information and cognitive impairment (n = 1); no contact information and intention to move from study area (n = 1). bHigh engagement = picked up ≥ 80% of diabetes-appropriate food boxes, attended ≥ 2 diabetes education classes, and had ≥ 1 primary care visit over the 6-mo follow-up period.