Impact of Food Distribution at Low-income Clinics on Health Outcomes of Patients With Diabetes

It is hypothesized that providing healthy foods may stabilize unhealthy eating patterns for diabetics so that HbA1c measurements significantly improve. The UCSD Student-Run Free Clinic Project (SRFCP) will offer boxes of nutritious food monthly along with a brief nutrition class to its diabetic patients and continue their otherwise usual care. The UCSD SRFCP will partner with a large food bank, Feeding America San Diego, that can provide monthly food boxes of healthy food along with education about eating healthy on a budget. Food insecurity negatively impacts health outcomes in diabetic patients; therefore enhancing food security with nutritious food as well as providing education to cultivate healthy eating habits could be a cost-effective way to improve health outcomes in diabetics, necessitating the use of human subjects for this study. Blood pressure, weight, and LDL cholesterol will be secondary outcome measures along with survey measures for diabetes distress, depression, dietary quality assessment, medication adherence, hypoglycemia, and food security.

Diabetics who enroll in this study will be randomly assigned to an initial 3-month period of either immediate intervention (the food boxes and education) or a wait list control group. The intervention involves receiving a box of nutritious food each month along with brief education provided by food pantry staff, in addition to usual medical care. In measuring clinical outcomes, this study will not deviate from routine care.

As a part of routine care screening, all UCSD SRFCP patients will receive the six-item 'Short Form' of the USDA Food Security Survey Module to assess their food security upon arrival in the waiting area. This survey will be self-administered or orally administered depending on patient preference. Regardless of food security status, everyone will be offered referral to local food banks and referral for Cal-Fresh (Food Stamps) application if eligible.

All patients who receive care at the UCSD SRFCP sites with a diagnosis of diabetes, regardless of food security status, will be offered these same resources in addition to being informed of this study. The investigators will track health outcomes from routine clinical visits by querying the electronic health records if patients chose to participate in the study. Participants will also be asked to complete a survey at baseline, 3 months, 6 months, and 9 months (for the wait list group). Those who are interested in the study will speak with a study coordinator and be provided a detailed discussion about the study.

Once the study is fully explained and ample time is given for patients to make a well-informed decision, the informed consent will be obtained in a private room or space with study coordinators fluent in the patient's preferred language (English or Spanish) who are capable of answering questions about the study. The informed consent forms will be provided in English and Spanish. It will be made clear to patients that they are under no obligation to participate and that refusal to participate in no way influences the routine care they receive at the UCSD SRFCP.