Introduction and Objective: US federal food assistance funds (SNAP) are often exhausted by month’s end, exacerbating food insecurity and in turn SH risk in people with insulin- or secretagogue-treated diabetes. EFOs (e.g., food pantries) offer a partial stopgap, but in areas with fewer EFOs relative to SNAP retailers SH vulnerability may be heightened. Incomplete EFO data have limited prior investigation. Using iNPHORM data and a newly compiled EFO dataset, we examine the association between SNAP retailer/EFO mix and SH incidence. Methods: Using webscraping across 85 open data services, we compiled a novel EFO dataset (n=74369), validated against Current Population Survey estimates. State-level SNAP% was calculated as percentage of all food access points (SNAP + EFO) that are SNAP retailers. Self-reported SH, state, and other individual characteristics were drawn from iNPHORM, a US-wide, 12-month panel survey of adults with type 1 or insulin- and/or secretagogue-treated type 2 (T1D, T2D) (n=985 with ≥1 follow-up and no missing SH data). Negative binomial regression (adjusting for age, education, household income, living situation, race, rurality, sex, and marital status) tested the association between state SNAP% and SH rate, for T1D and T2D. Results: In 985 respondents mean age was 51, 50.5% were female, and 83.4% had T2D. Among T1D respondents, there was a 20% (95% CI 7% - 34%) adjusted increase in SH rate per 1 percentage point increase in state SNAP%. No statistically significant association was observed for T2D. Conclusion: Higher state-level SNAP% was associated with significantly increased SH rates in T1D, but not T2D, possibly reflecting heterogeneity in medication regimen. While some states have expanded EFOs in response to policy changes reducing SNAP eligibility, such measured may be insufficient to mitigate SH where EFO capacity is limited. Disclosure S.J. Huang: None. J. Black: None. R. McCoy: None. A. Ratzki-Leewing: Advisory Panel; Current; Sanofi. Consultant; Current; Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Research Support; Current; Sanofi. Other - Paid presentation; Ended; Abbott. Consultant; Current; Sanofi. Funding iNPHORM was funded through an investigator-initiated grant from Sanofi GlobalNational Institutes of Health (5T32DK098107-09)
HUANG et al. (Fri,) studied this question.