Rayala Hannah-Therese, Stroud Brandon J, Sastre Lauren R
Brody School of Medicine, East Carolina University, Greenville, NC, USA.
Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA.
SAGE Open Med. 2025 Aug 23;13:20503121251346020. doi: 10.1177/20503121251346020. eCollection 2025.
Diabetes self-management education supports healthy dietary behaviors but often lacks food skill-building education to plan, budget for, select, and prepare (cook) healthier food.
This study examined the relationship between food skills, diabetes self-management, and stress with medically underinsured patients with type-2 diabetes mellitus within the Fresh Start Food is Medicine (FIM) program. A secondary objective was to examine the impact on diet quality and clinical outcomes.
Adults ( = 150) with type-2 diabetes mellitus participated in the 20-week Fresh Start FIM intervention, which included nine group education classes, a produce prescription, and telephone-based health coaching. Group education and skill-building centered around food skills and diabetes self-management. Measures included surveys (e.g., food skills confidence, diet quality, and stress) and clinical measures (e.g., weight, HbA1c, and blood pressure). Data analysis included paired -tests, Wilcoxon signed-rank tests, and linear regression.
Significant improvements were observed in food skills confidence ( < 0.001), diet quality (e.g., fruit = 0.03; vegetable < 0.001; whole grain < 0.001 consumption), diabetes self-management ( < 0.001), and perceived stress ( = 0.01). Food skills confidence and diabetes self-management were significant predictors of perceived stress ( = 0.05 and 0.009, respectively). Blood pressure significantly declined (systolic: -6.7 mmHg, = 0.007; diastolic, = 0.02).
Integrating food skills education and individualized behavioral support within an FIM intervention improved food skills confidence, diabetes self-management, and diet quality while reducing perceived stress among medically underinsured patients with type-2 diabetes mellitus. Enhanced self-efficacy in diabetes management and food skills were key contributors to stress reduction, emphasizing the importance of skill-oriented education within diabetes self-management education. These findings underscore the critical role of food skills in building capacity to improve dietary behaviors and health with resource-limited populations.
糖尿病自我管理教育有助于培养健康的饮食习惯，但往往缺乏规划、预算、选择和准备（烹饪）更健康食物的饮食技能培养教育。
本研究在“重新开始食物即药物”（FIM）项目中，探讨了饮食技能、糖尿病自我管理和压力与医疗保障不足的2型糖尿病患者之间的关系。次要目的是研究其对饮食质量和临床结局的影响。
150名2型糖尿病成年患者参与了为期20周的“重新开始FIM”干预项目，该项目包括9次小组教育课程、一份农产品处方和基于电话的健康指导。小组教育和技能培养围绕饮食技能和糖尿病自我管理展开。测量指标包括调查问卷（如饮食技能信心、饮食质量和压力）和临床指标（如体重、糖化血红蛋白和血压）。数据分析包括配对t检验、威尔科克森符号秩检验和线性回归。
饮食技能信心（P<0.001）、饮食质量（如水果摄入量P=0.03；蔬菜摄入量P<0.001；全谷物摄入量P<0.001）、糖尿病自我管理（P<0.001）和感知压力（P=0.01）均有显著改善。饮食技能信心和糖尿病自我管理是感知压力的显著预测因素（分别为P=0.05和P=0.009）。血压显著下降（收缩压：-6.7 mmHg，P=0.007；舒张压，P=0.02）。
在FIM干预中整合饮食技能教育和个性化行为支持，可提高饮食技能信心、糖尿病自我管理能力和饮食质量，同时降低医疗保障不足的2型糖尿病患者的感知压力。糖尿病管理和饮食技能方面自我效能的提高是减轻压力的关键因素，强调了以技能为导向的教育在糖尿病自我管理教育中的重要性。这些发现凸显了饮食技能在资源有限人群中提高饮食行为和健康水平方面的关键作用。
