Seligman Hilary K, Davis Terry C, Schillinger Dean, Wolf Michael S
University of California San Francisco, San Francisco, CA 94142, USA.
J Health Care Poor Underserved. 2010 Nov;21(4):1227-33. doi: 10.1353/hpu.2010.0921.
More than 14% of the American population is food insecure, or at risk of going hungry because of an inability to afford food. Food-insecure (FI) adults often reduce food intake or substitute inexpensive, energy-dense carbohydrates for healthier foods. We hypothesized these behaviors would predispose FI adults with diabetes to hypoglycemia and impaired diabetes self-management. We therefore assessed whether food insecurity was associated with multiple indicators of diabetes self-management (self-efficacy, medication- and glucose-monitoring adherence, hypoglycemia, or glycemic control) among 40 low-income adults with diabetes. Mean self-efficacy score was lower among FI than food-secure (FS) participants (34.4 vs. 41.2, p=.02). Food-insecure participants reported poorer adherence to blood glucose monitoring (RR=3.5, p=.008) and more hypoglycemia-related emergency department visits (RR=2.2, p=.007). Mean hemoglobin A1c was 9.2% among FI and 7.7% among FS participants (p=.08). Food insecurity is a barrier to diabetes self-management and a risk factor for clinically significant hypoglycemia.
超过14%的美国人口面临粮食不安全问题，即因无力购买食品而面临饥饿风险。粮食不安全（FI）的成年人常常减少食物摄入量，或者用廉价的、能量密集型碳水化合物替代更健康的食物。我们推测，这些行为会使患有糖尿病的FI成年人易发生低血糖，并损害糖尿病自我管理能力。因此，我们评估了40名低收入糖尿病成年患者中，粮食不安全是否与糖尿病自我管理的多个指标（自我效能感、药物和血糖监测依从性、低血糖或血糖控制）相关。FI参与者的平均自我效能感得分低于粮食安全（FS）参与者（34.4对41.2，p = 0.02）。粮食不安全的参与者报告称，其血糖监测依从性较差（RR = 3.5，p = 0.008），与低血糖相关的急诊就诊次数更多（RR = 2.2，p = 0.007）。FI参与者的平均糖化血红蛋白水平为9.2%，FS参与者为7.7%（p = 0.08）。粮食不安全是糖尿病自我管理的一个障碍，也是临床上显著低血糖的一个风险因素。
