Table 2.

A summary of published studies on food insecurity and self-report or clinical marker of diabetes management¹

Study2	Self-report or clinical marker	Study sample and setting	Measurement and level of food insecurity	Results
Nelson et al., 1998 (47)	Prevalence and risk factors of food insecurity in a patient population	Clinic population	Questions from Kendall et al. (55) and Hamilton et al. (56)	103 (61%) of 170 diabetic patients reported hypoglycemic reactions, 32 (31%) reported inability to afford food
		n = 709, 170 were receiving insulin
Nelson et al., 2001 (48)	Doctor encounters	NHANES III	1-item food Insufficiency	6% of adults with diabetes reported food insufficiency. Diabetic patients who were food insufficient reported more doctors encounters.
		n = 1503
Maddigan et al., 2006 (54)	Health-related quality of life among diabetic patients (4.1% of population)	Canadian Community Health Survey Cycle 1.1 (2000–2001)	3 questions about financial access to a sufficient quantity and quality of food—any food insecurity	15.5% experience some food insecurity. Food insecurity was negatively associated with quality of life among adults with diabetes [β = −0.07 (95% CI: 20.10, 20.04)]
		n = 4678
Gucciardi et al., 2009 (45)	Diabetes management	Canada Community Health Survey Cycle 3.1 (2005)	18-item HFI	9.3% were food insecure. No association with diabetes management. Food insecurity was associated with lower fruit and vegetable intakes, smoking, unmet health care needs, overnight patient, mood disorder, stroke, lower life satisfaction, poor self-rated health, poor mental health, higher stress
	Management services	n = 6237
	Self-care practices	Ontarians
	Health status	n = 2523
Seligman et al., 2010 (49)	Hypoglycemia	Clinic patients diagnosed with hypertension and diabetes in 2 urban settings	6-item HFSSM	45% were food insecure. Food insecure patients had lower self-efficacy scores, poor adherence to blood glucose monitoring, more emergency department visits for hypoglycemia, had higher HbA1c values.
	Self-report lifetime experience with hypoglycemia	n = 40 adults	2 levels: secure/insecure
Seligman et al., 2011 (50)	Hypoglycemia	Patients from 2 urban community health clinics	6-item HFSSM	46% were food insecure. Food insecure more likely (12.6% vs. 6.7%) to have 4+ hypoglycemia episodes (AOR = 2.0, 95% CI: 1.48–5.91)
	Validated self-report	n = 782 adults	2 levels: secure/insecure
	4+ severe episodes
Marjerrison et al., 2011 (53)	Glycemic control	Families with a child receiving insulin for diabetes in Nova Scotia	18-item HFSSM	21.9% food insecure.
	Hospitalization rates	n = 183 families	2 levels: secure/insecure	Children from food insecure families had higher HbA1c (9.5% vs. 9.0%) and hospitalization rates (30% vs. 10.5%) compared with children from food-secure families. In adjusted models, food insecurity was not associated with ≥9.0% HbA1c, but was associated with being hospitalized the previous year (OR = 3.66; 95% CI: 1.54–8.66)
	Mean and ≥9.0% HbA1c
Bawadi et al., 2012 (52)	Glycemic control	Clinic patients from major hospital	6-item HFSSM	51% were moderately secure and 27% food insecure.
	Mean HbA1c value	n = 843 adults	3 levels: secure/moderately secure/food insecure	BMI was greater among food-insecure patients compared with food secure (34.9 vs. 32.6, respectively). Both moderate and severe food insecurity were associated with a significantly higher mean HbA1c.
Seligman et al., 2012 (51)	Glycemic control	Immigration, Culture and Health Care (ICHC) study in Chicago, IL, and San Francisco, CA	6-item HFSSM	46% were food insecure.
	≥8.5% HbA1c	n = 711	2 levels: secure/insecure	Food-insecure diabetic patients more likely (42% vs. 33%) to have poor glycemic control (HbA1c >8.5%), difficulty with diet (64% vs. 49%), lower self-efficacy, and higher emotional distress
	Follow diabetic diet
	Self-efficacy
	Emotional distress

¹HbA1c, glycosylated hemoglobin; HFI, household food insecurity; HFSSM, household food security survey module.

²Studies are arranged by publication date.