3.2.0.0 Food In­se­cu­ri­ty

FI is the unre­li­able avail­abil­i­ty of nu­tri­tious food and the in­abil­i­ty to con­sis­tent­ly ob­tain food with­out re­sort­ing to so­cially un­ac­cept­able prac­tices. Over 14% (or one of every seven peo­ple) of the U.S. pop­u­la­tion is food in­se­cure. The rate is high­er in some racial/‍eth­nic mi­nor­i­ty groups, in­clud­ing African Amer­i­can and Lati­no pop­u­la­tions, in low-‍in­come house­holds, and in homes head­ed by a sin­gle moth­er. The risk for type 2 di­a­betes is in­creased twofold in those with FI (64) and has been as­so­ci­at­ed with low ad­her­ence to tak­ing med­i­ca­tions ap­pro­pri­ately and rec­om­mend­ed self-‍care be­hav­iors, de­pres­sion, di­a­betes dis­tress, and worse glycemic con­trol when com­pared with in­di­vid­u­als who are food se­cure (71,72). Risk for FI can be as­sessed with a val­i­dat­ed two-‍item screen­ing tool (73) that in­cludes the state­ments: 1) “With­in the past 12 months we wor­ried whether our food would run out be­fore we got money to buy more” and 2) “With­in the past 12 months the food we bought just didn’t last and we didn’t have money to get more.” An affirma­tive re­sponse to ei­ther state­ment had a sen­si­tiv­i­ty of 97% and specificity of 83%.

Treat­ment Con­sid­er­a­tions

In those with di­a­betes and FI, the pri­or­i­ty is mit­i­gat­ing the in­creased risk for uncon­trolled hy­per­glycemia and se­vere hy­po­glycemia. Rea­sons for the in­creased risk of hy­per­glycemia in­clude the steady con­sump­tion of in­ex­pen­sive car­bo­hy­drate-‍rich pro­cessed foods, binge eat­ing, finan­cial con­straints to the filling of di­a­betes med­i­ca­tion pre­scrip­tions, and anxiety/de­pres­sion lead­ing to poor di­a­betes self-‍care be­hav­iors. Hy­po­glycemia can occur as a re­sult of inad­e­quate or er­rat­ic car­bo­hy­drate con­sump­tion fol­low­ing the ad­min­is­tra­tion of sul­fony­lureas or in­sulin. See Table 9.1 for drug-‍specific and pa­tient fac­tors, in­clud­ing cost and risk of hy­po­glycemia, for treat­ment op­tions for adults with FI and type 2 di­a­betes. Pro­viders should con­sid­er these fac­tors when mak­ing treat­ment de­ci­sions in peo­ple with FI and seek local re­sources that might help pa­tients with di­a­betes and their fam­i­ly mem­bers to more reg­u­lar­ly ob­tain nu­tri­tious food (74).