• Andrew J Karter, Melissa M Parker, Elbert S Huang, Hilary K Seligman, Howard H Moffet, James D Ralston, Jennifer Y Liu, Lisa K Gilliam, Neda Laiteerapong, Richard W Grant, and Kasia J Lipska.
• Kaiser Permanente Northern California Division of Research, Pleasanton, CA, USA. andy.j.karter@kp.org.
• J Gen Intern Med. 2024 Oct 1; 39 (13): 240024062400-2406.

BackgroundSevere hypoglycemia is a serious adverse drug event associated with hypoglycemia-prone medications; older patients with diabetes are particularly at high risk. Economic food insecurity (food insecurity due to financial limitations) is a known risk factor for hypoglycemia; however, less is known about physical food insecurity (due to difficulty cooking or shopping for food), which may increase with age, and its association with hypoglycemia.ObjectiveStudy associations between food insecurity and severe hypoglycemia.DesignSurvey based cross-sectional study.ParticipantsSurvey responses were collected in 2019 from 1,164 older (≥ 65 years) patients with type 2 diabetes treated with insulin or sulfonylureas.Main MeasuresRisk ratios (RR) for economic and physical food insecurity associated with self-reported severe hypoglycemia (low blood glucose requiring assistance) adjusted for age, financial strain, HbA1c, Charlson comorbidity score and frailty. Self-reported reasons for hypoglycemia endorsed by respondents.Key ResultsFood insecurity was reported by 12.3% of the respondents; of whom 38.4% reported economic food insecurity only, 21.1% physical food insecurity only and 40.5% both. Economic food insecurity and physical food insecurity were strongly associated with severe hypoglycemia (RR = 4.3; p = 0.02 and RR = 4.4; p = 0.002, respectively). Missed meals ("skipped meals, not eating enough or waiting too long to eat") was the dominant reason (77.5%) given for hypoglycemia.ConclusionsHypoglycemia prevention efforts among older patients with diabetes using hypoglycemia-prone medications should address food insecurity. Standard food insecurity questions, which are used to identify economic food insecurity, will fail to identify patients who have physical food insecurity only.© 2024. The Author(s), under exclusive licence to Society of General Internal Medicine.

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