Examining Independent Associations Between Low Food Security, Race and Glycemic Control Among Older Americans with Diabetes in the NHANES 2009-2016 Waves Open Access
Thoms, David (Spring 2022)
Published
Abstract
Background: Glycemic control is an important indicator of health in people with diabetes, and failure to maintain it can lead to worse health outcomes. Previous research found independent associations between race/ethnicity and food security on glycemic control in adults with type 2 diabetes. These associations have not been adequately explored in older adults.
Methods: We conducted a secondary analysis of 1,326 adults with diabetes aged 65 and older who participated in the 2009-2016 National Health and Nutrition Examination Survey waves. Using logistic regression analysis, we examined relationships between glycemic control, food security, and race, controlling for demographic, social determinants of health, behavioral, and biomedical factors. We examined participants who identified as being non-Hispanic White, non-Hispanic Black, and Hispanic/Latino.
Results: We found a significant positive association between food security and glycemic control when adjusted for covariates. When compared to non-Hispanic Whites, there were group differences in glycemic control with Hispanic/Latinos but not with non-Hispanic Blacks. However, these differences were not significant when controlling for biomedical factors. Among the covariates, moderate to vigorous physical activity and oral medication use were found to be significantly associated with glycemic control.
Discussion: The consistent significant association between food security and glycemic control suggests the importance for glycemic control of macro factors, such as food security, even in the presence of behavioral (e.g., exercise) and biomedical (e.g., medication use) factors. The attenuation of relationship between race and glycemic control in the presence of biomedical factors needs to be examined by future research.
Conclusion: There is a positive association between food security and glycemic control in older adults with diabetes. Screening for food security in diabetes patients is recommended, as is expanding policies that improve food security, such as the Supplemental Nutrition Assistance Program. Ensuring medication adherence may be particularly important for improved glycemic control in Hispanic/Latino older adults.
Table of Contents
Chapter 1: Introduction and Rationale1
Introduction1
Problem Statement3
Problem Justification3
Theoretical Framework4
Purpose Statement5
Research Question and Sub-Question5
Significance Statement5
Literature Review7
Diabetes7
Glycemic Control8
SDOH and Sociodemographic Factors8
Food Security9
Race11
Other SDOH12
Sociodemographic Factors13
Behavioral Factors14
Physical Activity14
Smoking15
Biomedical Factors15
Depression16
Obesity16
Self Rated Health17
Oral Medication Use17
Methods19
Description of the NHANES dataset19
Study Sample19
Data Collection20
Measures21
Data Analysis23
Results25
Discussion29
Conclusion37
References38
Appendix A: Descriptive Tables44
Appendix B: Bivariate and Multivariate Logistic Regression Analysis46
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