Lack of access to food linked to increased medical utilization among diabetics

May 31, 2001

Diabetics who do not have enough money to maintain their special dietary needs are less healthy and require more medical attention than well-fed diabetics, potentially increasing costs to the health care system, according to a new study.

In an analysis of data on 1,503 people with diabetes gleaned from a survey conducted by the National Center for Health Statistics, those who did not have enough to eat due to financial constraints were more than twice as likely to report having poor or fair health than those who did not go hungry.

"Food insufficiency has been related to poor-quality diets, including lower consumption of fruits and vegetables and low intake of essential nutrients. Adult diabetics in general report low dietary compliance, and those with low incomes may have more difficulty following a diabetic diet due to financial constraints," say Karin Nelson, M.D., and associates at the University of California, Los Angeles.

The hungry diabetics averaged three more calls or visits to the doctor than the other diabetics in the study, contributing to the $7.7 billion a year in direct medical cost among the 5 percent of the population with diabetes.

"If food insufficiency leads to problems with disease management and increased physician utilization, it may be more cost-effective to ensure food security to this population than to provide additional medical services," she says.

Uncontrolled diabetes can lead to substantial health consequences, such as macular degeneration, which causes blindness, and neuropathy, which leads to ulcers and limb amputation.

The study is published in the June issue of the Journal of General Internal Medicine.

The researchers note that nearly half of the cost savings of recent welfare reform came from cuts to food and nutrition programs, including food stamp allotments.

Approximately 13 percent of diabetics in this study used food stamps, representing an estimated 1.2 million individuals nationally. A quarter of these diabetic adults reported not having enough food, compared with only 4 percent of those without food aid, Nelson says.

This suggests that reducing spending on food programs is likely to increase cost to the health care system, quite possibly wiping out any savings from the cuts.

She notes that limitations of this study include the fact that since it was based on data from a general health survey (NHANES III), researchers could not definitively establish that the association between food insufficiency and health status was a direct one. It also did not include objective diabetes measures, but relied on self-reported health status. The survey also did not include data on the homeless population.

The researchers also found that "food insufficiency was much more common among low-income groups, affecting almost one-fifth of those with annual incomes under the federal poverty level."
The Journal of General Internal Medicine, a monthly peer-reviewed journal of the Society of General Internal Medicine, publishes original articles on research and education in primary care. For information about the journal, contact Renee F. Wilson at (410) 955-9868.

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