Food insecurity and glycemic control in individuals with diagnosed and undiagnosed diabetes in the United States

Aims: Investigate the relationship between food insecurity and glycemic control in adults with diagnosed and undiagnosed diabetes. Methods: Using National Health and Nutrition Examination Survey (NHANES) between 2003–2016, food insecurity was measured using the household food insecurity scale. Glycemic control was measured using glycated hemoglobin (HbA1c) collected during the NHANES examination. Individuals were categorized into undiagnosed diabetes or diagnosed diabetes based on their measured HbA1c and response to whether they were told by a doctor or other health professional they have diabetes or were taking medications for diabetes. Sampling weights and survey procedures were used when conducting univariate and multivariable models using SAS version 9.4. Results: Approximately 13.7% of the population sample (35,216 adults representing 207,271,917 US adults) reported food insecurity. Reporting food insecurity was associated with 0.37 higher HbA1c for diagnosed (95% CI 0.15−0.60) and 0.45 higher HbA1c for undiagnosed diabetes (95% CI 0.05−0.85). In the undiagnosed diabetes population, those reporting food insecurity had 80% higher likelihood of HbA1c above 7% (OR = 1.80, 95% CI 1.06–3.06). Conclusions: Food insecurity had a stronger relationship with HbA1c for those with undiagnosed diabetes. Results suggest the importance of screening for individuals with food insecurity that may be at high risk for having undiagnosed diabetes.