{"pk":13373,"title":"Food Insecurity and Insulin Use in Hyperglycemic Patients Presenting to the Emergency Department","subtitle":null,"abstract":"Introduction:\n The prevalence of food insecurity (FI) and insulin rationing among patients with diabetes who present to the emergency department (ED) is unclear. We examined the prevalence of food insecurity and subtherapeutic insulin use among patients who presented to the ED with a blood glucose level of greater than 250 milligrams per deciliter.\nMethods:\n This was a single-center, cross-sectional survey of clinically stable, hyperglycemic adults in the ED for food insecurity using the Hunger Vital Sign screening tool. Patients who were insulin dependent were asked about insulin usage and rationing.\nResults:\n Of the 85 eligible patients, 76 (89.4%) were enrolled; 35 (46%) screened positive for food insecurity. Food insecure patients were 1.9 times more likely to be hospitalized than non-food insecure patients (relative risk = 1.90 [1.21-2.99], p<.01). Food insecure patients were younger than non-food insecure patients (50.4 vs 57.5 p<.02), and had significantly higher hemoglobin A1c (HgbA1c) levels (11.2% vs 9.9% p = 0.04). Of the 49 patients prescribed insulin, 17 (34.6%) stated they had used less insulin during the prior week than had been prescribed, and 21 (42.9%) stated they had used less insulin during the prior year than had been prescribed. Food insecure patients were more likely to have used less insulin than prescribed in the prior year (odds ratio = 3.60 [1.09-11.9], p = 0.04).\nConclusion: \nOur exploratory findings suggest almost half of clinically stable adults presenting to our inner-city ED with hyperglycemia experience food insecurity. More than one-third of those prescribed insulin used less than their prescribed amount in the prior year.","language":"en","license":{"name":"Creative Commons Attribution 4.0","short_name":"CC BY 4.0","text":"Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.","url":"https://creativecommons.org/licenses/by/4.0"},"keywords":[{"word":"Food Insecurity"},{"word":"Diabetes"},{"word":"Emergency Medicine"},{"word":"social determinants of health"}],"section":"Population Health and Social Emergency Medicine","is_remote":true,"remote_url":"https://escholarship.org/uc/item/823183bj","frozenauthors":[{"first_name":"Heng","middle_name":"Ky","last_name":"Nhoung","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Munish","middle_name":"","last_name":"Goyal","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Washington Hospital Center, Department of Emergency Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Maria","middle_name":"","last_name":"Cacciapuoti","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Hannah","middle_name":"","last_name":"Day","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Taymour","middle_name":"","last_name":"Hashemzadeh","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia","department":"None"},{"first_name":"Michelle","middle_name":"","last_name":"Magee","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Health,\u2028MedStar Diabetes Institute, Columbia, Maryland","department":"None"},{"first_name":"Yumi","middle_name":"S.","last_name":"Jarris","name_suffix":"","institution":"Georgetown University School of Medicine, Washington, District of Columbia\nMedStar Georgetown University Hospital, Georgetown University School of Medicine, Department of Family Medicine, Washington, District of Columbia","department":"None"}],"date_submitted":"2019-11-18T22:58:34Z","date_accepted":"2019-11-18T22:58:34Z","date_published":"2020-07-03T22:19:18Z","render_galley":null,"galleys":[{"label":"","type":"pdf","path":"https://journalpub.escholarship.org/westjem/article/13373/galley/7020/download/"}]}