Diabetes (i.e. Type 1, Type 2, gestational, and pre-diabetes) is a non-communicable disease that has been shown to disproportionately affect food insecure populations. Its management is highly complex as it necessitates significant lifestyle and dietary modifications. Patients must learn to monitor glucose levels, dose drugs appropriately, count carbohydrates, and eat balanced meals among a panoply of other considerations.
Diabetes management is further complicated when conflated with the challenges of food insecurity. Individuals with prediabetes and diabetes are more likely to experience food insecurity, and pregnant and food-insecure women have a higher likelihood of being diagnosed with gestational diabetes. Food insecurity is defined as the disruption of food intake and dietary patterns due to a lack of financial resources.
Food insecurity severely impedes an individual’s ability to manage diabetes due to an inability to afford nutritious and varied diets along with increased medical costs. In both children and adults with diabetes, food insecurity results in adverse health outcomes and higher rates of hospitalization and utilization of health services. Health care providers need effective strategies for working with adult and pediatric populations with both diabetes and food insecurity, however, guidelines to better support this population are lacking.
As such, our scoping review sought to determine emerging practices health care providers can implement in their practice or communicate to patients to best support both adult and pediatric patients with diabetes and food insecurity. Articles were included if it targeted a population with diabetes and food insecurity and offered recommendations, practices, strategies, or interventions that could be operationalized by health care providers. There were no geographic limitations, although articles had to be published in English. In total, 21 articles were included in the review.
Our review identified seven strategies for health care providers, including 1) screening for food insecurity, followed by 2) tailoring nutrition counseling, 3) managing medications, 4) referring patients to local resources, 5) establishing healthy coping strategies, 6) smoking cessation, and 7) developing a strong rapport with patients. Screening for food insecurity is a logical first step. Without identification, interventions cannot be initiated to support patients’ management of diabetes and food insecurity.
Following identification, health care providers can tailor nutrition counseling to fit the patients’ circumstances. For example, rather than recommending more expensive brown rice, dietitians can recommend consuming smaller portions of white rice. More cost-effective substitutions can also be suggested including buying canned or frozen foods when appropriate and plant-based proteins. Medication management is also critical in this population. Food insecure individuals tend to eat at irregular intervals in irregular quantities depending on access and availability of food. Therefore, medications altering glucose and insulin response must be adjusted to accommodate inconsistent eating patterns to prevent complications such as hyper- or hypoglycemia.
Health care providers can also refer patients to local resources such as food pantries or affordable grocery stores and social assistance that may improve food access and ease budgetary demands. However, ensuring follow-through in the update of these services by patients is still an ongoing issue. In addition, patients’ coping strategies in managing diabetes and food insecurity must be assessed and addressed to prevent diabetes distress and poor mental health. Smoking cessation is also a lifestyle change that may improve glycemic control and reduce the risk of vascular complications. In order to effectively implement these practices, a strong health care provider-patient rapport is required.
Our review highlights the need for a non-judgemental and empathetic approach in interacting with food insecure clients due to the stigma and shame associated with food insecurity.
Our review is the first study to our knowledge to determine emerging practices that health care providers can communicate or operationalize in their practice to adult and pediatric populations with both diabetes and food insecurity. While the review was intended to elucidate a global perspective, only articles from North American countries satisfied inclusion criteria, due in part to the English language criteria. More studies with an evaluative component are also needed to determine the effectiveness of the recommendations, strategies, practices, or interventions outlined in our review.
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