Accepted for/Published in: JMIR Formative Research
Date Submitted: Dec 12, 2025
Date Accepted: Aug 24, 2026
HbA1c and weight improvements with grocery delivery and low-carbohydrate education in adults with type 2 diabetes and food insecurity: Observational quality improvement cohort study
ABSTRACT
Background:
Type 2 diabetes mellitus (T2D) is one of the most significant chronic health challenges in Michigan, especially for individuals with food insecurity. Improving nutrition, including lowering carbohydrate intake, is foundational to T2D prevention and management. Grocery delivery paired with low-carbohydrate education has potential to reduce logistical barriers to dietary change but is not well understood in individuals with food insecurity.
Objective:
The objective of our study was to evaluate the impact of a paired grocery delivery and low-carbohydrate education on clinical metrics of HbA1c, weight, and diabetes medication use.
Methods:
The Healthy Eating Jumpstart enrolled adult Michiganders with T2D and low income or food insecurity in a 3-month, nonrandomized grocery delivery and low-carbohydrate education program. Clinical metrics of HbA1c, weight, and diabetes medication use were collected from medical records and evaluated for change from baseline at 3, 6, 9, and 12 months with stratification by baseline glycemic control and medication use. Statistical significance was assessed with signed-rank tests using the latest values for HbA1c and weight for each individual.
Results:
A total of 83 patients participated in Jumpstart. Participants primarily identified as female (72%), white (87%), and having a high school degree or less (45%). At baseline, the average HbA1c was 7.6% ± 2%, average weight was 105kg ± 25.8kg, and average BMI was 38.2±8.8. Overall reduction in HbA1c from baseline was 0.4%±1.4 (P=.02, n=68). Overall percent reduction in weight from baseline was 1.7%±4.4% (P=.005, n=66).
Conclusions:
The results from this clinical evaluation of the Jumpstart quality improvement program suggest that a combination food-is-medicine program can have sustained clinical impact on patient HbA1c and weight loss. Use of a low-burden program like Jumpstart may support long-term dietary change in patients with T2D with limited nutritional knowledge and access to food.
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