One quarter of people with diabetes in the United States suffer from food insecurity, an inability to or limitation in accessing nutritionally adequate food, and African Americans overall are three times more likely than whites to be food insecure.

In many cases, this poor access to nutrition among Type 2 diabetics leads to worse control over their chronic illness and more difficulty following a healthy diet compared to non-food insecure diabetics.

Two new studies led by scientists at the Medical College of Wisconsin (MCW) will focus specifically on food insecurity among African Americans with Type 2 diabetes in central-city Milwaukee.

While diabetes affects nearly 10 percent of the U.S. population, African Americans suffer at a higher rate – nearly 60 percent – than white Americans. African Americans are also three times more likely to be food insecure and four times more likely to experience complications of diabetes, such as amputations and end-stage renal disease.

With a more than $3.2 million, five-year grant from the National Institutes of Health Institute on Minority Health and Disparities, Leonard Egede, MD, MS, professor of medicine and chief of the Division of General Internal Medicine, and Rebekah Walker, PhD, assistant professor of medicine at MCW, will test the separate and combined efficacy of monthly food vouchers for farmer’s markets and monthly mailed food stock boxes layered upon diabetes education for low income, food insecure African Americans with Type 2 diabetes.

“Our plan is to conduct focus groups with community members and food pantries to identify barriers and facilitators to diabetes care and food supplementation,” Dr. Walker said. “Given lifestyle modification is a cornerstone of diabetes management, we expect to see that including this information with food supplementation will likely improve glycemic control in particularly vulnerable populations.

Dr. Walker will also lead a second study to refine and test an intervention to improve glycemic control, dietary intake, self-care and quality of life in food insecure African Americans with Type 2 diabetes. The intervention will involve weekly culturally relevant food supplementation boxes mailed to the participants and culturally tailored telephone-delivered diabetes education and skills training. This study is funded by a four-year, nearly $600,000 grant from the American Diabetes Association.

Several other studies have tested strategies to address food insecurity through food supplementation, including vouchers to cover the cost of food, coupons for farmer’s markets and pre-packaged food shipments to participants’ homes. However, results of these studies are still unclear in terms of if food supplementation alone is effective in individuals with diabetes.

“Another aspect still unclear is how best to understand and address the unique barriers faced by African Americans, who are often more likely to face the compounded impact of low socioeconomic status, food insecurity and diagnosis of diabetes,” Dr. Egede said. “These upcoming studies will seek to fill in the gaps in the research as well as study the cost effectiveness of these strategies.”