Can Prescribing Produce Help Manage Type 2 Diabetes?
Posted:
2023-08-21
What’s happening?
The health and economic burden of cardiovascular disease associated with type 2 diabetes on individuals and populations is well understood, including direct and indirect costs (1). Can prescribing ‘food as medicine’ have a positive effect on health outcomes, health care costs and health-related quality of life? A recent U.S. study that looked at the impact of implementing a fruit and vegetable prescription program for adults aged 40-79 years living with diabetes and food insecurity may help to provide some answers (2).
Study analysis
Produce prescription programs provide free or discounted produce and nutrition education/cooking guidance to individuals identified with diet-related conditions who often experience food insecurity (2). The authors conducted a systematic review and meta-analyses of 20 such programs (quasi experimental designs without control groups) and reported improvements in average fruit and vegetable intake (+0.8 servings/day), reduced BMI (-0.45 kg/m2) and reduced A1C (-0.63%) over a range of three to 18 months. Then, using data from three cycles of the National Health and Nutrition Examination Survey (NHANES, cycles 2013-2018), the potential health and economic impacts and cost-effectiveness of implementing produce prescription programs were assessed using a validated computer-based microsimulation model (2). Microsimulation models are used to generate outcomes for each individual to estimate the distribution of the outcome to help inform program and policy decision-making (3).
Overall, the modelling suggested that a produce prescription program that provided a monthly food voucher or food box (US$42/person/month) to 6.5 million U.S. adults with diabetes and food insecurity could prevent 292,000 cardiovascular events and gain 260,000 quality-adjusted life years (QALYs) (2). Taking into consideration food (US$37.3 billion) and administrative costs (US$7 billion), the intervention could save US$39.6 billion in health care costs and US$4.8 billion in productivity costs over a lifetime. The simulation also projected cost savings at five years and 10 years. Causality between the program and cost effects could not be established due to the nature of modelling and assumptions from studies that were based on short interventions (up to 18 months) that were sustained for a longer duration (up to five years, 10 years and lifetime). However, stratification of findings in population subgroups by age, race or ethnicity, education and baseline insurance status demonstrated similar results. The study authors suggested the implementation of produce prescription programs could offer a strong health and economic intervention to address rising health disparities and health care costs.
What now?
Diet can play a critical role in disease prevention and management (4) and eating patterns should be understood through a health disparities lens, focusing on the importance of consistent access, availability and affordability of nutritious foods (5).
The study’s outcomes provide estimates of possible health and quality of life impacts at individual and population levels (2). Further implementation and evaluation of produce prescription programs can help inform future program and policy development strategies (2) along with other food-based programs and interventions in health care and population health (6).
Dietitians should continue to advocate for individual and population-based interventions to address food insecurity, including adequate incomes (7), as well as system-level prevention strategies for type 2 diabetes, in addition to lifestyle and pharmacologic interventions (8).
Additional Content
References
- Einarson TR, Acs A, Ludwig C, Panton UH. Economic burden of cardiovascular disease in type 2 diabetes: a systematic review. Value Health. 2018 Jul;21(7):881-90. doi: 10.1016/j.jval.2017.12.019. Epub 2018 Feb 16. PMID: 30005761. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/30005761/
- Wang L, Lauren BN, Hager K, Zhang FF, Wong JB, Kim DD, Mozaffarian D. Health and economic impacts of implementing produce prescription programs for diabetes in the United States: a microsimulation study. J Am Heart Assoc. 2023 Aug;12(15):e029215. doi: 10.1161/JAHA.122.029215. Epub 2023 Jul 7. PMID: 37417296. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/37417296/
- Krijkamp EM, Alarid-Escudero F, Enns EA, Jalal HJ, Hunink MGM, Pechlivanoglou P. Microsimulation modeling for health decision sciences using R: a tutorial. Med Decis Making. 2018 Apr;38(3):400-42. doi: 10.1177/0272989X18754513. PMID: 29587047; PMCID: PMC6349385. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6349385/
- Dietitians of Canada. What nutrition strategies can prevent cardiovascular disease (CVD) in the healthy population (primary prevention)? In Practice-based Evidence in Nutrition® [PEN]. 2021-06-02. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=2671&pqcatid=146&pqid=2459. Access only by subscription. Click Sign Up on PEN login page.
- Walker RJ, Smalls BL, Campbell JA, Strom Williams JL, Egede LE. Impact of social determinants of health on outcomes for type 2 diabetes: a systematic review. Endocrine. 2014 Sep;47(1):29-48. doi: 10.1007/s12020-014-0195-0. Epub 2014 Feb 15. PMID: 24532079; PMCID: PMC7029167. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/24532079/
- Mozaffarian D, Blanck HM, Garfield KM, Wassung A, Petersen R. A Food is Medicine approach to achieve nutrition security and improve health. Nat Med. 2022 Nov;28(11):2238-2240. doi: 10.1038/s41591-022-02027-3. PMID: 36202998. Abstract available from: https://pubmed.ncbi.nlm.nih.gov/36202998/
- Dietitians of Canada. Household food insecurity background. In Practice-based Evidence in Nutrition® [PEN]. 2022-11-09. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=15294&trid=19092&trcatid=38. Access only by subscription. Click Sign Up on PEN login page.
- Dietitians of Canada. Diabetes/glucose intolerance background. In Practice-based Evidence in Nutrition® [PEN]. 2023-06-07. Available from: https://www.pennutrition.com/KnowledgePathway.aspx?kpid=3876&trcatid=38&trid=18507. Access only by subscription. Click Sign Up on PEN login page.