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)

Permanent URL: https://etd.library.emory.edu/concern/etds/k06988837?locale=en


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


Problem Statement3

Problem Justification3

Theoretical Framework4

Purpose Statement5

Research Question and Sub-Question5

Significance Statement5

Literature Review7


           Glycemic Control8

SDOH and Sociodemographic Factors8

           Food Security9


           Other SDOH12

           Sociodemographic Factors13

Behavioral Factors14

           Physical Activity14


Biomedical Factors15



           Self Rated Health17

           Oral Medication Use17


Description of the NHANES dataset19

Study Sample19

Data Collection20


Data Analysis23





Appendix A: Descriptive Tables44

Appendix B: Bivariate and Multivariate Logistic Regression Analysis46

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