Hippocampal miR-34a/SIRT1 and BDNF Responses Following Adolescent Stress: Differential Effects of Ketamine and Fluoxetine.

Household food insecurity (HFI), “limited or uncertain unavailability of nutritionally adequate and safe foods,” is prevalent among youth and young adults (YYA) with diabetes. Between 2016–2019, almost one in three YYA with type 2 diabetes and one in six YYA with type 1 diabetes experienced HFI in the last year. American Diabetes Association Standards explicitly recommend assessing HFI because of its central role in influencing the three pillars of optimal glycemic control: nutrition therapy, physical activity, and monitoring and self-management of glucose levels. HFI can negatively influence mental and physical health. Food insecure adults with chronic diseases must often choose between paying for care/food. Food insecurity among adults with diabetes is associated with four-fold higher cost-related medication underuse and food insecurity among children is associated with an almost 180% increase in foregone healthcare. Individuals experiencing HFI generally have higher healthcare utilization and expenditures and more missed work time relative to the food secure independent of other social determinants of health, especially among individuals with chronic conditions. In a national US study, children with HFI and a chronic condition had a 1.9 higher incidence rate ratio (IRR) of emergency department utilization compared to children without HFI and/or without chronic conditions. Among individuals with diabetes, the consequences of HFI include higher hemoglobin A1c (HbA1c) levels, greater fear of hypoglycemia and episodes of severe hypoglycemia, and higher frequency of hospitalization. In another study, HFI was associated with 3.5-fold higher odds of hospitalization among Canadian youth with insulin-dependent diabetes. Although much is known about the relationship between HFI and healthcare utilization generally, little is known about this relationship for YYA with diabetes and even less about how it relates to healthcare costs. Moreover, the non-healthcare sector costs related to healthcare use are rarely assessed. These costs are particularly relevant for YYA, a working age population in need of childcare alternatives. In a pilot study using a subsample from SEARCH (2013–2015), participants with HFI had 3-times higher prevalence rates of emergency department visits compared to food secure participants, but utilization was not monetized and emergency department utilization and hospitalizations were assessed separately. This study builds on this prior literature by assessing the association between HFI, healthcare utilization, acute care costs, and productivity losses among YYA with diabetes. We hypothesized households experiencing food insecurity would have higher costs relative to households without food insecurity, and that these associations would be moderated by continuous health insurance coverage.