Introduction and Objective: Food Is Medicine interventions are being promoted to improve glycemic control in type 2 diabetes mellitus (T2D), but limited randomized trial (RCT) data exist. We evaluated the efficacy of a scalable, technology-based grocery prescription program in low-income, high-risk adults with T2D.Methods: We conducted a 1:1 RCT in Kaiser Permanente Northern & Southern California integrated healthcare systems from Oct 2023-Dec 2025 in adults with Medicaid insurance, T2D, and glycosylated hemoglobin (A1c) ≥7.5%. We excluded patients with advanced kidney disease, were institutionalized, pregnant, had no internet access, required an interpreter, or no valid credit/debit card. The intervention used the Instacart online platform and provided a $100/mo stipend for healthy foods (e.g., fruits, vegetables, legumes, nuts/seeds, etc.) with 4 free deliveries/mo for 6 mos. The control arm received 4 free Instacart deliveries/mo for 6 mos with no stipend. The primary outcome was 6-mo A1c using an intent-to-treat approach.Results: Among 1007 subjects (510 intervention, 506 control), both arms were balanced in mean age (53.2 vs. 53.1 years); women (67.9% vs. 66.6%); Asian/Native Hawaiian/Pacific Islander (14.4% vs. 12.3%), Black (26.1% vs. 25.1%), and Hispanic ethnicity (40.9% vs. 41.5%); and mean A1c at entry (9.34% vs. 9.21%). Registration to use Instacart (88.6% vs. 50.8%) and mean monthly orders (1.5 vs. 0.2) were higher in intervention vs. control subjects. Follow-up A1c was available in 93.4% of subjects. Both arms had 6-mo reductions in A1c (Intervention: -0.63%, 95% CI: -0.78%, -0.47%; Control: -0.53%, 95% CI: -0.68%, -0.38%). After adjusting for baseline A1c and stratification factors, the intervention arm did not have a significantly lower 6-mo A1c than the control arm (8.63% vs 8.65%; difference: -0.06%, 95% CI: -0.26%, 0.14%, p=0.55).Conclusion: For low-income, high-risk adults with T2D, provision of monthly funds to purchase healthy foods through an online shopping platform did not improve 6-mo glycemic control vs. usual care.
C. Nau: Research Support; Current; NewDays.ai. R.W. Grant: None. R.V. Parikh: None. T. Tan: None. J.C. Lo: None. P. Schwartz: None. J.D. Vallejo: None. S. Alexeeff: None. M. Habib: None. H. Zhong: None. C. Chao: None. A. Erkenbeck: None. D. Mozaffarian: Consultant; Current; Google. Consultant; Ended; Amazon Health. Advisory Panel; Current; Instacart Health, Nourish. A. Go: Research Support; Ended; Novartis AG. Research Support; Current; Bristol-Myers Squibb Company. Advisory Panel; Current; Bristol-Myers Squibb Company, Janssen Pharmaceuticals, Inc. Research Support; Ended; Edwards Lifesciences Corporation.
The Kaiser Permanente Community HealthFund at the East Bay Community Foundation
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