Date of Award

Summer 2021

Document Type

Open Access Dissertation


Epidemiology and Biostatistics

First Advisor

Angela D. Liese


The purpose of this study was to assess the associations between household food insecurity (HFI) and glycemic control, physical activity, and diet quality in youth and young adults (YYA) with type 1 diabetes (T1D) and type 2 diabetes (T2D). Among older adults, HFI has been shown to complicate diabetes management due to the essential role of diet in diabetes management and the financial stress associated with HFI. Although HFI is more prevalent among YYA with diabetes than the general population, there are only a handful of studies that have focused on this population and, studies that include YYA with T2D are especially rare.

Each study cross-sectionally analyzed the association between HFI and outcomes using data from the SEARCH for Diabetes in Youth Study. HFI was measured with the 18-item US Household Food Security Survey Module. The survey was completed by young adult SEARCH participants or by parents of participants that were less than 18 years old.

The first study focused on the association between HFI and HbA1c, glycemic control, and acute diabetes complications (experiencing either diabetic ketoacidosis or hypoglycemia in the last year) in YYA with T2D. The results suggested that YYA with T2D were more likely to experience diabetic ketoacidosis or hypoglycemia if they lived in a food insecure household than a food secure household. The second study assessed the association between HFI, physical activity and inactivity. It found that YYA with T1D reported more time walking per week if they had HFI than if they did not. Additionally, YYA with T2D who had HFI spent more time sitting per day than those that did not have HFI. The final study examined the association between HFI and diet quality, measured with the Health Eating Index-2015. There was no statistical difference in diet quality between those who had HFI and those that did not. However, females with T1D and HFI had lower sodium component Health Eating Index-2015 scores than those who were food secure.

Each individual study indicated that HFI impacts diabetes management and/or behaviors which affect diabetes control in YYA with diabetes. Collectively, these studies lay the foundation for future analyses to assess the mediating role of lifestyle factors such as diet quality and physical activity in the relationship between HFI and glycemic control in YYA with diabetes. Ultimately, this research contributes broadly to the food insecurity literature and the body of evidence calling for diabetes healthcare providers to universally screen for HFI and tailor diabetes management plans to overcome obstacles that interfere with diabetes management.

Available for download on Tuesday, August 15, 2023

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