Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department

• Published in: The western journal of emergency medicine Vol. 21; no. 4; pp. 959 - 963
• Main Authors: Nhoung, Heng Ky, Goyal, Munish, Cacciapuoti, Maria, Day, Hannah, Hashemzadeh, Taymour, Magee, Michelle, Jarris, Yumi S
• Format: Journal Article
• Language: English
• Published: United States University of California Digital Library - eScholarship 03.07.2020; Department of Emergency Medicine, University of California, Irvine School of Medicine; eScholarship Publishing, University of California
• Subjects: Adult; Aged; Blood Glucose - analysis; Cross-Sectional Studies; Diabetes Mellitus; Emergency Service, Hospital; Female; Food; Food Insecurity; Food security; Glycated Hemoglobin A - analysis; Hospitalization; Humans; Hyperglycemia; Hyperglycemia - drug therapy; Insulin; Insulins - therapeutic use; Male; Middle Aged; Patient Compliance; Population Health and Social Emergency Medicine; Prevalence
• ISSN: 1936-900X; 1936-9018; 1936-9018
• DOI: 10.5811/westjem.2020.4.45918

The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter. This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing. Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21-2.99], p<.01). Food insecure patients were younger than non-food insecure patients (50.4 vs 57.5 p<.02), and had significantly higher hemoglobin A1c (HgbA1c) levels (11.2% vs 9.9% p = 0.04). Of the 49 patients prescribed insulin, 17 (34.6%) stated they had used less insulin during the prior week than had been prescribed, and 21 (42.9%) stated they had used less insulin during the prior year than had been prescribed. Food insecure patients were more likely to have used less insulin than prescribed in the prior year (odds ratio = 3.60 [1.09-11.9], p = 0.04). Our exploratory findings suggest almost half of clinically stable adults presenting to our inner-city ED with hyperglycemia experience food insecurity. More than one-third of those prescribed insulin used less than their prescribed amount in the prior year.