Research Description
Healthy eating is important for both diabetes management and prevention. Diets that include fresh, healthy foods, such as fruits and vegetables, are higher in fiber and lower in salt, fat, and added sugar. These diets are known to help manage blood glucose and body weight for people with diabetes and those at risk for diabetes. However, people who experience low income often have difficulty accessing healthy foods, such as fruits and vegetables. Lack of access to healthy food is also known as food insecurity, which is widely understood to be a social determinant of health that increases diabetes health disparities. Produce prescription programs are one unique, innovative way to help people with diabetes or those at risk for diabetes to afford, access, and eat more healthy fruits and vegetables. In these programs, health care providers can “prescribe” fruit and vegetable vouchers, which can be redeemed at various food retail locations such as grocery stores and farmers markets. Though widely appreciated and utilized by patients and health care providers who have access to these programs, there is limited research on the effects of these programs. The purpose of this study is to evaluate the health outcomes and cost effectiveness of produce prescription programs for people with limited income, and who have diabetes or are at risk for diabetes. Findings from this study will contribute to the evidence base that produce prescription programs are a cost-effective way to decrease diabetes health disparities and improve diabetes health outcomes.Research Profile
What area of diabetes research does your project cover? What role will this particular project play in preventing, treating and/or curing diabetes?Our research focuses on the impact of a national nutrition policy, funded by the US Department of Agriculture’s (USDA) Gus Schumacher Nutrition Incentive Program (GusNIP) – called produce prescriptions, for treatment and management of type 2 diabetes. Specifically, we will explore the effectiveness of produce prescription programs on diabetes-related health, fruit and vegetable consumption, and food security, as well as determining program costs and cost-effectiveness of these programs, related to improved health and quality of life of participants. Food insecurity, or lack of consistent access to enough food, harms health and well-being across the life span, is inextricably linked to households with low-income, and is a major risk factor for type 2 diabetes. Produce prescriptions are healthcare professional-prescribed vouchers or coupons, provided during medical visits, that can be redeemed for fruits and vegetables at participating food retail settings (e.g., farmers markets, grocery stores). Produce prescriptions alleviate healthy food cost and access barriers among households in need. They support and facilitate the purchase of fresh fruits and vegetables, which are high in fiber and low in sodium, added sugar, and saturated fat, and are key to successful diabetes prevention and management. Some studies have shown that produce prescriptions lead to increased and improved outcomes on fruit and vegetable intake, food security and some health outcomes, but research studies on how produce prescriptions affect people with diabetes have been few. The project described here is a robust national-level evaluation that will contribute crucial evidence needed to support adoption of these programs in healthcare and healthcare policy (e.g., Medicaid, insurers).
If a person with diabetes were to ask you how your project will help them in the future, how would you respond?Produce prescriptions, and importantly, integration of produce prescriptions into the healthcare space as a first line intervention in diabetes care and prevention, represents a paradigm shift in current thinking about health and healthcare to one that is more holistic and supportive to individuals’ health needs throughout the life span. It is not enough to treat diabetes with medication and education, as these don’t address root causes, which for many, are tied to social determinants of health (e.g., food security, income, race/ethnicity, zip code/neighborhood food availability) that are often beyond a person’s control. Produce prescriptions address these factors; factors that can either help or harm a person’s health and wellbeing. Grounded in the belief that healthy food should be a basic right for all, the benefits of produce prescriptions extend to all Americans. However, individuals with diabetes can especially benefit, as fruits and vegetables are protective (i.e., lowers the risk of) for diabetes-related outcomes.
Why important for you, personally, to become involved in diabetes research? What role will this award play?As a student, the very first research study I worked on was an ADA-funded faith-based program in Baltimore, MD in 2010. This was my first exposure to the American Diabetes Association and our collaboration with them was fantastic. Out of this experience, I learned that ADA not only supports, but emphasizes research that seeks to overcome equity issues dealing with the ability to access and afford healthy food, as a means to diabetes prevention and management. As the formal evaluators of USDA/NIFA GusNIP produce prescription programs, my interests naturally lie in research that explores the impact of financial incentives on health and well-being, as well as the impacts to society and the healthcare sector (e.g., cost to implement programs versus the health benefits from these programs). This ADA grant opportunity is advantageous in that it allows us to to rigorously evaluate a sub-set of GusNIP produce prescription programs that have launched (implementation of produce prescription programs are funded by USDA/NIFA) and that specifically focus on diabetes-related outcomes. Without ADA funds, these projects could not be evaluated to understand the impact of produce prescriptions of people with diabetes and the potential of produce prescriptions in diabetes prevention and management at a national scale. Observing and reporting on the causal impacts of produce prescription programs on participants’ health has immense implications for future federal policymaking.
In what direction do you see the future of diabetes research going?While I can’t speak for the sum total of all diabetes research on the horizon, I believe an extremely important direction in diabetes research is the adoption of effective and sustainable interventions into policy. Equally important are programs for diabetes prevention and management that work to improve root causes or contributors to inadequate diets, such as social determinants of health. Diabetes research that strives to move the needle on improving social determinants of health are especially important and timely, as in recent years food insecurity has risen among Americans (in part due to the Covid-19 pandemic, inflation, etc.) and this directly affects what people eat. While the causes of diabetes are multiple and complex, equitable access to healthy food is an attainable goal that can help prevent and treat diabetes and its complications, and so it is a common-sense strategy in which to focus efforts.