Seligman Hilary K, Lyles Courtney, Marshall Michelle B, Prendergast Kimberly, Smith Morgan C, Headings Amy, Bradshaw Georgiana, Rosenmoss Sophie, Waxman Elaine
Hilary K. Seligman (
Courtney Lyles is an assistant professor of medicine at UCSF and at the UCSF Center for Vulnerable Populations.
Health Aff (Millwood). 2015 Nov;34(11):1956-63. doi: 10.1377/hlthaff.2015.0641.
Food insecurity--defined as not having adequate quantity and quality of food at all times for all household members to have an active, healthy life--is a risk factor for poor diabetes control, yet few diabetes interventions address this important factor. Food pantries, which receive food from food banks and distribute it to clients in need, may be ideal sites for diabetes self-management support because they can provide free diabetes-appropriate food to people in low-income communities. Between February 2012 and March 2014, we enrolled 687 food pantry clients with diabetes in three states in a six-month pilot intervention that provided them with diabetes-appropriate food, blood sugar monitoring, primary care referral, and self-management support. Improvements were seen in pre-post analyses of glycemic control (hemoglobin A1c decreased from 8.11 percent to 7.96 percent), fruit and vegetable intake (which increased from 2.8 to 3.1 servings per day), self-efficacy, and medication adherence. Among participants with elevated HbA1c (at least 7.5 percent) at baseline, HbA1c improved from 9.52 percent to 9.04 percent. Although food pantries are nontraditional settings for diabetes support, this pilot study suggests a promising health promotion model for vulnerable populations. Policies supporting such interventions may be particularly effective because of food pantries' food access and distribution capacity.
粮食不安全被定义为无法始终为所有家庭成员提供充足数量和质量的食物,以过上积极健康的生活,它是糖尿病控制不佳的一个风险因素,但很少有糖尿病干预措施涉及这一重要因素。食品分发处从食品银行接收食物并分发给有需要的客户,可能是糖尿病自我管理支持的理想场所,因为它们可以为低收入社区的人们提供适合糖尿病患者的免费食物。在2012年2月至2014年3月期间,我们在三个州招募了687名患有糖尿病的食品分发处客户,进行了为期六个月的试点干预,为他们提供适合糖尿病患者的食物、血糖监测、初级保健转诊和自我管理支持。在血糖控制(糖化血红蛋白从8.11%降至7.96%)、水果和蔬菜摄入量(从每天2.8份增加到3.1份)、自我效能感和药物依从性的前后分析中都有改善。在基线时糖化血红蛋白升高(至少7.5%)的参与者中,糖化血红蛋白从9.52%改善到9.04%。尽管食品分发处是糖尿病支持的非传统场所,但这项试点研究为弱势群体提出了一个有前景的健康促进模式。支持此类干预措施的政策可能特别有效,因为食品分发处具备食物获取和分发能力。