Katherine Ann Sauder

Objective: To examine the relationship between levels of household food insecurity and disordered eating behaviors (DEB) among youth and young adults with youth‐onset type 1 (T1D) and type 2 diabetes (T2D).Method: We used cross‐sectional data from the multicenter SEARCH for Diabetes in Youth Study (2015–2020). The Household Food Security Survey Module and the Diabetes Eating Problem Survey‐Revised (DEPS‐R) were utilized to measure household food insecurity and continuous scores for DEB. In each stratum of diabetes type, we evaluated the association of household food insecurity levels with DEB through linear regression adjusting for potential confounders.Results: Participants (n = 2669) were on average 21.5 ± 5.1 years old and had a mean diabetes duration of 11.2 ± 3.3 years; 54.2% were female, 64.0% non‐Hispanic white, and respectively 12.9%, 11.1%, and 8.43% experienced marginal, low, and very low food security. The overall unadjusted mean DEPS‐R score was 13.5 ± 9.5, with scores of 18.6 ± 11.8 and 21.1 ± 11.7 among T1D and T2D participants with very low food security, and scores of 11.5 ± 8.9 and 15.2 ± 8.8 among T1D and T2D participants with high food security. Compared to participants who reported high food security, adjusted DEPS‐R scores among those with very low food security were 5.8 points (95% CI: 4.3, 7.4) and 6.6 points (95% CI: 3.3, 9.2) higher, respectively, in those with T1D (n = 2274) and T2D (n = 395). Less severe levels of household food insecurity showed similar associations with smaller effect sizes.Discussion: Addressing household food insecurity may decrease DEB and future adverse health outcomes for youth and young adults with diabetes.

Background: Physical activity (PA) is essential for optimal diabetes management. Household food insecurity (HFI) may negatively affect diabetes management behaviors. The purpose of this study was to cross-sectionally examine the association between HFI and PA in youth and young adults (YYA) with type 1 (N = 1998) and type 2 (N = 391) diabetes from the SEARCH for Diabetes in Youth Study. Methods: HFI was measured with the US Household Food Security Survey Module. PA was measured with the International Physical Activity Questionnaire Short Form. Walking, moderate-intensity PA (excluding walking), vigorous-intensity PA, moderate- to vigorous-intensity PA, and total PA were estimated as minutes per week, while time spent sitting was assessed in minutes per day. All were modeled with median regression. Meeting PA guidelines or not was modeled using logistic regression. Results: YYA with type 1 diabetes who experienced HFI spent more time walking than those who were food secure. YYA with type 2 diabetes who experienced HFI spent more time sitting than those who were food secure. Conclusions: Future research should examine walking for leisure versus other domains of walking in relation to HFI and use objective PA measures to corroborate associations between HFI and PA in YYA with diabetes.

Background: We examined arterial stiffness in individuals with type 1 diabetes, and explored whether differences between Hispanic, non‐Hispanic Black (NHB), and non‐Hispanic White (NHW) individuals were attributable to modifiable clinical and social factors. Methods and Results: Participants (n=1162; 22% Hispanic, 18% NHB, and 60% NHW) completed 2 to 3 research visits from ≈10 months to ≈11 years post type 1 diabetes diagnosis (mean ages of ≈9 to ≈20 years, respectively) providing data on socioeconomic factors, type 1 diabetes characteristics, cardiovascular risk factors, health behaviors, quality of clinical care, and perception of clinical care. Arterial stiffness (carotid–femoral pulse wave velocity [PWV], m/s) was measured at ≈20 years of age. We analyzed differences in PWV by race and ethnicity, then explored the individual and combined impact of the clinical and social factors on these differences. PWV did not differ between Hispanic (adjusted mean 6.18 [SE 0.12]) and NHW (6.04 [0.11]) participants after adjustment for cardiovascular risks ( P =0.06) and socioeconomic factors ( P =0.12), or between Hispanic and NHB participants (6.36 [0.12]) after adjustment for all factors ( P =0.08). PWV was higher in NHB versus NHW participants in all models (all P <0.001). Adjustment for modifiable factors reduced the difference in PWV by 15% for Hispanic versus NHW participants; by 25% for Hispanic versus NHB; and by 21% for NHB versus NHW. Conclusions: Cardiovascular and socioeconomic factors explain one‐quarter of the racial and ethnic differences in PWV of young people with type 1 diabetes, but NHB individuals still experienced greater PWV. Exploration of pervasive inequities potentially driving these persistent differences is needed.