LongItudinal Food security Experiments via SuPplemental Assistance with Nutrition for Diabetes


Food insecurity is a common and potent mediator in the development of type 2 diabetes and diabetes-related complications among low-income populations in the US.  Food insecurity pressures low-income individuals with type 2 diabetes to consume inexpensive food of poor dietary quality, forcing them to make difficult choices between paying more for higher-quality food or paying for medicine or other expenses such as housing or heat.  Furthermore, food insecurity among pregnant women is associated with an increased risk of gestational diabetes and other pregnancy-related complications.  LIFESPAN-D (LongItudinal Food security Experiments via SuPplemental Assistance with Nutrition for Diabetes) is comprised of two sub-studies. The first study relates to older, low-income adults. In 2019, California began to allow low income, elderly and/or disabled individuals receiving Supplemental Security Income (SSI) – populations with a high prevalence of food insecurity and risks for diabetes and its complications -- to receive simultaneous benefits from the Supplemental Nutrition Assistance Program (SNAP, formerly known as food stamps).  This study will harmonize and analyze statewide longitudinal datasets using a quasi-experimental pre-post design to determine whether the addition of the SNAP benefit is associated with county-level reductions in multiple outcomes including diabetes-related hospitalizations, individual-level improvements in cardiometabolic control among individuals with type 2 diabetes, reduced incidence of type 2 diabetes among individuals with prediabetes. The second study will evaluate the effects of a separate policy that allowed recipients of the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)—a program that provides nutrition support to low-income pregnant and postpartum women and children under 5—to receive an electronic benefit card rather than paper vouchers. The study will example whether this policy change leads to increased WIC benefit take-up and reductions in gestational diabetes and other pregnancy-related complications among pregnant women as well as unfavorable birth outcomes associated with diabetes risk in their offspring.

Dr. Dean Schillinger

I am very excited that NEXT-D3 will analyze natural experiments of diabetes policies in settings outside of health care delivery. Our LIFESPAN-D project examines a social policy, answering the question of whether receipt of federal nutrition assistance programs (WIC and SNAP) influence diabetes outcomes across the lifespan.

- Dr. Dean Schillinger, MD, Principal Investigator of UCSF team