Abstract P084: Food for Thought: Patient Perspectives on Medically Tailored Meal Delivery for Patients With Diabetes Who Experience Food Insecurity
Authors: Shahid Naysha , Terranova Jean , Wexler Deborah J , Berkowitz Seth A 
Published: July 2021

Introduction:
Food insecurity, limited or uncertain access to nutritious food owing to cost, is a major impediment to dietary adherence in diabetes management. Medically tailored meal (MTM) programs, which deliver ready-to-eat meals prepared under the supervision of a dietitian tailored to specific nutritional needs, are potentially transformative interventions for food insecure diabetes patients. However, mechanisms whereby MTM might improve diabetes management are understudied.

Hypothesis:
We hypothesized that MTM may improve diabetes management by overcoming financial barriers to following a healthy diet and modeling healthy meals.

Methods:
This qualitative study included 20 participants in a randomized crossover trial of MTM for patients with suboptimally controlled type 2 diabetes (Hemoglobin A1c > 8.0%) and food insecurity (assessed using USDA Food Security Household Survey Module). The goal was to investigate mechanisms whereby MTM affects diabetes management using semi-structured interviews, until saturation was achieved. Participants were asked to give their perceptions regarding how the meals influenced diabetes management and awareness. Interviews were recorded, transcribed verbatim, and coded independently by two investigators. Using qualitative analysis following the immersion-crystallization approach, we evaluated how receiving medically tailored meals influenced diabetes management for patients who are food insecure.

Results:
Many participants reported that the meals helped with managing their diabetes and increased their understanding about diabetes (example quotation: “When I started my A1c level was so high. And when I started this program they had to teach me how much food I have to eat and all the protein I have to get. And then through the program my A1c went down.”). Participants also noted that the program taught them about healthier food options and portion control, with many suggesting that the meals served as a model for their diet and meal preparation after the study (example quotations: “It gave me a couple of ideas as far as using let's say barley or bulgur wheat. It also gave me an idea of the kinds of things, the range of things that were acceptable, and the portion size was helpful too.” “I used to eat a lot of Italian macaroni and sauce, and eat bread, and dunk my bread in sauce. I don't do that anymore.”). Finally, participants noted that meal delivery relieved financial barriers to eating more healthily (example quotations: “Financially, it saved me a real lot of money. I would not have been able to afford those kinds of meals myself.” “It’s actually helped me out a lot because they cut me down on food stamps, so I was actually unable at the time to be able to eat the foods I was supposed to.“).

Conclusions:
Medically tailored meal delivery is a promising intervention that may help vulnerable patients with diabetes overcome several barriers to improving health.