Intensive Food-as-Medicine Program fails to improve Glycemic control in diabetes patients: JAMA

A recent JAMA Internal Medicine concluded that an intensive food-as-medicine program boosts engagement in preventive health care. Still, it didn't enhance glycemic control compared to standard care among adult participants. Programs for people with high biomarkers need a control group to show effectiveness. More research is required to develop food-as-medicine programs promoting better health outcomes.

This study determined if an intensive food-as-medicine program for diabetes patients and food insecurity can improve glycemic control and affect healthcare use. The study was conducted as a stratified randomized clinical trial with a waitlist design from April 19, 2019, to September 16, 2022. Participants were followed for one year and were randomly assigned to either the treatment group, which participated in the program immediately, or the control group, which waited six months. The trial took place at two sites, one rural and one urban. To be eligible for the study, participants required a T2D diagnosis, HbA1c level of 8% or higher, food insecurity, and residence within the service area of the participating clinics.

The program offered healthy groceries for ten meals/week, plus consultations, evaluations, coaching, and diabetes education for a year. The primary outcome was HbA1c at six months, with secondary outcomes including biometric measures, healthcare use, and self-reported diet/healthy behaviours at 6 and 12 months

The summary of this study includes the following points:

· Of 3712 patients assessed, 3168 were contacted, 1064 were deemed eligible, 500 consented and were randomized, and 465 patients completed the study.

· Of these, 349 patients had laboratory test results at six months. Both treatment and control groups experienced a decline in HbA1c levels, resulting in a non-significant adjusted mean difference of -0.10.

· Access to the program increased preventive health care, including more dietitian visits, active prescription drug orders for metformin and glucagon-like peptide one medication, and participants reporting improved diets.

This clinical trial showed that an intensive food-as-medicine program improved engagement with preventive health care but didn't affect glycemic control compared to usual care. Control groups are necessary to demonstrate effectiveness in programs targeting individuals with elevated biomarkers. More research is needed to design food-as-medicine programs that improve health.

Reference:

Doyle J et al.Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use: A Randomized Clinical Trial. JAMA Intern Med.