Delivering medically tailored groceries to adults with poorly controlled type 2 diabetes helped them lower their blood sugar over six months, according to a randomized controlled trial involving Medicaid patients in Southern California.
The grocery program was added to participants’ usual diabetes care, not used as a replacement for medication or other treatment. It also included culturally tailored recipes and access to phone-based nutrition counseling, meaning the study cannot determine how much of the benefit came from the food itself and how much came from the broader support surrounding it.
The study was published in the American Heart Association journal Circulation.
The trial included 460 adults receiving care through Kaiser Permanente Southern California. All had type 2 diabetes and persistently elevated blood sugar levels. Researchers recruited participants from 12 medical offices between November 2021 and July 2022.
Participants were randomly assigned to continue receiving usual care or to receive one of two levels of monthly grocery assistance for six months. The grocery benefits averaged about $135 or $175 per month.
Those in the grocery groups received weekly deliveries of foods selected with diabetes management in mind. The amount of food was adjusted according to household size. Participants also received culturally tailored recipes and could speak with a nutrition counselor by phone.
Compared with those receiving usual care alone, people who received the groceries had an additional 0.40 percentage-point reduction in HbA1c. HbA1c is a blood test used to estimate a person’s average blood sugar over the previous two to three months.
“This trial shows that food-based support can help patients with low incomes lower their blood sugar levels above and beyond the health care they receive,” said lead author Claudia Nau, a researcher with the Kaiser Permanente Southern California Department of Research & Evaluation.
The improvement was modest, and the study did not show that grocery assistance could replace standard diabetes treatment. Instead, the results suggest that helping people obtain appropriate food may make it easier for them to manage the condition alongside their existing medical care.
“Our findings suggest that addressing access to healthy food can play a meaningful role in diabetes care for patients, particularly those facing economic and social barriers,” Nau said.
Participants receiving groceries also became more likely to report having secure access to enough food and to foods that supported their health. The researchers found that the odds of food security increased by nearly 215% and the odds of nutrition security increased by 365% among grocery recipients.
Those figures describe changes in odds, rather than the percentage of participants who became food or nutrition secure. Still, they indicate that the program affected more than blood sugar. It also helped address some of the financial and practical conditions that can make diabetes management difficult.
People are often advised to buy more fruits, vegetables and other nutrient-rich foods after being diagnosed with type 2 diabetes. That advice may be difficult to follow when household food budgets are limited, appropriate foods are unavailable or patients are also feeding other family members.
The trial tested whether providing food directly could help bridge the gap between receiving nutrition advice and having the resources to act on it.
“These trial results further demonstrate that healthy food can be a powerful tool in treatment and management of chronic disease,” said senior author Dr. Dariush Mozaffarian, a cardiologist and director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University.
The findings do not mean that all grocery programs will produce the same results. Participants were Medicaid-insured Kaiser Permanente patients in Southern California whose blood sugar remained elevated despite receiving care. The effects could differ among people whose diabetes is already well controlled, those living in other regions or those receiving food without recipes, delivery and nutrition support.
The study also followed participants for six months. It did not establish whether the blood sugar improvements continued after the grocery deliveries ended or whether the program reduced medication use, hospitalizations or long-term diabetes complications.
Researchers found similar blood sugar improvements in the groups receiving the lower and higher grocery amounts. That result suggests the more expensive benefit did not provide an additional advantage for HbA1c during the trial, although more research would be needed to determine the most effective and affordable program design.
The study also did not determine whether potential health care savings would offset the cost of purchasing and delivering groceries. Those questions will be important as insurers, health systems and policymakers consider whether medically tailored food programs should be incorporated into Medicaid and other health benefits.
“For too long nutrition has been an afterthought in healthcare, despite poor diets driving immense disease burden and healthcare costs globally - not just in the United States,” said Dr. Jason Wu, head of nutrition science at The George Institute for Global Health and a co-principal investigator for the trial.
The findings add to an evolving body of research on Food is Medicine programs, which can include medically tailored meals, groceries selected for particular health needs and produce prescriptions. Results across programs have not always been consistent, in part because the interventions, populations and levels of support vary.
This trial provides stronger evidence than an observational study because participants were randomly assigned to receive the program or usual care. It suggests that when adults with poorly controlled type 2 diabetes face economic barriers, providing medically appropriate food and practical nutrition support can contribute to better blood sugar control.
The study was funded by Kaiser Permanente Community Health. Kaiser Permanente Southern California conducted the trial within its health care system, and several study authors were affiliated with Kaiser Permanente.