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Screening for food insecurity among diabetes patients

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By screening for food security challenges among patients with diabetes and their families, health care workers can offer tailored recommendations around meal choices and community resources that can assist with diabetes management.

Ryerson University nutrition professor Enza Gucciardi and her team have developed a tool that can assist with such screenings. Professor Gucciardi says diabetes is becoming more prevalent, and her research has revealed higher rates of food insecurity among people with diabetes than people who do not have diabetes.

Common recommendations to help treat diabetes include healthy eating and active lifestyles, which can be expensive – especially with the current trend of increasing food prices. Statistics Canada’s Consumer Price Index recently showed that the price of fresh vegetables was 16.7 per cent higher in spring 2019 compared to the same time in 2018, while fresh meat increased 2.9 per cent.

“We’re guessing that food security is going to be more of a problem, but because it’s such a cornerstone for diabetes management, we also thought it was important to start screening,” said professor Gucciardi.

The screening starts with a conversation between a health care worker and the patient or their family in terms of food security. If a worker can determine that there are challenges in the household around having enough healthy food, they can tailor recommendations around diet and medication to stay within the patient’s budget. They can also help connect families with community resources that may be able to help.

Professor Gucciardi’s team developed a simple, three-question screening tool along with a guide for health care providers to use. They’ve tested the tool in settings like hospitals and community health centres, such as SickKids and South Riverdale Community Health Centre, and with different age groups such as adults versus children with diabetes and their families.

One study explored the feasibility of introducing food insecurity assessments by interviewing dieticians and families of children with diabetes. The results, published in the journal Diabetes Spectrum, suggested that a standardized and respectful screening method could assist dietitians in tailoring treatment and support plans for food-insecure families.

Along with the three-question screening tool, professor Gucciardi has helped collate emerging strategies for care providers to better support these patients. This work was recently published in the journal PLOS ONE. In another study, published in the Canadian Journal of Diabetes, she found that adult patients were willing to share their experiences of food insecurity and that this information was helpful for care providers.

“A lot of times it’s not comfortable to disclose that you are food insecure,” she said. “But often people feel relieved that someone cares, that someone’s talking to them about this.”

Professor Gucciardi says it’s important that health care providers are aware that the prevalence of food insecurity is higher in diabetic populations, and that if there are red flags such as someone not taking their medications or with high blood sugar, the provider should ask questions rather than make assumptions. “What are the circumstances that are preventing them from achieving their management goals?” she asked.

The screening toolkit is available on professor Gucciardi’s website for anyone to use (opens in new window) .

Funding and support for this research has been provided by the Lawson Foundation, Ryerson University grants and the Banting and Best Diabetes Centre.