With half of screened participants showing abnormal blood sugar levels, a Chicago-based study underscores the urgent need for targeted screenings and lifestyle support in food-insecure neighborhoods.

Study: Prevalence and underdiagnosis of diabetes mellitus in a food insecure population. Image Credit: ADragan / Shutterstock

In a recent article published in the journal Scientific Reports, researchers examined the prevalence and self-awareness of prediabetes and diabetes in a population experiencing food insecurity attending two food pantries, Beyond Hunger and Harmony Church, in West Chicago.

Their findings indicate a high prevalence of diabetes and prediabetes among this population, with many patients unaware of their condition and struggling to control their blood sugar levels.

Background

The eighth most common cause of mortality in the U.S. is diabetes mellitus (DM), which is closely linked to serious complications like neuropathy, kidney disease, and cardiovascular diseases. Type 2 diabetes mellitus (T2DM) typically develops gradually as resistance to insulin grows and beta-cell exhaustion occurs.

Many people remain undiagnosed for years during a prodromal stage known as prediabetes, characterized by A1c levels between 5.7% and 6.4%, with normal levels defined as less than 5.7%, and diabetes as greater than 6.4%. In 2021, more than 97 million Americans were estimated to have prediabetes. Although pharmacotherapy is vital for managing T2DM, lifestyle modifications focusing on exercise and diet are essential.

However, food-insecure individuals face significant challenges maintaining a healthy diet due to limited access to nutritious foods. An estimated 12.8% of American households reported food insecurity in 2022. Food insecurity appears to be strongly associated with higher rates of diabetes and delayed disease detection.

Despite the established link between T2DM and food insecurity, little research has explored the management and awareness of diabetes in food-insecure populations.

About the study

This study addressed an important research gap by investigating prediabetes and diabetes prevalence in a food-insecure community, emphasizing the necessity of targeted education and prevention efforts.

The Cardiometabolic Health Initiative (CHI), founded by medical students, is an interdisciplinary group that includes health coaches, community health professionals, students, nurses, and physicians. CHI offers free cardiometabolic screenings at food pantries serving food-insecure and under-resourced populations across West Chicago.

This retrospective study collected data from August 2023 to December 2024 during CHI screening events. A total of 191 patients were screened using point-of-care hemoglobin A1c (HbA1c) testing. Patients were categorized based on A1c results: normal if their A1c was below 5.7%, prediabetic if they were in the range of 5.7 to 6.4%, or diabetic if levels were greater than 6.4%. Self-reported diabetes diagnoses were also recorded.

A power analysis confirmed that the sample size was sufficient to detect a 10% difference in diabetes and prediabetes prevalence compared to national estimates.

The researchers analyzed the relationship between patients’ self-reported diabetes status and their measured A1c levels to assess disease prevalence, awareness, and control within the population. They specifically evaluated the proportion of individuals with controlled (A1c 7%) among those who self-reported having diabetes and identified undiagnosed cases based on elevated A1c among those who did not report a diagnosis.

The findings aimed to provide insight into the burden of diabetes and prediabetes among food-insecure individuals and to highlight gaps in diagnosis and management.

Findings

A total of 191 patients underwent A1c testing, of whom 63% identified as female. On average, the patients were 54 years old, and those in the group who self-reported DM were older (60.6 compared to 52.2).

Overall, the body mass index (BMI) was 29.2 kg/m², which was slightly higher in the DM group (31.1 compared to 28.7 kg/m²). Men who reported having diabetes had a significantly higher waist circumference (112.6 cm) than men who did not (97.9 cm); among women, the difference was less pronounced (96.9 cm vs. 100.7 cm). The self-reported diabetes group was 45% Black or African American and 45% Hispanic or Latino; the non-reported group was 37% Black and 43% Hispanic, with no significant differences between groups.

The overall average A1c was slightly over 6%. Half of the patients had abnormal A1c levels: 35% were prediabetic, while 15% were diabetic. In the group that self-reported DM, average A1c levels were 7.6%, with 24 patients showing controlled and 18 showing uncontrolled diabetes. In the group that did not report DM, 90 patients had normal A1c, 56 were prediabetic, and 3 had diabetic-range A1c, indicating previously undiagnosed diabetes. This represents 38% with prediabetes and 2% with undiagnosed diabetes in the non-reported group.

Conclusions

This study found a high prevalence of prediabetes and diabetes in a population experiencing food insecurity in West Chicago, with 50% of individuals having abnormal A1c levels. Among screened individuals, 22% self-reported a diabetes diagnosis, which is nearly double the national average of 10.7%, aligning with prior findings that food insecurity increases chronic disease risk.

Poor access to healthy foods may lead to unhealthy diets, poor glycemic control, and complications such as cardiovascular disease and kidney disease. Notably, 38% of patients without a prior diabetes diagnosis had prediabetic A1c levels, and three were newly identified as diabetic, underscoring the importance of routine screenings in at-risk populations.

The study also findings from a 30-year lifestyle intervention trial showing that changes in diet and exercise significantly reduced diabetes progression, cardiovascular events, and all-cause mortality.

The study authors acknowledged some limitations of their analysis, including their reliance on self-reported diabetes status, which may underestimate undiagnosed cases, and their focus on a food-insecure population in West Chicago, which limits broader generalizability.

The findings suggest an urgent need for community-based screenings, health education initiatives, and accessible preventive services to reduce undiagnosed and uncontrolled diabetes among food-insecure populations.