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Food insecurity from recession increases risk for those with diabetes in low-income, rural areas
Homenko DR. J Nutr Educ Behav. 2010;42:404-409.
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A lack of access to nutritious and safe foods, or food insecurity, hinders the ability of a patient with diabetes to adhere to dietary recommendations. New data, however, indicate that telemedicine may provide a way to overcome this hurdle.
Food insecurity affects at least 10% of the US population, with older adults and those living in low-income, rural areas taking the biggest hit. For patients in this population with diabetes, the problem is further compounded by the scarcity of certified diabetes educators in rural medical practices.
Researchers for the Informatics for Diabetes Education and Telemedicine demonstration project tested the efficacy of a remote intervention in older Medicare patients with diabetes living in rural areas of upstate New York. They offered a self-management training program involving alternating monthly video visits with a nurse diabetes educator and a diabetes educator.
According to follow-up data collected via telephone, 23% of 74 participants reported mild food insecurity. These patients had a higher mean BMI of 35.5 compared with 30.5 for those who were food-secure (P=.01), and they had lower annual household incomes of less than $20,000 (P=.03). They were also twice as likely to consider cost of ingredients in food preparation compared with food-secure respondents (P=.03).
Results revealed that 97% of all participants purchased fresh produce and 85% also bought canned goods. Ninety-three percent reported understanding how to prepare appropriate food choices, although only 51% said they followed the dietitian’s advice 5 to 7 days per week.
Despite differences in food security, the ability to follow the dietitian’s guidance in food selection and glycemic control appeared comparable between the two groups.
“This finding suggests that telemedical nutrition support services have the potential to be an important adjunct for rural primary care providers whose patients have poor access to the services of dietitians,” Ruth Weinstock, MD, PhD, of the State University of New York Upstate Medical University in Syracuse, said in a press release.
“Food insecurity may become a greater problem for older patients living on fixed incomes as the cost of food rises or economically depressed rural localities lose food-distribution outlets,” the researchers wrote. “Nutrition education with sensitivity to food insecurity issues, as well as services providing access to low-cost, healthful food, are needed for many older, rural patients with diabetes. Telemedicine can help with the former; public policies are critical for the latter.”
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