The effect of food is medicine interventions on diabetes-related health outcomes among low-income and food-insecure individuals: A systematic review and meta-analysis

OBJECTIVE: In this study, we aim to review the current evidence of Food is Medicine interventions on diabetes outcomes among low-income or food-insecure individuals. METHODS: Seven databases were searched from January 1, 2000 to October 26, 2021 for full-text articles written in English. The studies included experimental studies of any duration and design which addressed the effect of Food is Medicine interventions on fruit and vegetable (F&V) intake and glycated hemoglobin (A1C) levels among low-income or food-insecure populations with prediabetes or diabetes of any age group. Only direction of effect of interventions on F&V intake were ascertained due to high variability in outcome measurement. A1C results were pooled using generic inverse variance with a fixed-effects model. Heterogeneity was assessed using Cochran's Q and quantified by I(2). RESULTS: Sixteen studies were included. Five of the 8 studies reported a significant increase in F&V intake. Seven of the 14 studies reported a significant decrease in A1C levels. A meta-analysis of 5 randomized controlled trials (n=843) resulted in clinically meaningful reductions in A1C compared with control (mean difference, -0.47%; 95% confidence interval, -0.66 to -0.29, I(2)=88%, p<0.0001). Half (n=8) of the studies have a high risk of bias due to missing data, detection bias, and confounding. CONCLUSIONS: Food is Medicine interventions are effective in increasing F&V intake and reducing A1C levels of the target population. More randomized controlled studies are needed to validate the results.