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Arnold School of Public Health

Angela Liese awarded $3.3 million NIH grant to research the impact of disparities in food security for youth and young adults with diabetes

June 20, 2018 | Erin Bluvas,

Angela Liese, professor of epidemiology and biostatistics, will serve as the principal investigator on a more than $3.3 million, five-year grant from the National Institute of Diabetes and Digestive and Kidney Diseases, together with her long-term collaborator, Jason Mendoza of Seattle Children’s’ Research Institute. With a team* of 15 collaborators from eight different institutions, the project will examine the impact of disparities in food security on glycemic control and healthcare utilization among youth and young adults with diabetes in three areas of the United States, including South Carolina, Seattle, Washington and surrounding counties, and Colorado.  

This research will leverage data from the ongoing SEARCH for Diabetes in Youth Study (2015-2020) combined with new data to conduct a food insecurity-focused longitudinal study. The multi-site study will be the first to characterize the unique household food insecurity challenges and consequences experienced by youth and young adults with diabetes in the U.S. It will also be the first to examine household food insecurity as a mechanism for disparities in adverse outcomes among minorities within this population.

“Food insecurity is at near-record-high levels in the U.S.,” says Liese. “In 2015, for example, one in eight households was food insecure, with one in six households with children affected.”

Meanwhile, researchers have documented increases in both Type 1 and Type 2 diabetes. Between 2001 and 2009, the prevalence of Type 1 and Type 2 diabetes increased by 21 percent and 31 percent, respectively. The incidence of Type 1 increased to a much greater degree among Hispanics and non-Hispanic blacks compared to non-Hispanic whites. There were also disparities in Type 2 diabetes in these groups.

Among those who have diabetes, 55.6 percent of youth and young adults with Type 1 diabetes (45 percent with Type 2) do not achieve optimal glycemic control—the overarching goal of diabetes management, which is key to reducing the risk of morbidity and preventing premature mortality. Again, minorities are further disadvantaged, with 65 percent of non-Hispanic black and 61 percent of Hispanic youth and young adults with Type 1 diabetes not achieving optimal glycemic control compared to 29 percent of non-Hispanic whites (for Type 2 diabetes, these numbers are 41 and 49 percent vs 19 percent, respectively).

“These trends suggest that an increasing number of youth and young adults, particularly minorities and many with food insecurity, will be burdened with diabetes,” says Liese. “Our preliminary data show that food insecurity affects 19 percent of those with Type 1 and 38 percent of those with Type 2 diabetes.”

Previous research has already linked childhood food insecurity with poor mental health and physical health (e.g., depression, behavioral problems, poor social skills, anemia, bone density). The disproportionate prevalence of food insecurity among racial/ethnic minorities may make them more vulnerable to these adverse health outcomes.

Living with diabetes in a household with food insecurity is particularly challenging due to the strict self-management of medication and dietary intake that the condition requires. The researchers leading the present study believe that household food insecurity may help explain outcome disparities among youth and young adults with diabetes and lead to interventions that address food insecurity and eliminate disparities. 

“This study has major implications for clinical practice, policy and future research,” says Liese. “Findings from our study may provide evidence that we need to enhance current food security screening approaches, reconsider strategies for referring patients to resources, develop interventions that bring about equity with regard to racial/ethnic disparities in diabetes-related outcomes and lay the groundwork for advocacy efforts for food assistance programs, which may need tailoring for persons with diabetes.”

*Collaborators include: Edward Frongillo, Kate Flory, Anwar Merchant (University of South Carolina), Jason Mendoza, Catherine Pihoker, Davene Wright (Seattle Children’s Research Institute), Katherine Sauder, Dana Dabelea (University of Colorado, Denver), Elizabeth Mayer-Davis (University of North Carolina, Chapel Hill), Deborah Bowlby (Medical University of South Carolina), Bryce Nelson (Greenville Health System), Ralph D’Agostino, Beth Reboussin, Leora Henkin (Wake Forest University), and Santica Marcovina (University of Washington).


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