TOPLINE:
Despite boosting engagement with preventive healthcare, an intensive food-as-medicine program did not improve glycemic control in patients with uncontrolled type 2 diabetes (T2D) and self-reported food insecurity any better than usual medical care.
METHODOLOGY:
- A randomized clinical trial tested if an intensive food-as-medicine program improved glycemic control and affected healthcare use in patients with diabetes and food insecurity.
- The trial included 500 patients (81% White, 55% women, mean age, 55 years) with T2D, glycated hemoglobin (A1c) levels of ≥ 8%, food insecurity, and residence within the service area of the participating clinics.
- Patients were randomly assigned to either participate in the food-as-medicine program immediately (treatment group) or after 6 months (control group receiving usual care).
- The food-as-medicine program provided healthy groceries for 10 meals/week for the entire household, along with dietitian consultations, nurse evaluations, health coaching, and diabetes education.
- The primary outcome was participants' A1c levels at 6 months, and secondary outcomes included healthcare use, self-reported diet, and healthy behaviors at both 6 months and 12 months.
TAKEAWAY:
- After 6 months, both the treatment and control groups reported a substantial decline in A1c levels (1.5 and 1.3 percentage points, respectively), with a nonsignificant adjusted mean difference of −0.10 (P = .57).
- Patients in the treatment group, as opposed to the control group, showed higher engagement with preventive healthcare at 6 months, making more visits to the program clinic (13.00 vs 0.72) and dietitians (2.7 vs 0.6).
- The number of outpatient visits, reflecting healthcare usage, was also significantly higher in the treatment vs control group at 6 months (P = .007).
- There was no detectable impact on total claims, with an insignificant reduction in inpatient or emergency department claims offset by an insignificant increase in outpatient claims.
IN PRACTICE:
"Programs targeted to individuals with elevated biomarkers require a control group to demonstrate effectiveness to account for improvements that occur without the intervention. Additional research is needed to design food-as-medicine programs that improve health," the authors wrote.
SOURCE:
This study, with first author Joseph Doyle, PhD, from MIT Sloan School of Management, Cambridge, was published online on December 26, 2023, in JAMA Internal Medicine.
LIMITATIONS:
This study was carried out amid the COVID-19 pandemic, and outcomes might have been different during the nonpandemic period. The research was conducted in a single, large-scale healthcare system in Pennsylvania, where the control group's usual care may have been very beneficial.
DISCLOSURES:
This study was funded by the Robert Wood Johnson Foundation, the Abdul Latif Jameel Poverty Action Lab, and the Massachusetts Institute of Technology Sloan Health Systems Initiative. Coauthor John Cawley declared receiving personal fees from Novo Nordisk, Inc., outside the submitted work.