Department of Family Medicine, University of Michigan, Ann Arbor, MI, United States.
Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, United States.
JMIR Res Protoc. 2024 May 15;13:e54043. doi: 10.2196/54043.
People with low income are disproportionately affected by type 2 diabetes (T2D), and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low-carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low-carbohydrate eating for people with T2D, although food-as-medicine interventions paired with nutrition education offer a promising solution.
This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity.
This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up.
This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program.
This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D.
INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/54043.
低收入人群更容易受到 2 型糖尿病（T2D）的影响，美国有 17.6%的 T2D 患者经历食物不安全和低饮食质量。低碳水化合物饮食计划可以改善血糖控制，促进体重减轻，并与改善心血管代谢健康和全因死亡率相关。尽管以食物为药物的干预措施与营养教育相结合提供了一种有前途的解决方案，但对于 T2D 患者的低碳水化合物饮食支持知之甚少。
该计划旨在通过使用食品杂货配送和低碳水化合物教育来支持饮食变化的开始，以提高 T2D 和食物不安全或低收入人群的低碳水化合物营养质量。
这是在密歇根州的 21 个初级保健诊所进行的非随机试点研究。患有 T2D 和食物不安全或低收入的成年人有资格参加。患者由初级保健诊所工作人员推荐。所有参与者都接受了为期 3 个月的计划，其中包括每月 80 美元的健康食品信用额度、Shipt 的免费食品杂货配送服务以及低碳水化合物营养教育。食品信用额度仅限于购买健康食品。教育材料与提供者和患者合作开发，包括印刷、数字、互动网络和视频格式。在入组时，参与者完成了一份调查，包括人口统计学、糖尿病健康状况、饮食和体育活动以及糖尿病管理和知识。在 3 个月的计划结束后，参与者完成了一项调查，其中包括重复评估糖尿病健康状况、饮食和体育活动以及糖尿病管理和知识。还收集了参与者对体验和感知计划影响、食物购买行为以及教育材料使用情况的看法。糖尿病健康信息补充了参与者医疗记录中的数据。我们计划进行混合方法分析，以评估计划的可行性、可接受性和影响。主要质量改进（QI）措施是患者推荐和入组的数量、80 美元食品信用额度的使用、食品购买行为分析、参与者对该计划的体验以及计划成本。次要 QI 措施包括血红蛋白 A、体重、药物、自我效能、糖尿病和碳水化合物知识以及基线和随访之间的活动的变化。
该计划于 2022 年 10 月开始。预计数据收集将于 2024 年 6 月结束。共有 151 名患者被推荐参加该计划，其中 83 名（55%）参加了该计划。平均年龄为 57 岁（SD 13；范围 18-86），72%（57/79）为女性，90%（70/78）为白人，96%（74/77）为非西班牙裔。所有参与者在计划期间都成功地下了杂货订单。
该试点 QI 计划旨在通过使用食品杂货配送和低碳水化合物营养教育来改善 T2D 和食物不安全人群的饮食质量。我们的发现可能有助于为未来的 QI 计划和包括食品杂货配送和教育在内的针对 T2D 患者的以食物为药物干预措施的研究提供信息。
国际注册报告标识符（IRRID）：DERR1-10.2196/54043。
