In the United States, type 2 diabetes (T2D) is more common in all racial and ethnic minority groups than in non-Hispanic White populations. T2D that is not properly controlled significantly raises the risk of serious complications, such as high blood pressure, heart disease, chronic kidney disease, and stroke. Maintaining a healthy, balanced diet low in refined grains, added sugars, sodium, and saturated fats is a critical part of managing T2D. However, it can be challenging for people experiencing food insecurity to access the nutritious foods needed to maintain a healthy diet. In a new NIMHD-supported study, researchers analyzed the impact of food insecurity, diet quality, and other factors on T2D management. They found that having a poor-quality diet, living with food insecurity, being Black or African American or Hispanic or Latino, and not having access to health care are all correlated with a higher risk of uncontrolled T2D.
The researchers examined health data from more than 1,500 adults 20 years old or older who had T2D. The data were drawn from the National Health and Nutrition Examination Survey (NHANES), which measures the health and nutrition of people living in the United States. The data used in this study were collected from 2011 to 2016. NHANES used blood test results to detect uncontrolled T2D and questionnaires to collect information on participants, including their health examination, food intake, and food security.
Using NHANES data on food intake, the researchers used the Healthy Eating Index 2015 (HEI-2015) to calculate the quality of diets, based on the most recent recommendations for a healthy diet. The HEI-2015 ranks a person’s diet on a scale of 0 to 100, based on the food types and amounts that a person usually eats, including fruit, vegetables, whole grains, dairy, total protein, fats, processed foods, sodium, and sugar. For this study, the researchers considered participants who had a score of 60 or lower as having a poor-quality diet. To measure food security, the researchers analyzed NHANES data from a set of 10 questions that asked whether a participant was always able to get safe, nutritious food. The researchers then analyzed these data and other information for factors that are associated with uncontrolled T2D.
Although most of the participants had their diabetes under control, about 16% who had uncontrolled T2D also had food insecurity; 68% consumed a poor-quality diet, and 24% both consumed a poor-quality diet and had food insecurity. Participants who had a poor-quality diet were about five times more likely to have uncontrolled T2D than participants with good-quality diets. Participants who were living with food insecurity had even more trouble managing their T2D; they were eight times more likely to have uncontrolled T2D than participants with consistent access to and ability to afford healthy food. Participants who had both a poor-quality diet and food insecurity—about a quarter of the group—were even more likely to have uncontrolled T2D. In general, the study participants, who all had T2D, had a poorer-quality diet and a higher level of food insecurity than what has been reported for the general public.
The study showed that Black or African American participants and Hispanic or Latino participants were more likely to have uncontrolled T2D than non-Hispanic White participants were. This supports previous research findings that found higher rates of uncontrolled T2D and mortality in racial and ethnic minority populations. Participants who did not have regular health care or who had been referred to a diabetes specialist also had a high risk of uncontrolled T2D.
Overall, the study’s results show the interaction of poor diet and food insecurity on diabetes control and the importance of improving access to healthy foods, especially for people at risk of uncontrolled T2D. The researchers suggest that people who live with food insecurity may depend on nutrition assistance programs and that public health initiatives that promote access to healthy foods could help improve diet quality and food security. Also, making culturally sensitive health and nutrition information available in multiple languages could help people who are more likely to have uncontrolled T2D understand the importance of healthy food choices. Policies that address the combined challenges of food insecurity, poor diet quality, and limited access to health care could help address uncontrolled T2D in racial and ethnic minority populations and in underserved communities.

Shaheen, M., Kibe, L. W., & Schrode, K. M. (2021). Dietary quality, food security and glycemic control among adults with diabetes. Clinical Nutrition ESPEN, 46, 336–342. doi:10.1016/j.clnesp.2021.09.735.
Page updated September 16, 2022
Grant No.: U54MD007598
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