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- Title
Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial.
- Authors
Berkowitz, Seth A.; Delahanty, Linda M.; Terranova, Jean; Steiner, Barbara; Ruazol, Melanie P.; Singh, Roshni; Shahid, Naysha N.; Wexler, Deborah J.
- Abstract
<bold>Background: </bold>Food insecurity, defined as inconsistent food access owing to cost, leads to poor health.<bold>Objective: </bold>To test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.<bold>Design: </bold>Randomized cross-over clinical trial.<bold>Participants: </bold>Forty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign").<bold>Intervention: </bold>In the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.<bold>Main Measures: </bold>The primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.<bold>Key Results: </bold>Mean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).<bold>Conclusions: </bold>For food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).
- Subjects
MEDITERRANEAN diet; FOOD security; APPETITE
- Publication
JGIM: Journal of General Internal Medicine, 2019, Vol 34, Issue 3, p396
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-018-4716-z