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TOPLINE:

Food insecurity more than quadrupled the risk for severe hypoglycemia among older patients with type 2 diabetes (T2D). Food insecurity rates among older adults more than tripled from 1999-2003 to 2015-2019. Both economic and physical food insecurity were associated with severe hypoglycemia, but only economic factors are captured in standard screening questionnaires.

METHODOLOGY:

• Survey-based cross-sectional study of 1164 adults with T2D aged ≥ 65 years treated with insulin or sulfonylureas.
• Economic food insecurity was defined by affirmative responses to "In the past 12 months, how often did the food you bought just not last and you didn't have money to get more?"
• Physical food insecurity was assessed with "In the past 12 months, how often did you not have enough food to eat because of difficulty cooking or shopping for food?"
• Severe hypoglycemia was defined as "In the past 12 months, have you had low blood sugar that resulted in passing out or needing help from someone else?"

TAKEAWAY:

• Food insecurity was reported by 12.3% of respondents.
• Among those with food insecurity, 38.4% reported only economic food insecurity, 21.1% reported only physical food insecurity, and 40.5% reported both types.
• Severe hypoglycemia event in the past year was reported by 5.4%, most often (78%) due to "skipped a meal, did not eat enough, or waited too long to eat."
• Food insecurity of any type was strongly linked to severe hypoglycemia (risk ratio [RR], 4.1; P = .002) after adjustment for age, frailty, A1c, Charlson comorbidity score, and financial strain.
• Economic food insecurity and physical food insecurity were each independently strongly associated with severe hypoglycemia (RR, 4.3; P = .02 and RR, 4.4; P = .002, respectively).
• The relationship was even stronger for those with both types of food insecurity (RR, 5.4; P = .009).

IN PRACTICE:

"Although clinicians may not be able to directly improve food security for their patients, clinicians can use information about food insecurity to tailor an insulin regimen that is safer for the patient…or they can target food insecurity through a referral to social services or to other community programs."

"Understanding the causes of food insecurity should help inform the choice of intervention (eg, referral to food pantry for economic food insecurity vs home health aide for physical food insecurity)."

SOURCE:

This study, conducted by Andrew J. Karter, PhD, of Kaiser Permanente Northern California Division of Research, Pleasanton, California, and colleagues, was published on May 20, 2024, in the Journal of General Internal Medicine.

LIMITATIONS:

Observational, cross-sectional study design can't prove causation. Possible residual confounding.

DISCLOSURES:

This study was supported by funding from grants from the National Institute of Aging and National Institute of Diabetes and Digestive and Kidney Diseases.