Hemoglobin A1c and Weight Changes Associated With Grocery Delivery and Low-Carbohydrate Education in Adults With Type 2 Diabetes and Food Insecurity: Observational Quality Improvement Cohort Study

Abstract Background Type 2 diabetes mellitus (T2D) is one of the most significant chronic health challenges in Michigan, especially for individuals with food insecurity. Improving nutrition, including lowering carbohydrate intake, is foundational to T2D prevention and management. Grocery delivery paired with low-carbohydrate education has the potential to reduce logistical barriers to dietary change but is not well understood in individuals with food insecurity. Objective The objective of our study was to evaluate changes in clinical metrics of hemoglobin A 1c (HbA 1c ), weight, and diabetes medication use after a paired grocery delivery and low-carbohydrate education program. Methods The Healthy Eating Jumpstart Program (hereafter, Jumpstart) enrolled adult Michiganders with T2D and low income or food insecurity from 21 Michigan primary care practices between October 2022 and May 2023. Jumpstart was a 3-month, nonrandomized grocery delivery and low-carbohydrate education quality improvement program without a control group. Participants received US $80 every month through Shipt to purchase eligible healthy foods, along with low-carbohydrate educational materials. Clinical metrics of HbA 1c , weight, and diabetes medication use were collected from medical records from 6 months before enrollment through 12 months after enrollment. Changes in HbA 1c and weight from baseline were evaluated at 3, 6, 9, and 12 months, with stratification by baseline glycemic control and glucagon-like peptide-1 receptor agonist (GLP-1 RA) medication use, respectively. Overall change was assessed with paired t tests comparing baseline values to each participant’s latest value for HbA 1c and weight. Medication changes were assessed by comparing baseline and 12-month dosing to categorize changes as increased, decreased, eliminated, or unchanged. Results A total of 83 patients participated in Jumpstart. Participants were primarily female (57/79, 72%), White (70/79, 89%), and had a high school degree or less (35/79, 44%). At baseline, the average HbA 1c was 7.6% (SD 2%), average weight was 105 (SD 25.8) kg, and average BMI was 38.2 (SD 8.8) kg/m 2 . The overall reduction in HbA 1c from baseline was 0.4% (SD 1.4%; P =.02; n=68), and this reduction was greater when limited to individuals with uncontrolled HbA 1c at baseline (mean 0.7%, SD 1.8; P =.02; n=38). The overall percent reduction in weight from baseline was 1.7% (SD 4.4%; P =.002; n=66), but this change was not significant when limited to non–GLP-1 RA users. Most medications had no change in dosing (77/166, 46%), and slightly more medications were increased or added (n=52, 31%) than decreased or discontinued (n=37, 22%). Conclusions The results from this clinical evaluation suggest that the Jumpstart quality improvement program was associated with improvements in HbA 1c that persisted beyond 6 months and small reductions in weight among participants. A low-burden program such as Jumpstart may be a feasible approach to support long-term dietary change in patients with T2D and food insecurity or low income.