Hemoglobin A1c and Weight Changes Associated With Grocery Delivery and Low-Carbohydrate Education in Adults With Type 2 Diabetes and Food Insecurity: Observational Quality Improvement Cohort Study.

چکیده اصلی

BACKGROUND: Type 2 diabetes mellitus (T2D) is one of the most significant chronic health challenges in Michigan, especially for individuals with food insecurity. Improving nutrition, including lowering carbohydrate intake, is foundational to T2D prevention and management. Grocery delivery paired with low-carbohydrate education has the potential to reduce logistical barriers to dietary change but is not well understood in individuals with food insecurity. OBJECTIVE: The objective of our study was to evaluate changes in clinical metrics of hemoglobin A1c (HbA1c), weight, and diabetes medication use after a paired grocery delivery and low-carbohydrate education program. METHODS: The Healthy Eating Jumpstart Program (hereafter, Jumpstart) enrolled adult Michiganders with T2D and low income or food insecurity from 21 Michigan primary care practices between October 2022 and May 2023. Jumpstart was a 3-month, nonrandomized grocery delivery and low-carbohydrate education quality improvement program without a control group. Participants received US $80 every month through Shipt to purchase eligible healthy foods, along with low-carbohydrate educational materials. Clinical metrics of HbA1c, weight, and diabetes medication use were collected from medical records from 6 months before enrollment through 12 months after enrollment. Changes in HbA1c and weight from baseline were evaluated at 3, 6, 9, and 12 months, with stratification by baseline glycemic control and glucagon-like peptide-1 receptor agonist (GLP-1 RA) medication use, respectively. Overall change was assessed with paired t tests comparing baseline values to each participant's latest value for HbA1c and weight. Medication changes were assessed by comparing baseline and 12-month dosing to categorize changes as increased, decreased, eliminated, or unchanged. RESULTS: A total of 83 patients participated in Jumpstart. Participants were primarily female (57/79, 72%), White (70/79, 89%), and had a high school degree or less (35/79, 44%). At baseline, the average HbA1c was 7.6% (SD 2%), average weight was 105 (SD 25.8) kg, and average BMI was 38.2 (SD 8.8) kg/m2. The overall reduction in HbA1c from baseline was 0.4% (SD 1.4%; P=.02; n=68), and this reduction was greater when limited to individuals with uncontrolled HbA1c at baseline (mean 0.7%, SD 1.8; P=.02; n=38). The overall percent reduction in weight from baseline was 1.7% (SD 4.4%; P=.002; n=66), but this change was not significant when limited to non-GLP-1 RA users. Most medications had no change in dosing (77/166, 46%), and slightly more medications were increased or added (n=52, 31%) than decreased or discontinued (n=37, 22%). CONCLUSIONS: The results from this clinical evaluation suggest that the Jumpstart quality improvement program was associated with improvements in HbA1c that persisted beyond 6 months and small reductions in weight among participants. A low-burden program such as Jumpstart may be a feasible approach to support long-term dietary change in patients with T2D and food insecurity or low income.

ترجمه فارسی چکیده

پس‌زمینه: دیابت نوع ۲ یکی از چالش‌های مهم سلامت مزمن در میشیگان است، به‌ویژه برای افراد دارای ناتوانی غذایی. بهبود تغذیه، از جمله کاهش مصرف کربوهیدرات، پایه‌ای برای پیشگیری و مدیریت دیابت است. هدف: ارزیابی تغییرات شاخص‌های بالینی هموگلوبین A1c (HbA1c)، وزن و مصرف داروهای دیابت پس از یک برنامه آموزشی و تحویل مواد غذایی. روش‌ها: برنامه «شروع تغذیه سالم» (Jumpstart) از اکتبر ۲۰۲۲ تا مه ۲۰۲۳، ۸۳ بیمار را از ۲۱ مطب مراقبت اولیه ثبت کرد. بیماران ۸۰ دلار ماهانه دریافت کردند تا مواد غذایی سالم تهیه کنند و آموزش کم‌کربوهیدرات دریافت کردند. شاخص‌ها از ۶ ماه قبل تا ۱۲ ماه بعد ثبت شدند. نتایج: میانگین HbA1c پایه ۷.۶٪ و میانگین وزن ۱۰۵ کیلوگرم بود. کاهش کلی HbA1c ۰.۴٪ (P=.02) و کاهش وزن ۱.۷٪ (P=.002) گزارش شد. نتیجه‌گیری: برنامه Jumpstart با بهبود HbA1c و کاهش جزئی وزن همراه بود.

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