JMIR Publications

ABSTRACT

Background:

Food insecurity (FI) is a risk factor for type 2 diabetes (T2D) that disproportionately affects Latinas.

Objective:

We propose that FI cycles over the course of a month according to disbursement of food assistance benefits and seek to understand whether this cycling is related to diabetes risk.

Methods:

Participants were adult Latinas living in Hartford CT, a small state capital city in northeastern, USA. They were recruited through a community agency in Hartford, CT and were invited to participate if they were receiving Supplementary Nutrition Assistance Program (SNAP) benefits, screened positive for FI, and had elevated risk factors for T2D. Using a micro-longitudinal design, we collected data twice per month for 3 months (week two which is a period of food budget adequacy and week four which is a period of food budget inadequacy). We will determine if the monthly cycling of FI is associated with near-term diabetes risk (fasting glucose, fructosamine, glycosylated albumin) and long-term risk (body mass index, waist circumference, and HbA1c). We will determine whether household food inventory, psychological distress, and binge eating mediate associations. To assess the relationship between monthly cycling of FI with diabetes risk markers, we will use repeated measures general linear mixed models (GLMMs). To assess the role of mediators, we will perform a causal pathway analysis. Participant enrollment was from April 1, 2021, to February 21, 2023. Quantitative methods and baseline demographic data for the sample are reported here.

Results:

Of the 845 participants screened, 685 were not eligible. The most common exclusions being because they did not receive SNAP benefits (n=229), were outside of the age range (n=155), had extant diabetes (n=90), or did not have elevated risk for type 2 diabetes (n=83). Of the n=160 that were eligible, n=73 declined with the most common reason for declining was lack of time, lack of transportation, and concerns about COVID; n=87 enrolled in the study. As can be seen in Table 1, just over half (54.0%) of the sampled self-identified as Puerto Rican, mean age was 35.1 ± 5.8 years, with 17.1 ± 11.6 years in the mainland U.S. Just under half (47.1%) spoke Spanish only, 69.0% had no formal schooling and 31.0% had <8th grade education. Modal household size was 4 including 2 children, and 44.5% were not living with a partner. About half (54.0%) were unemployed, 63.2% reported a monthly income <$1,000 and 63.2% used food pantries.

Conclusions:

This study will demonstrate how FI cycles over the course of the month, as well as whether and to what degree the cycling itself is related to risk for T2D. Further, the study will provide evidence for some putative mechanisms of this association that can serve as future intervention targets. Clinical Trial: Pilot study, R21. Not a registered trial.