PDF(Pubmed)
Abstract：
BACKGROUND: People with low income are disproportionately affected by type 2 diabetes (T2D), and 17.6% of US adults with T2D experience food insecurity and low diet quality. Low-carbohydrate eating plans can improve glycemic control, promote weight loss, and are associated with improved cardiometabolic health and all-cause mortality. Little is known about supporting low-carbohydrate eating for people with T2D, although food-as-medicine interventions paired with nutrition education offer a promising solution.
OBJECTIVE: This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity.
METHODS: This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A1c, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up.
RESULTS: This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program.
CONCLUSIONS: This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D.
UNASSIGNED: DERR1-10.2196/54043.
OBJECTIVE: This program aims to support the initiation of dietary changes by using grocery delivery and low-carbohydrate education to increase the quality of low-carbohydrate nutrition among people with T2D and food insecurity.
METHODS: This program was a nonrandomized pilot conducted at 21 primary care practices in Michigan. Adults with T2D and food insecurity or low income were eligible to enroll. Patients were referred by primary care clinic staff. All participants received the 3-month program, which included monthly US $80 credits for healthy foods, free grocery delivery from Shipt, and low-carbohydrate nutrition education. Food credits were restricted to the purchase of healthy foods. Education materials, developed in collaboration with providers and patients, included print, digital, interactive web, and video formats. At enrollment, participants completed a survey including demographics, diabetes health, diet and physical activity, and diabetes management and knowledge. After the 3-month program, participants completed a survey with repeat assessments of diabetes health, diet and physical activity, and diabetes management and knowledge. Perspectives on participant experience and perceived program impact, food purchasing behaviors, and use of educational materials were also collected. Diabetes health information was supplemented with data from participant medical records. We plan to perform mixed methods analysis to assess program feasibility, acceptability, and impact. Primary quality improvement (QI) measures are the number of patients referred and enrolled, use of US $80 food credits, analysis of food purchasing behavior, participant experience with the program, and program costs. Secondary QI measures include changes in hemoglobin A1c, weight, medications, self-efficacy, diabetes and carbohydrate knowledge, and activity between baseline and follow-up.
RESULTS: This program started in October 2022. Data collection is expected to be concluded in June 2024. A total of 151 patients were referred to the program, and 83 (55%) were enrolled. The average age was 57 (SD 13; range 18-86) years, 72% (57/79) were female, 90% (70/78) were White, and 96% (74/77) were of non-Hispanic ethnicity. All participants successfully ordered grocery delivery during the program.
CONCLUSIONS: This pilot QI program aimed to improve diet quality among people with T2D and food insecurity by using grocery delivery and low-carbohydrate nutrition education. Our findings may help inform the implementation of future QI programs and research studies on food-as-medicine interventions that include grocery delivery and education for people with T2D.
UNASSIGNED: DERR1-10.2196/54043.
摘要：
背景：低收入人群不成比例地受到2型糖尿病（T2D）的影响，17.6%的T2D美国成年人经历食物不安全和饮食质量低。低碳水化合物饮食计划可以改善血糖控制，促进减肥，与改善心脏代谢健康和全因死亡率相关.对于支持T2D患者的低碳水化合物饮食知之甚少，尽管以食物为药物的干预措施与营养教育相结合提供了一个有希望的解决方案.
目的：该计划旨在通过使用杂货配送和低碳水化合物教育来支持饮食改变的启动，以提高患有T2D和食物不安全的人的低碳水化合物营养质量。
方法：该项目是在密歇根州21个初级保健实践中进行的非随机试验。患有T2D和粮食不安全或低收入的成年人有资格报名。患者由初级保健诊所工作人员转诊。所有参与者都接受了为期3个月的计划，其中包括每月80美元的健康食品积分，Shipt免费送货上门,和低碳水化合物营养教育。食品信贷仅限于购买健康食品。教育材料,与提供者和患者合作开发，包括印刷品，数字,交互式网络，和视频格式。在入学时，参与者完成了一项包括人口统计在内的调查，糖尿病健康,饮食和身体活动，以及糖尿病管理和知识。在三个月的计划之后，参与者完成了一项对糖尿病健康进行重复评估的调查，饮食和身体活动，以及糖尿病管理和知识。对参与者体验和感知的计划影响的看法，食品购买行为，还收集了教育材料的使用。糖尿病健康信息补充了参与者医疗记录的数据。我们计划进行混合方法分析，以评估方案的可行性，可接受性,和影响。主要质量改进(QI)措施是转诊和登记的患者数量，使用80美元的食品积分，食品购买行为分析，参与者对该计划的体验，和方案成本。次要QI指标包括血红蛋白A1c的变化，体重,药物,自我效能感,糖尿病和碳水化合物知识，基线和随访之间的活动。
结果：该计划于2022年10月开始。数据收集预计将于2024年6月完成。共有151名患者被转诊到该计划，和83（55％）纳入。平均年龄为57(SD13;范围18-86)岁，72%(57/79)为女性，90％（70/78）是白人，96%(74/77)属于非西班牙裔种族.所有参与者都在计划期间成功订购了杂货交付。
结论：该试验QI计划旨在通过使用杂货配送和低碳水化合物营养教育来改善患有T2D和食物不安全的人群的饮食质量。我们的发现可能有助于为未来QI计划的实施以及有关食品作为药物干预措施的研究提供信息，其中包括为T2D患者提供杂货和教育。
■DERR1-10.2196/54043。
目的：该计划旨在通过使用杂货配送和低碳水化合物教育来支持饮食改变的启动，以提高患有T2D和食物不安全的人的低碳水化合物营养质量。
方法：该项目是在密歇根州21个初级保健实践中进行的非随机试验。患有T2D和粮食不安全或低收入的成年人有资格报名。患者由初级保健诊所工作人员转诊。所有参与者都接受了为期3个月的计划，其中包括每月80美元的健康食品积分，Shipt免费送货上门,和低碳水化合物营养教育。食品信贷仅限于购买健康食品。教育材料,与提供者和患者合作开发，包括印刷品，数字,交互式网络，和视频格式。在入学时，参与者完成了一项包括人口统计在内的调查，糖尿病健康,饮食和身体活动，以及糖尿病管理和知识。在三个月的计划之后，参与者完成了一项对糖尿病健康进行重复评估的调查，饮食和身体活动，以及糖尿病管理和知识。对参与者体验和感知的计划影响的看法，食品购买行为，还收集了教育材料的使用。糖尿病健康信息补充了参与者医疗记录的数据。我们计划进行混合方法分析，以评估方案的可行性，可接受性,和影响。主要质量改进(QI)措施是转诊和登记的患者数量，使用80美元的食品积分，食品购买行为分析，参与者对该计划的体验，和方案成本。次要QI指标包括血红蛋白A1c的变化，体重,药物,自我效能感,糖尿病和碳水化合物知识，基线和随访之间的活动。
结果：该计划于2022年10月开始。数据收集预计将于2024年6月完成。共有151名患者被转诊到该计划，和83（55％）纳入。平均年龄为57(SD13;范围18-86)岁，72%(57/79)为女性，90％（70/78）是白人，96%(74/77)属于非西班牙裔种族.所有参与者都在计划期间成功订购了杂货交付。
结论：该试验QI计划旨在通过使用杂货配送和低碳水化合物营养教育来改善患有T2D和食物不安全的人群的饮食质量。我们的发现可能有助于为未来QI计划的实施以及有关食品作为药物干预措施的研究提供信息，其中包括为T2D患者提供杂货和教育。
■DERR1-10.2196/54043。
