Household food insecurity and associations with hemoglobin A1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study

Faisal S Malik; Angela D Liese; Alice Ellyson; Lauren A Reid; Beth A Reboussin; Katherine A Sauder; Edward A Frongillo; Catherine Pihoker; Dana Dabelea; Kristi Reynolds; Elizabeth T Jensen; Santica Marcovina; Deborah A Bowlby; Jason A Mendoza; SEARCH for Diabetes in Youth Study Group

doi:10.1016/j.diabres.2024.111608

Household food insecurity and associations with hemoglobin A_1c and acute diabetes-related complications in youth and young adults with type 1 diabetes: The SEARCH for Diabetes in Youth study

Diabetes Res Clin Pract. 2024 Apr 3:212:111608. doi: 10.1016/j.diabres.2024.111608. Online ahead of print.

Authors

Affiliations

¹ Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States. Electronic address: faisal.malik@seattlechildrens.org.
² University of South Carolina, Columbia, United States.
³ Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States.
⁴ South College, Atlanta, United States.
⁵ Wake Forest University School of Medicine, Winston-Salem, United States.
⁶ University of Colorado Anschutz Medical Campus, Aurora, United States.
⁷ Kaiser Permanente Southern California, Pasadena, United States.
⁸ Medpace Reference Laboratories, Cincinnati, OH, United States.
⁹ Medical University of South Carolina, Charleston, United States.
¹⁰ Department of Pediatrics, University of Washington School of Medicine, Seattle, United States; Seattle Children's Research Institute, Seattle, United States; Fred Hutchinson Cancer Center, Seattle, United States.

PMID: 38574894
DOI: 10.1016/j.diabres.2024.111608

Abstract

Aims: To examine, among youth and young adults (YYA) with type 1 diabetes (T1D), the association of household food insecurity (HFI) with: 1) HbA_1c and 2) episodes of diabetic ketoacidosis (DKA) and severe hypoglycemia.

Methods: HFI was assessed using the U.S. Household Food Security Survey Module in SEARCH for Diabetes in Youth participants with T1D between 2016 and 2019. Linear and logistic regression models adjusted for age, diabetes duration, sex, race, ethnicity, clinic site, parent/participant education, household income, health insurance, and diabetes technology use.

Results: Of 1830 participants (mean age 20.8 ± 5.0 years, 70.0 % non-Hispanic White), HbA_1c was collected for 1060 individuals (mean HbA1c 9.2 % ± 2.0 %). The prevalence of HFI was 16.4 %. In the past 12 months, 18.2 % and 9.9 % reported an episode of DKA or severe hypoglycemia, respectively. Compared to participants who were food secure, HFI was associated with a 0.33 % (95 % CI 0.003, 0.657) higher HbA_1c level. Those with HFI had 1.58 (95 % CI 1.13, 2.21) times the adjusted odds of an episode of DKA and 1.53 (95 % CI 0.99, 2.37) times the adjusted odds of an episode of severe hypoglycemia as those without HFI.

Conclusions: HFI is associated with higher HbA_1c levels and increased odds of DKA in YYA with T1D.

Keywords: Food insecurity; Social determinants of health; Type 1 diabetes; Young adults; Youth.