MedPage Today recently published a very interesting report, entitled “Addressing Food Insecurity in Type 2 Diabetes: Fresh food initiative cut HbA1c 20% among patients with poor glycemic control.” In that report, published online on April 11, Judy George, a contributing editor, wrote that “More than 14 percent of all households in the U.S. are food insecure, meaning they cannot reliably get nutritious food. And, the link between food insecurity and diabetes is strong: people with food insecurity carry twice the risk of type 2 diabetes.” What’s more, she wrote, “Food-insecure patients are more likely to have poorer glycemic control, have 5 times more encounters with doctors each year, and experience more frequent episodes of hypoglycemia.”
George quoted a number of experts on the subject, including Madeline Shalowitz, M.D., an endocrinologist at NorthShore University Health System, based in the Chicago suburb of Evanston, Ill. "If your patient is food insecure, he or she may not be able to afford the essential nutrition you are prescribing. They may not share that information unless you ask, and you must ask them in a sensitive way,” Dr. Shalowitz noted. “Otherwise, "you may assume your patient is non-adherent," she added. "You may prescribe insulin for glucose control, perhaps unnecessarily."
George also wrote that, “In 2011, Kaiser Permanente in Colorado studied households in two pediatric clinics—one in an underserved, low-income community, the other in a more affluent area—and found that, in the low-income neighborhood, 18 percent of households were food insecure. Surprisingly, so were 11.5 percent of the middle-class families.” "This led us to realize food insecurity may be more widespread than we had imagined," Sandra Hoyt Stenmark, MD, of Kaiser Permanente in Denver, told George. Further, Kaiser clinicians began at that time to ask patients about food insecurity, offering patients who screened positive the hotline number to Hunger Free Colorado, a statewide nonprofit organization. But when they tracked results, they found only 5 percent of patients had connected with the food bank.
"We realized that was an insufficient strategy, so we developed an outreach process in which we asked patients for their permission to send only their demographic information to the hotline, so they could then provide nutrition services," Stenmark told George. "And what we discovered is that 78 percent connected to resources." The next step, George noted, “was to develop ways to help more physicians address the topic and connect patients with resources. This led to the Food Insecurity Screening Algorithm for Adults with Diabetes, a document that Stenmark collaborated on with the CDC's Nutrition and Obesity Policy Research and Evaluation Network (NOPREN).” And she quoted Enza Gucciardi, Ph.D., an expert in food insecurity and diabetes at Ryerson University in Toronto, Canada, as noting that, if physicians don't screen for food security, they can't see the full picture or make realistic recommendations.
In that context, it was very encouraging to read both George’s MedPage Today article, and an article that Healthcare Informatics Associate Editor Heather Landi wrote back in February, about an exciting initiative at the Danville, Pennsylvania-based Geisinger Health System. As she noted in her report, under the headline, “Can a Prescription for Fresh Food Treat Diabetes? At Geisinger, an Informatics-Driven Project Is Showing Promising Results,” “With the aim of addressing food insecurity, as a significant social factor impacting health, and to improve patients’ diabetes management, Geisinger launched an IT- and data analytics-driven Fresh Food Farmacy initiative to give away fresh, healthy food to diabetes patients. The health system initially launched the program in July 2016 as a pilot project at Geisinger Shamokin Area Community Hospital in Coal Township, in Northumberland County, which has the second-highest rate of long-term diabetes complications in central Pennsylvania.”
And Landi quoted Andrea Feinberg, M.D., medical director of Health and Wellness at Geisinger Health, and the clinical champion of the Fresh Food Farmacy, as stating that “Geisinger is very focused on approaching medical conditions from a population health perspective—we not only want to take care of each person that’s in front of us and provide them with the best state-of-the art care that we can, but we also look at our patients in their communities and see how we can improve the overall health of those that we serve.”
As Landi further noted, “While Geisinger healthcare leaders are using an old approach, essentially “food as medicine,” to tackle medical conditions, the Fresh Food Farmacy initiative is an informatics-driven project that relies heavily on data integration, analytics and mobile technology to do everything from tracking clinical outcomes to managing the food supply chain.”