Medically Tailored Meals Outperform Food Subsidies in Lowering HbA1c for Type 2 Diabetes
核心洞察
A randomized trial found medically tailored meals plus lifestyle counseling lowered HbA1c (搜索) significantly more than monthly food subsidies at 6 months (7.74% vs. 8.17%, P = .037).
The meal intervention also improved systolic blood pressure, reduced food insecurity, and enhanced diet quality and self-efficacy compared to subsidies.
A separate Kaiser Permanente study showed weekly healthy grocery deliveries improved blood sugar by nearly half a point over 6 months in Medicaid patients with diabetes.
Adults with type 2 diabetes (搜索) who face food insecurity achieved significantly better glycemic control when provided medically tailored meals delivered directly to their homes compared to those receiving a monthly food subsidy, according to new research presented at the American Diabetes Association Scientific Sessions in New Orleans.
The open-label, parallel-group, randomized trial enrolled 194 adults with type 2 diabetes (搜索) who faced food insecurity (mean age, 56 years; 60.3% women; 56.7% white; mean HbA1c (搜索), 8.44%). Participants were randomly assigned to one of two nutritional interventions over 6 months: medically tailored meals with lifestyle counseling, or a $40 per month food subsidy.
"Medically tailored meals tend to be more expensive, but may overcome more barriers to healthy eating and so are potentially more effective," said Seth A. Berkowitz, MD, MPH, associate professor of medicine at University of North Carolina School of Medicine (搜索), during his presentation. "On the flip side, it means giving up more control over your diet, so they may not be right for everyone."
Superior Glycemic Outcomes with Tailored Meals
At 6 months, the medically tailored meal group achieved a significantly lower HbA1c (搜索) compared to the food subsidy group (7.74% vs. 8.17%; P = .037). The meal intervention also conferred lower systolic blood pressure (124.3 mm Hg vs. 130.8 mm Hg; P = .02), while diastolic blood pressure and body weight were similar between the two groups.
Participants in the medically tailored meal arm received 10 meals and 1 quart of milk per week delivered to their homes, with a registered dietitian tailoring meals based on each person's preferences and comorbidities. Lifestyle counseling sessions were conducted over the phone. Adherence was high, with participants completing a median of 10 out of 12 possible counseling sessions and receiving meal deliveries for a median of 24 out of 26 weeks.
Broader Benefits Beyond Blood Sugar
Beyond glycemic improvements, the medically tailored meal intervention produced meaningful secondary benefits. Adults in this group reported less food insecurity (mean difference, −1.15 points; 95% CI, −2.02 to −0.27; P = .01), better diet quality (mean difference, 1.55 points; 95% CI, 0.12-2.98; P = .03), and better diet self-efficacy (mean difference, 6.2 points; 95% CI, 2.2-10.21; P = .003) compared to those receiving food subsidies. Quality of life and diabetes distress did not differ between the interventions.
Complementary Evidence from Grocery Delivery Research
These findings align with a separate Kaiser Permanente study published in Circulation, which demonstrated that weekly healthy grocery deliveries helped adults with diabetes on Medicaid improve their blood sugar. That study of 460 participants found blood sugar levels dropped by nearly half a point over 6 months compared to usual care.
"This study shows that getting healthy food can help people lower their blood sugar without needing more medicine," said Claudia Nau, PhD, who led the Kaiser Permanente study. "Our results suggest that making healthy food easier to get can really help people with diabetes, especially those who have a hard time affording or finding healthy food."
The Kaiser Permanente study tested two types of grocery deliveries—one with higher-cost foods and one with lower-cost options—and found both groups showed similar improvements in blood sugar. Participants also received culturally relevant recipes and could consult with a nutrition expert over the phone.
Durability Concerns and Future Directions
A notable limitation emerged in the medically tailored meals trial: among participants who attended follow-up at 1 year, there was no difference for any outcomes between the groups. Berkowitz noted this suggests that benefits from the interventions did not persist 6 months after they concluded.
"This suggests that we may need to couple the clinical interventions with social policy to promote the conditions needed for health," Berkowitz said. He also acknowledged that the trial analyzed a single medically tailored meal program and was conducted among a population in the New England region that did not face "adverse conditions."
"Food prescriptions are a useful way to provide care that looks at the whole person, linking medical treatments with what people really need at home," Nau added. "Studies like this show health organizations and Medicaid programs how they can offer food benefits in a way that works well and makes sure everyone gets fair treatment."