>> Michelle: Welcome to today's NDEP webinar,
Food Insecurity and Its Impact
on Diabetes Management: Identifying
Interventions that Make a Difference.
My name is Michelle Owens-Gary and I'm a
Behaviorial Scientist at the Centers for Disease
Control and Prevention Division of
Diabetes Translation in Atlanta.
Today I’m honored to present a fantastic
panel of experts.
Our first presenter is Dr. Victoria Mayer,
who is an assistant professor in the
Department of Population Health Science
and Policy and in the Department of Medicine
at the Icahn School of Medicine at Mt. Sinai.
Dr. Mayer will be followed by
Dr. Monideepa Becerra.
Dr. Becerra is an assistant professor in
the Department of Health Science and Human Ecology
and coordinator of the Master of Public Health
program at California State University, San Bernardino.
And our third and final presenter is
Dr. Gary Ferguson who recently joined the
Rural Alaska Community Action Program as
its Chief Executive Officer.
>> Victoria: I’m going to start by sharing some
common definitions of food security,
food insecurity, and hunger.
The United States Department of Agriculture
defines food security as “access at all times
to enough food for an active and
and healthy life.” Food insecurity,
on the other hand, is the
“household-level economic and social condition of
limited ability to acquire adequate food.”
Another commonly used definition of food insecurity
is “whenever the availability of nutritionally adequate
and safe food or the ability to acquire
acceptable food in socially acceptable ways
is limited or uncertain.”
Food insecurity is different from hunger.
Hunger may result from food insecurity, but
it is “an individual-level physiological condition,”
which may be defined as “the sensation
caused by involuntary lack of food."
These items, or these quotations, are from
the ADA Standards of Medical Care for
Diabetes from 2017 in the section
“Tailoring Treatment to Reduce Disparities.”
The ADA states that “providers should assess
social context, including potential food insecurity,
housing stability, and financial barriers, and
apply that information to treatment decisions.”
“Patients should be referred to local community
resources when available.” "Providers should recognize
that food insecurity complicates diabetes management
and seek local resources that can help patients
and the parents of patients with diabetes
to more regularly obtain nutritious food,”
and that "providers should consider risk of
hypoglycemia in medication decisions."
>> Monideepa: So, a study was done recently looking
at a systematic review. So, this
is when they take all the studies published
in North America and try to find a
cumulative summary of what the
studies have shown.
And, they noticed the higher the rate of
food insecurity, the higher the rate of diabetes.
So, diabetes rate among those who were
food insecure in the United States was 10.2 percent.
But, when you compared to those who are
food secure, it was 7.4 percent.
And, it’s not just those who were food insecure.
The researchers then broke that down into
different levels of food insecure.
So, mild food insecurity or severe
food insecurity. When looking at the
diabetes rate among mild food insecurity, it
was 10 percent. When you look at
diabetes rate among severe food insecurity,
it went up to 16.1 percent.
So again, a much larger percent of
those who were food insecure, severely
food insecure, had type 2 diabetes rates.
There were several other studies, and I
will only mention a few of them,
have shown similar trends.
In the longitudinal study, again, this is
where the population is followed over time,
They’ve shown that, if a population is food insecure,
they’re 50 percent more likely to have
type 2 diabetes. The patients who
are food insecure are also—have a higher
rate of type 2 diabetes even after accounting
for everything else. For example,
lifestyle factors, smoking, drinking, physical
activity, income level, employment.
Even after accounting for all of that, if
you are food insecure, two to three times
more likely to have type 2 diabetes.
A similar trend was also shown with
food insecurity and gestational diabetes, and
we know gestational diabetes could potentially
lead to type 2 diabetes in the long term.
One of the major things that we also
noticed is looking at the healthcare burden of
food insecure individuals. This is not
just about what happens to the health outcome,
but also are they spending more money because
of worse health outcomes? National Health
Interview Survey, which is a large-scale
national study, it is not limited by
the issue we have with small data where
we cannot generalize to the population.
Because they use Census information to make
these data weighted to represent the entire
United States, we can draw larger conclusions
for the U.S. population. And, one of
the studies, they showed a dose-dependent
relationship, which means the higher the food
insecurity level, the less diabetics [people
with diabetes] were to use medication.
And, this was even higher among racial
ethnic minorities as well as those who
had more than one chronic disease.
A similar study using the same database
also found that one in six patients who
have diabetes were also food insecure.
And, if they were food insecure, they
were less likely to use medication, they
were reducing the medication, they were
delaying it or avoiding it
because it’s financially hard to afford medication.
A smaller study, however, found that diabetic
[people with diabetes] patients who
were going to food banks, kitchens, or
soup kitchens were actually one-third of them
were paying for medication versus food.
This slide really talks about in California
Health Interview Survey, which is the largest
state health survey looking at emergency department
utilization among diabetics [people with diabetes].
And, diabetics [people with diabetes] who were food secure,
they reported a rate of ED utilization at
about 7 percent. But, food-insecure
diabetics [people with diabetes] actually visited
the emergency department a lot higher,
nearly at 13 percent, showing a much higher
rate of healthcare utilization. This higher
rate of healthcare utilization means higher co-pay,
higher medical bill, which means we’re going
back to the same situation where patients are
having to choose between food versus healthcare-
what they need to maintain their health services.
And, our previous researcher already mentioned SNAP.
And, the research does in fact show that SNAP reduces
the burden of food insecurity. However, this
is not true for all populations. A study
in California, which has one of the largest Hispanic
populations, showed that Hispanics, even when eligible,
are less likely to participate in SNAP.
And, that is often because of lack of
knowledge, stigma, the healthcare costs, which
limits their ability to want to apply to SNAP,
as well as transportation. And, this is where
a promotora model or promotoras, which are community
health workers, can come in very handy.
It has been shown to be useful in
small scale and Mexico-Texas border, as well in
small parts of California, where community-based
resources that are promoted by community health
workers or promotoras can reach that population that
are stigmatized by participating in SNAP.
This has also shown some potential with
the veteran population but hasn’t been pilot-tested
in a large scale, where community health
workers can reach the veteran population
and marginalized population to make sure they’re
registering for SNAP or even if they’re
reducing the stigma and addressing transportation.
>> Gary: So, shifts in diet. When you look at
a changing diet from a more traditional
diet to a more Western diet, you see
trends, and we know that stress and that
was a big component. I just want to highlight
that it isn’t just always about the food.
It’s also about the stress. In the native
community, there’s a big push to understand
and help alleviate the trauma that’s connected with
historical trauma and helping people to address
inter-generational trauma, which is connected
also to chronic disease, including diabetes.
Now, I’d like to talk about decolonizing
healthcare, where we look at food and
and food as medicine. It’s a really important
concept for our traditional peoples, and it’s such
a rich way that we’re decolonizing our healthcare
and our food systems, and there’s a lot
that has been highlighted already.
I just want to draw our attention to
CDC’s work that has already been highlighted
around traditional foods across America. And, in
in our native communities, there’s some
amazing resources that have been highlighting
some of these best practices in local food
systems and traditional foods.
And one of them, The Store Outside Your Door,
which I’ve been a part of since 2006,
which is a— this is our YouTube channel,
where you can watch a very short video
on how to hunt, fish, gather, and
grow your own food. And we connect
to culture, language, and elders, and youth.
There’s a lot of components that we look at,
sharing this knowledge with our next generation
and preserving this knowledge. And, since then,
some of the elders we worked with have
already passed. So, we’re feeling very blessed
to have captured the wisdom that
that they share with us.
And also part of the CDC, Native Diabetes
Wellness Program, there is many programs
across the nation that have been highlighted
that you can go online and learn more about
about these programs to and [ones in] Alaska.