Evaluating diabetes self-management education and support services delivered alone and in combination with produce packages at a Texas Food Bank.

Abstract

Food banks can successfully deliver diabetes self-management education and support (DSMES) services, which improve glycemic control and reduce adverse outcomes among people with diabetes (PWD). However, consequences of providing produce packages with DSMES in food banks are unknown. This study assessed pre-to-post intervention changes in hemoglobin A1c (HbA1c), food security, and other outcomes among PWD (type 1 or 2) in two 8-week interventions delivered by a Texas food bank, one providing DSMES services alone (Diabetes Hands On [DHO], n = 31) and one providing DSMES services plus fruit/vegetable packages (Diabetes Hands On Plus [DHO+], n = 48). At pre- and post-intervention, HbA1c and body mass index (BMI) were directly measured, and surveys assessed food security, diabetes distress, diabetes self-efficacy, diabetes knowledge, medication-taking, perceived social support, fruit and vegetable intake, and diabetes-specific food security. Post-intervention questionnaires gauged program satisfaction. Participants in both DHO and DHO+ showed significant improvements in HbA1c, BMI, diabetes distress, diabetes self-efficacy, diabetes knowledge, vegetable intake, and some measures of diabetes-specific food security (p < .05 for each outcome). Average decreases in HbA1c were greater among DHO (-0.6%) versus DHO+ participants (-0.2%). Food security improved significantly in DHO participants only (pre: 32% very low; post: 10%, p = .001), as did medication-taking (p = .03). Fruit intake increased significantly in DHO+ participants only (p = .04). When asked to assess DHO/DHO+ overall, over 95% of both programs' participants provided "excellent" ratings. This study suggests that this food bank's DSMES services, with or without produce, may have been effective for improving HbA1c and other clinical, behavioral, and psychosocial outcomes among PWD. Benefits of providing produce alongside DSMES remain unclear. Further research may be needed to explore factors such as dose, duration, and household-level use. Studies in other geographies and non-food-bank settings may increase understanding of the generalizability of findings.