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Is “Food as Medicine” a Game Changer for Diabetes?

Kerri Waldron

March 24, 2024

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6 min read

Providing healthy meals to individuals with Type 2 diabetes modestly reduced blood sugar levels, underscoring the need for ongoing research to refine food-as-medicine programs.

Study of rigorous trial shows mixed results, suggests need to keep examining how nutrition can combat a pervasive disease.

How much can healthy eating improve a case of diabetes? A new healthcare program attempting to treat diabetes by means of improved nutrition shows a very modest impact, according to the first fully randomized clinical trial on the subject.

The study, co-authored by

Clinical Trial Findings and Implications

The program involved people with high blood sugar levels, in this case an HbA1c hemoglobin level of 8.0 or more. Participants in the clinical trial who were given food to make 10 nutritious meals per week saw their hemoglobin A1c levels fall by 1.5 percentage points over six months. However, trial participants who were not given any food had their HbA1c levels fall by 1.3 percentage points over the same time. This suggests the program’s relative effects were limited and that providers need to keep refining such interventions.

“We found that when people gained access to [got food from] the program, their blood sugar did fall, but the control group had an almost identical drop,” says Doyle, the Erwin H. Schell Professor of Management at MIT Sloan.

Food Insecurity and Health Outcomes

Given that these kinds of efforts have barely been studied through clinical trials, Doyle adds, he does not want one study to be the last word, and hopes it spurs more research to find methods that will have a large impact. Additionally, programs like this also help people who lack access to healthy food in the first place by dealing with their food insecurity.

“We do know that food insecurity is problematic for people, so addressing that by itself has its own benefits, but we still need to figure out how best to improve health at the same time if it is going to be addressed through the health care system,” Doyle adds.

Research Methodology and Participant Demographics

The paper, “The Effect of an Intensive Food-as-Medicine Program on Health and Health Care Use: A Randomized Clinical Trial,” was published recently in JAMA Internal Medicine.

The authors are Doyle; Marcella Alsan, a professor of public policy at Harvard Kennedy School; Nicholas Skelley, a predoctoral research associate at MIT Sloan Health Systems Initiative; Yutong Lu, a predoctoral technical associate at MIT Sloan Health Systems Initiative; and John Cawley, a professor in the Department of Economics and the Department of Policy Analysis and Management at Cornell University and co-director of Cornell’s Institute on Health Economics, Health Behaviors and Disparities.

Study Execution and Results

To conduct the study, the researchers partnered with a large health care provider in the Mid-Atlantic region of the U.S., which has developed food-as-medicine programs. Such programs have become increasingly popular in health care, and could apply to treating diabetes, which involves elevated blood sugar levels and can create serious or even fatal complications. Diabetes affects about 10 percent of the adult population.

The study consisted of a randomized clinical trial of 465 adults with Type 2 diabetes, centered in two locations within the network of the health care provider. One location was part of an urban area, and the other was rural. The study took place from 2019 through 2022, with a year of follow-up testing beyond that. People in the study’s treatment group were given food for 10 healthy meals per week for their families over a six-month period, and had opportunities to consult with a nutritionist and nurses as well. Participants from both the treatment and control groups underwent periodic blood testing.

Analyzing the Program’s Effectiveness

Adherence to the program was very high. Ultimately, however, the reduction in blood sugar levels experienced by people in the treatment group was only marginally bigger than that of people in the control group.

Those results leave Doyle and his co-authors seeking to explain why the food intervention didn’t have a bigger relative impact. In the first place, he notes, there could be some basic reversion to the mean in play — some people in the control group with high blood sugar levels were likely to improve that even without being enrolled in the program.

Future Directions and the Role of Meal Preparation

“If you examine people on a bad health trajectory, many will naturally improve as they take steps to move away from this danger zone, such as moderate changes in diet and exercise,” Doyle says.

Moreover, because the healthy eating program was developed by a health care provider staying engaged with all the participants, people in the control group may have still benefitted from medical engagement and thus fared better than a control group without such health care access.

It is also possible the DOI: 10.1001/jamainternmed.2023.6670

Support for the study came from the Robert Wood Johnson Foundation; the Abdul Latif Jameel Poverty Action Lab (J-PAL); and the MIT Sloan Health Systems Initiative. Outside the submitted work, Cawley has reported receiving personal fees from Novo Nordisk, Inc, a pharmaceutical company that manufactures diabetes medication and other treatments.

Source: scitechdaily.com