• Seth A Berkowitz, Linda M Delahanty, Jean Terranova, Barbara Steiner, Melanie P Ruazol, Roshni Singh, Naysha N Shahid, and Deborah J Wexler.
• Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA, USA. seth_berkowitz@med.unc.edu.
• J Gen Intern Med. 2019 Mar 1; 34 (3): 396-404.

BackgroundFood insecurity, defined as inconsistent food access owing to cost, leads to poor health.ObjectiveTo test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.DesignRandomized cross-over clinical trial.ParticipantsForty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item "Hunger Vital Sign").InterventionIn the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of "on-meals" (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and "off-meals" (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.Main MeasuresThe primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0-100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.Key ResultsMean "on-meal" HEI score was 71.3 (SD 7.5) while mean "off-meal" HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% "on-meal" vs. 62% "off-meal," p = 0.047), less hypoglycemia (47% "on-meal" vs. 64% "off-meal," p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).ConclusionsFor food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).

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