Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2018 Nov 14

PMID 30421335

Citations 68

Authors

Seth A Berkowitz

Linda M Delahanty

Jean Terranova

Barbara Steiner

Melanie P Ruazol

Roshni Singh

Naysha N Shahid

Deborah J Wexler

Affiliations

Soon will be listed here.

Abstract

Background: Food insecurity, defined as inconsistent food access owing to cost, leads to poor health.

Objective: To test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.

Design: Randomized cross-over clinical trial.

Participants: Forty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign").

Intervention: In the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.

Main Measures: The primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.

Key Results: Mean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).

Conclusions: For food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).

Citing Articles

Food Insecurity and Clinical Outcomes in Surgical Trauma Patients.

Ehsan A, Jones A, Saha S, Hathi P, Huang C, Vengadassalapathy S JAMA Surg. 2025; .

PMID: 40042856 PMC: 11883571. DOI: 10.1001/jamasurg.2025.0045.

Associations Between Suboptimal Social Determinants of Health and Diabetes Distress in Low-Income Patients on Medicaid.

Williams E, Juarez L, Presley C, Agne A, Cherrington A, Howell C J Gen Intern Med. 2025; .

PMID: 40029547 DOI: 10.1007/s11606-025-09367-z.

Acceptability of a community health worker-led health literacy intervention on lifestyle modification among hypertensive and diabetes patients in the City of Harare, Zimbabwe.

Katena N, Shamu S, Fana G, Dewa E, Dombojena A, Rusakaniko S PLOS Glob Public Health. 2025; 5(2):e0003541.

PMID: 39928654 PMC: 11809805. DOI: 10.1371/journal.pgph.0003541.

Gaining stakeholder perspectives to shape a produce prescription program to improve maternal and birth outcomes: a qualitative study.

Vilme H, Zhang F, OTierney-Ginn P, Sun C, Anyanwu O, Fahmi R Front Public Health. 2025; 12:1462908.

PMID: 39882113 PMC: 11774915. DOI: 10.3389/fpubh.2024.1462908.

Association of Hospital-Based Social Needs Interventions with Potentially Preventable Admissions.

Knox M, Brewster A, Ahern J, Shortell S, Hague E, Rodriguez H J Gen Intern Med. 2025; .

PMID: 39825177 DOI: 10.1007/s11606-024-09203-w.

References

Seligman H, Jacobs E, Lopez A, Sarkar U, Tschann J, Fernandez A . Food insecurity and hypoglycemia among safety net patients with diabetes. Arch Intern Med. 2011; 171(13):1204-6. PMC: 4230711. DOI: 10.1001/archinternmed.2011.287. View

Berkowitz S, Terranova J, Hill C, Ajayi T, Linsky T, Tishler L . Meal Delivery Programs Reduce The Use Of Costly Health Care In Dually Eligible Medicare And Medicaid Beneficiaries. Health Aff (Millwood). 2018; 37(4):535-542. PMC: 6324546. DOI: 10.1377/hlthaff.2017.0999. View

Schwingshackl L, Bogensberger B, Hoffmann G . Diet Quality as Assessed by the Healthy Eating Index, Alternate Healthy Eating Index, Dietary Approaches to Stop Hypertension Score, and Health Outcomes: An Updated Systematic Review and Meta-Analysis of Cohort Studies. J Acad Nutr Diet. 2017; 118(1):74-100.e11. DOI: 10.1016/j.jand.2017.08.024. View

Patel Y, Gadiraju T, Gaziano J, Djousse L . Adherence to healthy lifestyle factors and risk of death in men with diabetes mellitus: The Physicians' Health Study. Clin Nutr. 2016; 37(1):139-143. PMC: 5513764. DOI: 10.1016/j.clnu.2016.11.003. View

Spong C, Bianchi D . Improving Public Health Requires Inclusion of Underrepresented Populations in Research. JAMA. 2017; 319(4):337-338. PMC: 10082651. DOI: 10.1001/jama.2017.19138. View

. 1. Improving Care and Promoting Health in Populations: . Diabetes Care. 2017; 41(Suppl 1):S7-S12. DOI: 10.2337/dc18-S001. View

Seligman H, Lyles C, Marshall M, Prendergast K, Smith M, Headings A . A Pilot Food Bank Intervention Featuring Diabetes-Appropriate Food Improved Glycemic Control Among Clients In Three States. Health Aff (Millwood). 2015; 34(11):1956-63. DOI: 10.1377/hlthaff.2015.0641. View

Wang D, Leung C, Li Y, Ding E, Chiuve S, Hu F . Trends in dietary quality among adults in the United States, 1999 through 2010. JAMA Intern Med. 2014; 174(10):1587-95. PMC: 5924699. DOI: 10.1001/jamainternmed.2014.3422. View

Basu S, Berkowitz S, Seligman H . The Monthly Cycle of Hypoglycemia: An Observational Claims-based Study of Emergency Room Visits, Hospital Admissions, and Costs in a Commercially Insured Population. Med Care. 2017; 55(7):639-645. PMC: 5695234. DOI: 10.1097/MLR.0000000000000728. View

10.

Coppell K, Kataoka M, Williams S, Chisholm A, Vorgers S, Mann J . Nutritional intervention in patients with type 2 diabetes who are hyperglycaemic despite optimised drug treatment--Lifestyle Over and Above Drugs in Diabetes (LOADD) study: randomised controlled trial. BMJ. 2010; 341:c3337. PMC: 2907481. DOI: 10.1136/bmj.c3337. View

11.

Monsivais P, Aggarwal A, Drewnowski A . Time spent on home food preparation and indicators of healthy eating. Am J Prev Med. 2014; 47(6):796-802. PMC: 4254327. DOI: 10.1016/j.amepre.2014.07.033. View

12.

Berkowitz S, Seligman H, Rigdon J, Meigs J, Basu S . Supplemental Nutrition Assistance Program (SNAP) Participation and Health Care Expenditures Among Low-Income Adults. JAMA Intern Med. 2017; 177(11):1642-1649. PMC: 5710268. DOI: 10.1001/jamainternmed.2017.4841. View

13.

Willink A, Dugoff E . Integrating Medical and Nonmedical Services - The Promise and Pitfalls of the CHRONIC Care Act. N Engl J Med. 2018; 378(23):2153-2155. DOI: 10.1056/NEJMp1803292. View

14.

Szanton S, Samuel L, Cahill R, Zielinskie G, Wolff J, Thorpe Jr R . Food assistance is associated with decreased nursing home admissions for Maryland's dually eligible older adults. BMC Geriatr. 2017; 17(1):162. PMC: 5525341. DOI: 10.1186/s12877-017-0553-x. View

15.

Palar K, Napoles T, Hufstedler L, Seligman H, Hecht F, Madsen K . Comprehensive and Medically Appropriate Food Support Is Associated with Improved HIV and Diabetes Health. J Urban Health. 2017; 94(1):87-99. PMC: 5359179. DOI: 10.1007/s11524-016-0129-7. View

16.

Berkowitz S, Baggett T, Wexler D, Huskey K, Wee C . Food insecurity and metabolic control among U.S. adults with diabetes. Diabetes Care. 2013; 36(10):3093-9. PMC: 3781549. DOI: 10.2337/dc13-0570. View

17.

Wing R . Long-term effects of a lifestyle intervention on weight and cardiovascular risk factors in individuals with type 2 diabetes mellitus: four-year results of the Look AHEAD trial. Arch Intern Med. 2010; 170(17):1566-75. PMC: 3084497. DOI: 10.1001/archinternmed.2010.334. View

18.

Alley D, Asomugha C, Conway P, Sanghavi D . Accountable Health Communities--Addressing Social Needs through Medicare and Medicaid. N Engl J Med. 2016; 374(1):8-11. DOI: 10.1056/NEJMp1512532. View

19.

Silverman J, Krieger J, Kiefer M, Hebert P, Robinson J, Nelson K . The Relationship Between Food Insecurity and Depression, Diabetes Distress and Medication Adherence Among Low-Income Patients with Poorly-Controlled Diabetes. J Gen Intern Med. 2015; 30(10):1476-80. PMC: 4579205. DOI: 10.1007/s11606-015-3351-1. View

20.

Hager E, Quigg A, Black M, Coleman S, Heeren T, Rose-Jacobs R . Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics. 2010; 126(1):e26-32. DOI: 10.1542/peds.2009-3146. View