Speakers

Connor Drake, PhD, MPA
Research Health Scientist
Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT)
Durham VA Health System HSR&D
Assistant Professor
Department of Population Health Sciences
Duke University School of Medicine

Susan Spratt, MD
Department of Medicine
Division of Endocrinology, Metabolism, and Nutrition
Department of Family Medicine and Community Health
Duke University School of Medicine

Abigail Rader, MS
PhD Candidate
Department of Population Health Sciences
Duke University School of Medicine

Slides

Keywords

Food Insecurity; Groceries; Food as Medicine; Diabetes; Cardiovascular Health; Cardiovascular Disease; Cardiometabolic Health

Key Points

• In 2022, an estimated 12.8% of American households experienced food insecurity (FI): a lack of consistent access to safe, nutritious, or sufficient food for every person in a household to live an active, healthy life. FI is also associated with increased cardiometabolic health risk. While promising interventions to improve food security (and, by extension, cardiometabolic health) exist, methodological limitations such as a lack of pragmatic designs limit conclusions on their effectiveness.

• The Eat Well pragmatic trial sought to better understand the real-world effectiveness of a produce prescription program when it came to improving cardiometabolic health-related outcomes and utilization patterns. They found that Eat Well did not improve outcomes among diabetic patients at risk for food insecurity. However, an affirmative outreach approach supported rapid scaling of the program.

• Produce prescription programs may require greater duration, dose, intensity, and attention to household and implementation factors, including a focus on different at-risk groups, to improve health outcomes. Reducing cost barriers to purchasing fruits and vegetables alone may not be sufficient to improve food security – at least, not enough to improve cardiometabolic health outcomes.

Discussion Themes

Based on initial descriptive analyses, the amount spent on the card had no significant clinical effect – even among the most adherent participants.

Patients often face multiple overlapping social needs (housing, transportation, etc.), and addressing food alone may not be enough for those with the highest complexity. While the intervention was kept simple for scalability’s sake, diabetes management likely requires a more integrated, multi-sector approach that looks at factors like food, exercise, medications, education, behavioral health support, and monitoring.

Future research should identify opportunities to improve implementation, test interventions in higher-risk populations, and collect additional details on patient-reported outcomes.