Older adults with type 2 diabetes who don’t have enough to eat, know where they will get their next meal, or have the ability to shop for or prepare food are at higher risk of having severe low blood sugar, a new Kaiser Permanente study found.
The study also found that health care providers may miss some older adults at risk of experiencing severe low blood sugar — known as hypoglycemia — if they ask only about economic food insecurity, or being able to afford food, and not physical food insecurity, or being able to shop for food or prepare meals.
The research, published in the spring in the Journal of General Internal Medicine, looked at 1,164 adults ages 65 and older enrolled in the Kaiser Permanente Northern California Diabetes and Aging Study. Everyone in the study was taking insulin or sulfonylureas to treat their type 2 diabetes.
Twelve percent of the study participants reported food insecurity. Of these, 38% had not been able to afford food, while 21% had not been able to shop for food or prepare meals, and 40% had faced both.
“The questions used by the U.S. Department of Agriculture and health care systems typically ask only about whether people can afford food,” said Andrew J. Karter, PhD, a senior research scientist with the Kaiser Permanente Division of Research who led the study. “Our research suggests that if providers don’t ask patients if they are able to shop for food or prepare meals, they may miss 1 in 5 patients at risk of severe hypoglycemia.”
Drugs used to treat type 2 diabetes keep blood sugar levels stable. But when a person taking insulin or sulfonylureas eats less or exercises more than usual, their blood sugar levels may get so low that they then develop severe hypoglycemia. People with diabetes who experience severe hypoglycemia are not able to eat, drink, or take their diabetes medication on their own. They can also pass out. If the severe hypoglycemia lasts for a long time, it can damage their heart and other organs.
The study found that the people who experienced both economic and physical food insecurity were 4 times more likely to have a severe hypoglycemic episode than those who did not face food insecurity.
The main reasons people gave for experiencing a severe hypoglycemic episode were skipping a meal, not eating enough, or waiting too long to eat.
“To prevent hypoglycemia in these patients, we should identify and address both physical and economic causes of food insecurity as they may require distinct solutions,” said senior author Kasia Lipska, MD, MHS, an endocrinologist at Yale University School of Medicine.
The researchers said they hope their findings will highlight the changes needed to improve how patients are screened for food insecurity.
“Our study suggests health care providers need to consider also asking patients about physical food insecurity,” said study co-author Hilary Seligman, MD, MAS, a professor at the University of California, San Francisco. “This is particularly important for patients who are at high risk of poor diabetes outcomes.”
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