Enhancing diabetes self-management and reducing stress through food skills education with medically under-insured individuals with type-2 diabetes

Background: Diabetes self-management education supports healthy dietary behaviors but often lacks food skill-building education to plan, budget for, select, and prepare (cook) healthier food. Objectives: This study examined the relationship between food skills, diabetes self-management, and stress with medically underinsured patients with type-2 diabetes mellitus within the Fresh Start Food is Medicine (FIM) program. A secondary objective was to examine the impact on diet quality and clinical outcomes. Methods: Adults ( n = 150) with type-2 diabetes mellitus participated in the 20-week Fresh Start FIM intervention, which included nine group education classes, a produce prescription, and telephone-based health coaching. Group education and skill-building centered around food skills and diabetes self-management. Measures included surveys (e.g., food skills confidence, diet quality, and stress) and clinical measures (e.g., weight, HbA1c, and blood pressure). Data analysis included paired t -tests, Wilcoxon signed-rank tests, and linear regression. Results: Significant improvements were observed in food skills confidence ( p < 0.001), diet quality (e.g., fruit p = 0.03; vegetable p < 0.001; whole grain p < 0.001 consumption), diabetes self-management ( p < 0.001), and perceived stress ( p = 0.01). Food skills confidence and diabetes self-management were significant predictors of perceived stress ( p = 0.05 and 0.009, respectively). Blood pressure significantly declined (systolic: −6.7 mmHg, p = 0.007; diastolic, p = 0.02). Conclusion: Integrating food skills education and individualized behavioral support within an FIM intervention improved food skills confidence, diabetes self-management, and diet quality while reducing perceived stress among medically underinsured patients with type-2 diabetes mellitus. Enhanced self-efficacy in diabetes management and food skills were key contributors to stress reduction, emphasizing the importance of skill-oriented education within diabetes self-management education. These findings underscore the critical role of food skills in building capacity to improve dietary behaviors and health with resource-limited populations.