Greater food insecurity from recession poses increased risk to low income individuals with diabetes

The economic recession impacts many aspects of our lives including an increase incidence of food insecurity. This can have serious consequences for those suffering from chronic illnesses like diabetes.

For diseases like diabetes, in which nutrition and menu planning play a key role in treatment, food insecurity can be devastating. A study in the November/December issue of the Journal of Nutrition Education and Behavior explores how technology advancement in the form of telemedicine can provide cost-effective ways to treat those with diabetes experiencing food insecurity.

Investigators evaluated rural older adults with diabetes reporting the presence or absence of food insecurity with respect to meal planning, obesity, and diabetes control after receiving a telemedicine intervention that included nutrition counseling. Findings from this study reveal that food-insecure adults with diabetes had a higher body mass index and were more likely to consider the cost of food than food-secure adults with diabetes. However, after nutrition counseling via telemedicine, both groups reported that they usually or always adhered to the dietitian's advice and did not differ significantly in lab values associated with diabetes care.

Food security, as defined by the American Dietetic Association, is “access by all people, at all times to sufficient food for an active and healthy life includes at a minimum: the ready availability of nutritionally adequate and safe foods, and an assured ability to acquire acceptable foods in socially acceptable ways.” However, 10% of adults with diabetes were classified as having food insecurity in the Third National Health and Nutrition Examination Survey.1 Unfortunately, “older patients with diabetes commonly do not directly indicate to their primary care provider that money, lack of nutrition knowledge, transportation, physical disability, or other barriers are preventing them from complying with dietary recommendations” says lead author Dr. Daria Homenko, who conducted this work at the State University of New York Upstate Medical University.

This study documents that low-income older individuals with diabetes and food insecurity have the ability to follow an appropriate meal plan after receiving nutrition education by telemedicine, which has not been previously reported. Co-author, Dr. Ruth Weinstock, Professor of Medicine at SUNY Upstate Medical University in Syracuse, New York, states, “in the IDEATel project [telemedicine], nutrition education was effectively delivered to rural older adults with diabetes using telemedicine. This study demonstrated that among participants classified as both food secure and mildly insecure, individuals were usually able to follow the dietitian's advice. 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.”

Researchers participating in this multi-center study believe “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. 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.”

Within the article, the researchers emphasize the importance of providing access to dietitians and diabetes education to underserved older adults with diabetes using telemedicine.

The article is “Food Insecurity and Food Choices in Rural Older Adults with Diabetes Receiving Nutrition Education via Telemedicine” by Daria R. Homenko, MD; Philip C. Morin, MS; Joseph P. Eimicke, MS; Jeanne A. Teresi, EdD, PhD; Ruth S. Weinstock, MD, PhD. It appears in the Journal of Nutrition Education and Behavior, Volume 42, Issue 6 (November/December 2010) published by Elsevier.

1 Seligman HK, Bindman AB, Vittinghoff E, Kanaya AM, KushelMB. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002. JGen Intern Med. 2007;22:1018-1023.