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Latinos With Diabetes and Food Insecurity in an Agricultural Community

Moreno, Gerardo MD, MSHS*; Morales, Leo S. MD, PhD†,‡; Isiordia, Marilu MS§; de Jaimes, Fatima N. RN; Tseng, Chi-Hong PhD; Noguera, Christine MS#; Mangione, Carol M. MD, MSPH¶,**

doi: 10.1097/MLR.0000000000000348
Original Articles

Background: Latinos from agricultural communities have a high prevalence of food insecurity and are at increased risk of obesity and diabetes, yet little is known about the associations between food insecurity and diabetes outcomes.

Objective: To examine the associations between food insecurity and diabetes outcomes among rural Latinos.

Methods: Cross-sectional survey with medical chart abstraction of 250 Latinos with diabetes. Primary outcomes are the control of 3 intermediate diabetes outcomes (hemoglobin A1C ≤8.0%, LDL-cholesterol ≤100 mg/dL, and blood pressure ≤140/90 mm Hg), a composite of control of the 3, and receipt of 6 processes of care. Secondary outcomes are cost-related medication underuse and participation in self-care activities.

Results: Fifty-two percent of patients reported food insecurity and 1-in-4 reported cost-related medication underuse. Patients with food insecurity were more likely to report cost-related medication underuse [adjusted odds ratio (AOR)=2.49; 95% confidence intervals (CI), 1.30, 4.98; P=0.003], less likely to meet the composite measure for control of the 3 intermediate outcomes (AOR=0.24; 95% CI, 0.07, 0.84; P<0.05), and less likely to receive a dilated eye examination (AOR=0.37; 95% CI, 0.18, 0.77; P<0.05) and annual foot examinations (AOR=0.42; 95% CI, 0.20, 0.84; P<0.05) compared with those who were food secure.

Conclusions: Among this rural Latino population, food insecurity was independently associated with not having control of the intermediate diabetes outcomes captured in the composite measure, not receiving dilated eye and foot examinations, and with self-reporting cost-related medication underuse.

*UCLA Department of Family Medicine, Los Angeles, CA

School of Medicine

School of Public Health, University of Washington, Seattle, WA

§Department of Psychology at the University of California, Davis

Golden Valley Health Centers Inc., Merced

UCLA Department of General Internal Medicine, Division of Health Services, Los Angeles

#Community Medical Centers Inc, Stockton

**UCLA School of Public Health, Los Angeles, CA

G.M. was supported by the Robert Wood Johnson Foundation Clinical Scholars Program at UCLA, NIA Paul B. Beeson Career Development Award (K23 AG042961-01) in aging research, and the California Endowment. C.M.M. was funded under NIA/NIH RCMAR/CHIME P30AG021684.

The content does not necessarily represent the official views of the NIA or the NIH.

The authors declare no conflict of interest.

Reprints: Gerardo Moreno, MD, MSHS, UCLA Department of Family Medicine, 10880 Wilshire Blvd., Suite 1800, Los Angeles, CA 90024. E-mail:

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.