MON-543 Lowering Food Insecurity And Improving Diabetes With Financial Incentives

Abstract Disclosure: R.J. Walker: None. J.A. Campbell: None. L.E. Egede: None. Introduction and Objective: Food insecurity, defined as limited or uncertain access to adequate food for an active, healthy life, is reported by 28.6% of individuals living in poverty, and is associated with higher likelihood of diabetes. Food insecure adults with type 2 diabetes have worse clinical outcomes compared to food secure individuals. Monetary interventions are shown to be effective in improving diabetes outcomes but have not been tested within the context of food insecurity. The objective of this pilot study was to test preliminary efficacy of income supplementation and financial incentives intervention in reducing HbA1c for food insecure adults with type 2 diabetes. Methods: 50 adults with poorly controlled type 2 diabetes received an intervention that included 1) unconditional basic income supplementation of $100 per month, 2) reimbursement of up to $100 per month conditional on healthy food purchasing, and 3) incentives at 6-months for dropping HbA1c ($150 for a drop of 2%+, $100 for a drop of 1%-1.9% or $50 for a drop of 0.5%-0.9%). All participants also received monthly diabetes education/skills training mailings. Longitudinal mixed models with treatment, time, and treatment x time interactions for change in HbA1c from baseline were run using 0.5% as a clinically meaningful drop in HbA1c and p<0.05 as statistically significant. This preliminary analysis focused on one arm of a larger pilot study. Results: The sample had a mean age 52, 61% female, 53.0% Black, 8.1% Hispanic, 25% making <$10,000 per year, 3.3% with no insurance and 51% with Medicaid. We found clinically and statistically significant drops in HbA1c of 0.99% (-1.39, -0.60, p<0.001) at 3-months and 0.78% (-1.18, -0.37, p<0.001) at 6-months. Feedback from participants was positive and they expressed appreciation for the unconditional income supplementation and the ability to further supplement purchase of healthy food options with the conditional incentives. Conclusion: A multiple component income supplementation and financial incentive intervention provided to food insecure adults with diabetes resulted in clinically meaningful reductions in HbA1c. Future studies need to test the intervention against a control group and follow participants for longer periods of time to investigate if monetary approaches are beneficial compared to standard care and identify sustainability of effect over time. Presentation: Monday, July 14, 2025