In this sample of Iranian adults with type 2 diabetes, 37% of patients were food-insecure. The majority of patients with well-controlled diabetes were food-secure and the majority of patients with poor glycemic control had some degrees of food insecurity. On the other hand, there was a significant association between food insecurity and glycemic control. As food insecurity increased, the likelihood of poor glycemic control increased. This association with sever insecurity remained significant after adjustment for confounding factors. In this study, although food security was not significantly associated with overall self-care scores, “following a healthy diet” and “doing regular physical activity” behaviors were significantly higher in the food secure group than in the food insecure group. There was also a significant inverse association between self-care and HbA1c, as well as a positive association between food insecurity and HbA1c.
Findings on the prevalence of food insecurity in diabetic patients referred to Eghlid health center showed that 37% of households had food insecurity. In a cross-sectional study in Shiraz on 135 newly diagnosed diabetic patients, the prevalence of food insecurity was 66.7% (32). In a study in Canada, the relationship between food insecurity and diabetes was examined and the results showed that food insecurity was more prevalent among diabetics than non-diabetics (9.3% vs. 6.8%) (39). A study by Mohammad Aria et al. showed that the prevalence of food insecurity was 85.3% in diabetics and 67.1% in non-diabetics (31). It seems that the reason for the difference in the prevalence of food insecurity in different studies is due to differences in the population in terms of geographical, socio-economic and cultural conditions as well as food habits.
With increasing food insecurity, the probability of poor glycemic control increased. Other studies in this field have also reported a significant association between food insecurity and decreased glycemic control (40–43). Adults with food insecurity provide most of their diet through high-calorie and low-nutrient foods, which diabetic patients are recommended to avoid, such as refined carbohydrates, added sugar and fat. These foods are cheaper than balanced calorie foods such as fruits, vegetables, and dairy products (44, 45). People with food insecurity are at risk of diets with less variety, lower quality, lack of micronutrients, and low intake of fruits and vegetables, which can lead to poor glycemic control in diabetics.
In self-care scales, following a healthy diet and doing regular exercise was significantly higher among food secure group than food insecure group, but the overall self-care score was not significantly different between the groups. In some studies, there was no association between food insecurity and diabetes self-care (29, 46). While in some other studies, there was a significant relationship between food insecurity and lack of self-care behaviors (22, 27, 47).
In the present study, self-care was inversely related to HbA1c and food insecurity was directly associated with HbA1c. Similar results were found in some other studies (48). Improving self-care behaviors is the first step in helping patients better control their disease. It also emphasizes the design and strengthening of interventions related to self-care behaviors and helps caregivers to better control the patient and reduces the associated complications.
One of the weaknesses of this study is the cross-sectional design of the present study, so we will not be able to interpret the results of this study in the form of a causal relationship. The use of self-administered questionnaires is another weakness of this study, and therefore the actual behaviors of patients may not be reported. In this study, we could control for important confounders. Also, using the USDA food security questionnaire, which is one of the best options for measuring household food security, is another strength of this study.