Effect of free healthy food access on diabetes control: a living systematic review

Individuals experiencing food insecurity are more likely to develop diabetes and diabetes complications. Programs aimed at improving access to healthy foods differ between jurisdictions. There are completed and ongoing trials of interventions that improve access to fruits and vegetables for people with type 2 diabetes experiencing food insecurity. We aimed to examine the effects of interventions providing free access to healthy foods for individuals with prediabetes or type 2 diabetes on health outcomes. We searched seven electronic databases on July 30, 2025 for controlled trials and quasi-experimental studies of interventions providing free access to healthy foods from 1980 to the present day of the search. Title and abstract screening and full text reviews were conducted in Covidence by two independent reviewers. The population was people with type 2 diabetes or prediabetes, who have a low-income or are experiencing food insecurity. We included clinical trials and quasi-experimental studies of interventions providing access to healthy food options at no cost. Two authors independently performed data extraction and bias and certainty assessments. Results were pooled using random-effects meta-analyses. We assessed risk of bias using the ROB 2 tool for clinical trials. Outcomes were HbA1c, fruit and vegetable consumption, food security, financial security, health care utilization, overall health, and quality of life. Seven trials were included; all had high risk of bias. There was low certainty that interventions may be associated with a small reduction in HbA1c, which was not statistically significant (mean difference − 0.10 [95% CI -0.36 to 0.17]; p = 0.48). There was low certainty that interventions may reduce food insecurity (risk ratio 0.87 [95% CI 0.80 to 0.95]; p = 0.0013). Interventions providing free access to healthy foods may improve diet quality, increase vegetable and fruit consumption, reduce blood pressure and improve overall health but data were from few trials. The interventions reduced food insecurity and may improve glycemic control but reduction in HbA1c was not statistically significant or large. The findings are limited by high risk of bias and small number of trials.