Intensive food-as-medicine program improves engagement, not glycemic control
Patients with diabetes and food insecurity who received healthy groceries, dietitian consults, nurse evaluations, health coaching, and diabetes education had increased engagement with preventive care but no significant change in HbA1c levels versus usual care.
An intensive food-as-medicine program increased engagement with preventive care in patients with type 2 diabetes and food insecurity but did not appear to improve glycemic control versus usual care, a recent trial found.
Researchers performed a stratified randomized clinical trial at one rural and one urban site at a large health system in the mid-Atlantic U.S. to evaluate whether an intensive food-as-medicine program improved glycemic control and affected health care use. From April 19, 2019, to Sept. 16, 2022, patients were randomly assigned to participate in the program immediately (treatment group) or six months later (control group). Patients were eligible if they had a type 2 diabetes diagnosis, an HbA1c level of 8% or higher, and food insecurity; lived in the service area of the participating clinics; and were affiliated with the health care system.
The program provided healthy groceries and recipes for 10 meals per week for each patient's household, in addition to dietitian consults, nurse evaluations, health coaching, and diabetes education. Program duration was usually one year. HbA1c level at six months was the primary outcome, with secondary outcomes including health care use and self-reported diet and healthy behaviors at six and 12 months. The results were published Dec. 26, 2023, by JAMA Internal Medicine.
Four hundred sixty-five patients completed the study, and of these, 349 (170 in the treatment group and 179 in the control group) had laboratory test results available six months after enrollment. HbA1c levels decreased substantially in both groups at six months (1.5 percentage points in the treatment group and 1.3 percentage points in the control group), with a between-group adjusted mean difference of 0.10 percentage point (95% CI, −0.46 to 0.25 percentage point; P=0.57). Patients in the treatment group had more dietitian visits (mean [SD], 2.7 [1.8] vs. 0.6 [1.3] visits), active prescription drug orders for metformin (58.26% vs. 50.64%) and glucagon-like peptide-1 receptor agonists (49.56% vs. 35.32%), and self-reported improved diet compared with one year earlier (153 of 164 patients [93.3%] vs. 132 of 171 patients [77.2%]).
The authors noted that their study was conducted during the COVID-19 pandemic at one large health system and that patients in the control group may have changed their behaviors at enrollment due to eventual participation in the program, among other limitations. They concluded that the intensive food-as-medicine program evaluated in this randomized clinical trial increased engagement with preventive health care but did not improve glycemic control versus usual care.
“Food-as-medicine programs differ in their design, and 1 explanation for the lack of health improvement in glycemic control is that providing healthy ingredients still may leave participants with the obstacle of preparing the meal. The primary alternative approach may be to deliver complete, medically tailored meals,” the authors wrote. “Future research that tests how such program parameters are related to health improvements may inform the optimal design of food-as-medicine programs.”