Food Insecurity and Glycaemic Control: The Clinic Visit That Cannot Fix the Kitchen
DOI:
https://doi.org/10.5281/zenodo.22238762Keywords:
Food insecurity, Social determinants, Glycaemic control, Food is medicine, Health system screeningAbstract
Food insecurity is consistently associated with worse glycaemic control, and the association survives adjustment. In a safety-net
population where 46 per cent of patients were food insecure, 42 per cent of those patients had an HbA1c of 8.5 per cent or above
against 33 per cent of food-secure patients, an adjusted odds ratio of 1.48. In a longitudinal cohort followed for a mean of 37
months, food insecurity was associated with an HbA1c 0.6 percentage points higher, and the gap did not narrow over time. The
more instructive finding is what was not associated. In the same cohort, living in an area of low physical food access made no
significant difference, and in a separate health system of 5,500 patients, area-level food insecurity alone did not predict control
while self-reported unmet food need did. Intervention evidence is weaker than the observational literature: results come largely
from before-and-after studies with substantial attrition, and a randomised evaluation found no effect on HbA1c except within a
self-selected fully engaged subgroup. This review sets out what is established, what is measured badly, and why the geographic
framing misleads.
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