Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, South Carolina, USA.
Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington, USA.
Pediatr Diabetes. 2022 Nov;23(7):982-990. doi: 10.1111/pedi.13386. Epub 2022 Jul 10.
To examine the association between household food insecurity (HFI), glycemic control, severe hypoglycemia and diabetic ketoacidosis (DKA) among youth and young adults (YYA) with youth-onset type 2 diabetes.
This cross-sectional study included 395 YYA with type 2 diabetes from the SEARCH for Diabetes in Youth Study (2015-2019). HFI was reported by young adult participants or parents of minor participants via the US Household Food Security Survey Module. Glycemic control was assessed by HbA and analyzed as a continuous and categorical variable (optimal: <7.0%, suboptimal: ≥7.0%-9.0%, poor: >9.0%). Acute complications included self-reported severe hypoglycemia or DKA in the last 12 months. Adjusted logistic and linear regression were used for binary and continuous outcomes, respectively.
Approximately 31% reported HFI in the past 12 months. Mean HbA among those with HFI was 9.2% compared to 9.5% without HFI. Of those with HFI, 56% had an HbA >9.0% compared to 55% without HFI. Adjusted models showed no associations between HFI and glycemic control. Of those with HFI, 14.4% reported experiencing DKA and 4.7% reported severe hypoglycemia. YYA with HFI had 3.08 times (95% CI: 1.18-8.06) the odds of experiencing DKA as those without HFI. There was no association between HFI and severe hypoglycemia.
HFI was associated with markedly increased odds of DKA but not with glycemic control or severe hypoglycemia. Future research among YYA with type 2 diabetes should evaluate longitudinally whether alleviating HFI reduces DKA.
研究青少年和年轻成人（YYA）中家庭食物不安全（HFI）与血糖控制、严重低血糖和糖尿病酮症酸中毒（DKA）之间的关系。
本横断面研究纳入了来自青少年糖尿病研究（SEARCH for Diabetes in Youth Study，2015-2019 年）的 395 名青少年起病 2 型糖尿病患者。HFI 由成年患者或未成年患者的父母通过美国家庭食物安全调查模块报告。通过 HbA 评估血糖控制，并将其作为连续和分类变量进行分析（最佳：<7.0%，次优：≥7.0%-9.0%，较差：>9.0%）。急性并发症包括在过去 12 个月内报告的严重低血糖或 DKA。采用调整后的逻辑回归和线性回归分别对二分类和连续结局进行分析。
约 31%的患者在过去 12 个月内报告存在 HFI。有 HFI 的患者的平均 HbA 为 9.2%，而无 HFI 的患者为 9.5%。在有 HFI 的患者中，56%的患者 HbA>9.0%，而无 HFI 的患者为 55%。调整模型显示 HFI 与血糖控制之间无关联。在有 HFI 的患者中，14.4%报告发生 DKA，4.7%报告严重低血糖。有 HFI 的 YYA 发生 DKA 的几率是无 HFI 的患者的 3.08 倍（95%CI：1.18-8.06）。HFI 与严重低血糖之间无关联。
HFI 与 DKA 的发生风险显著增加有关，但与血糖控制或严重低血糖无关。未来对青少年和年轻成人 2 型糖尿病患者的研究应评估是否缓解 HFI 可降低 DKA 的发生。
