Introduction and Objective: Food insecurity is a key risk factor for severe hypoglycemia among insulin users. Whether this extends to non-insulin-treated secretagogue users remains unexamined, despite widespread prescribing of these agents, particularly in cost-sensitive contexts. We analyzed data from the iNPHORM study to address this gap.Methods: Adults (≥18 years) with type 2 diabetes (T2D) on secretagogues (no insulin) were recruited from a US-wide probability-based internet panel. An online screener, baseline, and ≤12 monthly questionnaires captured Level 3 (severe) hypoglycemia frequency and other participant-reported data. A validated item assessed food insecurity at baseline: “Within the past 12 months, did you ever cut the size of your meals or skip meals because there was not enough money for food?” Complete cases with ≥1 follow-up were analyzed. Multivariable negative binomial regression estimated the association between food insecurity and annualized Level 3 hypoglycemia rates, with follow-up time as an offset. A directed acyclic graph identified confounders.Results: N=339 were analyzed (male: 50.7%; age: 54.8 [SD 13.2] years; T2D duration: 10 [IQR 12] years). Among those exposed to past-year food insecurity (n=64; 19%), the incidence proportion (IP) of Level 3 hypoglycemia was 34.4 (95% CI 23.9-46.6)% and the incidence rate (IR) was 12.3 (95% CI 5.5-27.1) events per person-year (EPPY). Among those not exposed, the IP was 18.9 (95% CI 14.7-24.0)% and the IR was 2.1 (95% CI 1.3-3.3) EPPY. Food insecurity was associated with an adjusted rate ratio of 2.1 (95% CI 1.4-3.1; p<0.001).Conclusion: In this first-of-its-kind study, past-year food insecurity was linked to a two-fold higher subsequent annual rate of Level 3 hypoglycemia among non-insulin-treated secretagogue users—one of the largest T2D subgroups in the US. A single food insecurity question may serve as a simple medication-safety screen to flag individuals for whom secretagogue use warrants extra caution.
A. Ratzki-Leewing: Advisory Panel; Current; Sanofi. Consultant; Current; Vertex Pharmaceuticals Incorporated, Dexcom, Inc. Research Support; Current; Sanofi. Other – Paid presentation; Ended; Abbott. Consultant; Current; Sanofi. J. Black: None. A. Kahkoska: Other – Dexcom provides Devices for clinical research in kind or at reduced cost, through my institution; Current; Dexcom, Inc. Y. Lin: Other – Clinical trial site; Current; DEKA, Zucara Therapeutics.
Funding for iNPHORM was provided though an investigator-initiated grant from Sanofi Global.
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