JMIR Publications

ABSTRACT

Background:

People with low-income are disproportionately affected by type 2 diabetes (T2D) and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low carbohydrate eating for people with T2D, though food-as-medicine interventions paired with nutrition education offer a promising solution.

Objective:

This pilot program aims to support the initiation of dietary changes by using grocery delivery and low carbohydrate education to increase the quality of low carbohydrate nutrition among people with T2D and food insecurity.

Methods:

The program was implemented in primary care practices associated with the Michigan Collaborative for Type 2 Diabetes (MCT2D). We planned to enroll 150 adults with T2D and food insecurity. All participants received the three-month program, which included a Healthy Choice Allowance ($80 per month), free grocery delivery from SHIPT.com, and low carbohydrate lifestyle nutrition education. We plan to perform a mixed methods quality improvement (QI) program evaluation. The primary QI measures will be the number of patients referred and enrolled, rate of utilization of the Healthy Choice Allowance, and analysis of low carbohydrate food purchase and ordering behavior. We will also conduct qualitative interviews of participants and clinic staff regarding their experience in the pilot program. Secondary QI measures will include changes in Hemoglobin A1C, weight, medication utilization, activity, and diabetes and carbohydrate knowledge.

Results:

This program started in October 2022. Data collection is expected to be concluded in June 2024. As of September 2023, a total of 151 patients were referred to the program and 83 participants were enrolled. The average age was 57 years-old (range from 18-86), 72% were female, 89% White race and 94% non-Hispanic ethnicity.

Conclusions:

The findings will inform future large-scale implementation of food-as-medicine and paired grocery delivery and education policies and practices among insurers, health systems, and state and federal government stakeholders.