Food Insecurity and Diabetes: Evidence of Psychosocial Consequences During the COVID-19 Pandemic in the United States

OBJECTIVES: To analyze the associations between food insecurity (FI) and diabetes distress (DD) related to COVID-19 in adults with pre-diabetes/diabetes in the United States (US). METHODS: We fielded a national, web-based survey among low-income adults in the US (N = 1,756). Measures included FI status, using the 18-item USDA Household Food Security Module, and DD, using the 17-item Diabetes Distress Scale. Multinomial logistic regression models examined the relationship between FI and DD among adults with pre-diabetes, type-1, or type-2 diabetes (n = 317). RESULTS: Overall, 58.4% of participants reported little/no distress, 15.7% reported moderate distress and 25.9% reported high distress. Adults with FI had a higher prevalence of high DD (43.3% vs. 13.5%) and moderate DD (23.3% vs. 11.9%) compared to individuals with food security (p < 0.001). Compared to individuals with food security, individuals experiencing FI had clinical levels of distress (moderate or high) for the emotional burden subscale (70.4% vs. 27.7%), regimen-related subscale (71.4% vs. 34.7%), interpersonal subscale (23.6% vs. 58.64% vs. 23.6%) and physician-related subscale (57.4% vs. 17.1%). CONCLUSIONS: During the COVID-19 pandemic, FI was associated with higher DD among individuals with pre-diabetes/diabetes in the US. Healthcare providers should screen for DD and connect patients to resources to help manage their food and mental health needs. FUNDING SOURCES: This research was supported by a grant from Poverty Solutions at the University of Michigan. In addition, JAW was supported by the National Institutes of Diabetes and Digestive And Kidney Diseases of the National Institutes of Health (Award #K01DK119166) and CWL was supported by the Eunice Kennedy Shriver National Institute for Child Health and Human Development (Award #4R00HD084758). HP was funded as a Sight and Life Scholar by the Sight and Life Global Nutrition Research Institute.