Updated 07 February 2017

South African diabetics with tight food budgets at risk

The majority of South Africans struggle to afford enough food - a factor that can have a detrimental effect on blood glucose control for those with type 2 diabetes.


People with type 2 diabetes who don't always have enough money for food have worse blood sugar control than people who don't worry about where their next meal will come from, new research finds.

"We talk about healthy eating a lot in diabetes education, but we also need to talk about food accessibility. We need to ask, 'Can you get these foods?' " said study author Britt Rotberg, assistant director of the Emory Diabetes Education Training Academy and the Emory Latino Diabetes Education Program in Atlanta.

Food security is a huge issue in South Africa. The 2013 South African Health and Nutrition Examination Survey (SANHANES-1) found that 54% of the country's population does not have access to enough food, News24 reports. The Human Sciences Research Council defines food security as all members of a family or household having access to enough food at all times to live an active and healthy lifestyle.Previous research has found a 2.5 times higher risk of diabetes in food-insecure households, the researchers said.

The current study included people with type 2 diabetes participating in the Emory Latino Diabetes Education Program. This program is designed to provide education and support to help improve blood sugar management. Two-thirds of the study participants don't have health insurance. And 76 percent have household incomes below $15,000 a year, according to the study.

Read: High-fibre diet may curb type 2 diabetes risk

A1C higher for food insecure

The researchers asked whether or not people had been worried about having enough food to eat in the last 30 days. Those who had were identified as food insecure.

There were 137 food insecure people, and 167 people who were food secure, the researchers said. Blood sugar levels were significantly better in people with food security. The A1C level in people who were food secure averaged 7.6 percent. In those who were food insecure, the A1C average was almost 10 percent.

A1C is a blood test that estimates blood sugar levels over the past three months or so. In general, the goal for people with diabetes is to have an A1C of lower than 7 percent, according to the ADA.

The average body mass index (or BMI, which is a rough estimate of body fat) was 31 in both groups, Rotberg said. A BMI of 30 and over is considered obese. Someone who is 5-foot-9 and weighs more than 203 pounds is considered obese, according to the U.S. Centers for Disease Control and Prevention.

Read: Diabetics often ignore health warnings

Food insecure go for "bad carbs"

"The food insecure are still eating calories, but they're not healthy calories. Some of the inexpensive foods are processed foods, fast foods and not a lot of vegetables," Rotberg explained.

The researchers found that the food insecure people weren't eating as many vegetables. About 38 percent said they ate more than one-third of a plate of non-starchy vegetables at their main meal. For the food secure, 62 percent ate more than a third of a plate of veggies at their primary meal, the study found.

Rotberg said that the researchers suggested using frozen vegetables in the education program. "People often say they can't buy fresh vegetables because they don't last long. So, we're emphasizing frozen, and even canned - watch the sodium though. Frozen can sometimes even be more nutritious than fresh," said Rotberg.

Nutritionist and diabetes educator Maudene Nelson, from Columbia University in New York City, said when people tell her they can't afford to eat fresh veggies, she works with them to see which foods they are eating and helps them understand how those foods are affecting their blood sugar levels. "First, there needs to be an awareness that any source of carbohydrate can affect your blood sugar," she said.

"There's a lot of misinformation - actually myth-information - around what foods will have an effect on your blood sugar," Nelson explained.

"Rice, for example. People think brown rice is better for their blood sugar. But, brown rice will have an effect on your blood sugar right away just like white rice. Rice and beans is better, but beans often aren't a major part of rice and beans," Nelson said.

She said the plate method is an easy way to start eating healthier. "Fill one-quarter of your plate with a starch, one-quarter with a meat or other protein and half with veggies. The plate method is a good way to make our meals body-friendly."

Read more:

Mediterranean diet may protect against diabetes

Low-carb diet helps obese diabetics

Carbs debate: the importance of GI


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