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Double jeopardy: Food insecurity and diabetes

Arnold School researchers make important discoveries and plan intervention study

One in five youth and young adults with diabetes in the U.S. lives in a household with limited or uncertain availability of nutritional food, a precarious situation that makes coping with diabetes difficult.

While the combination of food insecurity and diabetes has been much studied among older adults, a University of South Carolina public health professor and her team are among the first to focus on the burden of food insecurity in youth and young adults with diabetes, who are at higher risk for negative consequences.

“Food-insecure young adults with diabetes are in a real bind when it comes to managing their glucose,” says Angela D. Liese, an epidemiology professor in the Arnold School of Public Health who has conducted diabetes and food insecurity research for more than two decades. “One of our most recent research articles documents that the limited or unreliable availability of food correlates with markedly higher levels of fear of having abnormally low blood sugar.”

Such fear is well placed, Liese says. Very low blood sugar, a condition known as hypoglycemia, can be life-threatening, and young individuals with Type 1 or 2 diabetes who experience hypoglycemia are believed to be at much higher risk for impaired cognitive function.

Liese and her research team recently concluded a Centers for Disease Control-funded study in South Carolina, Washington, California, Colorado and Ohio, which helped reveal the prevalence and causal effects of youth and young adults with diabetes who experience food insecurity. A follow-up study, funded by the National Institutes for Health, is focused on about 1,100 households in South Carolina, Colorado and Washington.

Being depressed or anxious makes it less likely that you’re going to be able to manage your diabetes well.

Angela Liese

“For young people with diabetes, not knowing where your next meal is coming from takes a psychological and emotional toll, and we see much higher rates of depressive symptoms and anxiety in our study population,” Liese says. “Being depressed or anxious makes it less likely that you’re going to be able to manage your diabetes well.”

Diabetes Care, a leading academic journal, has recently published several articles Liese and her team have distilled from their research on food insecurity and youth and young adults with diabetes. Those topics have included the prevalence and predictors of food insecurity as well as the fear of hypoglycemia experienced by that population who are dealing with food insecurity.

The Journal of the Academy of Nutrition and Dietetics has recently accepted for publication another article from Liese’s team that focuses on food insecurity and dietary intake in the entire population of youth and adults with diabetes. Findings from that research reveal diets very poor in recommended intake of nearly all of 10 key nutrients (calcium, fiber, magnesium, potassium, sodium, vitamins C, D, E, saturated fat and added sugar). The researchers found that those with type 1 diabetes generally consumed foods with too much sodium and not enough fiber.

While the federally funded Supplemental Nutrition Assistance Program (formerly the Food Stamp Program) helps supplement the food budget of families that need support, more policy-level action is needed to address continuing shortfalls in the system, Liese says.

“People with diabetes already have much higher expenditures in daily life — these supplies that you need to test your blood sugar level every day are expensive, as are the medications,” Liese says. “And you need to test not just once but up to four times a day. If you don’t have health insurance, it’s a real challenge. So, people stretch their medication or go without medication, and none of that is good for their health.”

As the Arnold School team continues to comb through data collected in their research, Liese is looking ahead to the next logical step: an intervention study that addresses all factors associated with food insecurity and diabetes management.

“The ultimate goal of any intervention we plan is that a person will be better able to manage their diabetes so that their blood sugar levels stay more in the range that they need to be in, but also that their mental health and their quality of life is good,” she says. “And that will take a very holistic intervention approach.”