Food insecurity was associated with severe hypoglycaemia among older patients with type 2 diabetes who used insulin or sulfonylureas.

Food insecurity can be economic (i.e. lack of financial resources to buy food) or physical (i.e. difficulty shopping for food or preparing meals). Economic food insecurity is a risk factor for hypoglycaemia in patients with diabetes, but physical food insecurity has not been studied widely. Researchers analysed survey data from 1200 older adults (age, 65 years and older) with type 2 diabetes in the Northern California Kaiser Permanente system who were using insulin or sulfonylureas.

Twelve per cent of respondents reported having food insecurity. Among those patients, 38% had economic insecurity, 21% had physical insecurity and 41% had both. Overall, 5% reported severe hypoglycaemic events (defined as passing out or needing help from another person), most commonly due to skipping meals, not eating enough or waiting too long to eat. Adjusted relative risk for severe hypoglycaemia was fourfold higher among patients with either financial or physical food insecurity and was fivefold higher when both were present.

Comment: I spend a substantial amount of time educating older patients with type 2 diabetes who use insulin or sulfonylureas about hypoglycaemia, often focusing on avoiding dosing errors. This study’s observational design does not establish causality, but I will be inquiring about both economic and physicalfoodinsecuritiestohelp identify patients who are at risk for serious hypoglycaemia.

David S. Weisman, DO, FACP, Associate Professor of Medicine Clinician Educator, Georgetown University Medical Center, Washington, DC; Associate Program Director in Internal Medicine, MedStar Health, Baltimore, USA.

Karter AJ, et al. Food insecurity and hypoglycemia among older patients with type 2 diabetes treated with insulin or sulfonylureas: the Diabetes and Aging study. J Gen Intern Med 2024; 39: 2400-2406.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine.