Background
Food insecurity is a significant barrier to effective diabetes management, as it limits access to nutritious foods necessary for glycemic control. Patients with diabetes who experience food insecurity are at higher risk for poor health outcomes, including uncontrolled blood sugar and increased healthcare utilization. Despite the recognized need for interventions that address food insecurity, evidence on the effectiveness of produce prescription programs remains limited.
Study Design
This pragmatic randomized clinical trial enrolled 2155 patients with diabetes at risk for food insecurity from an integrated academic health system in the southeastern US. Participants were randomly assigned to either a produce prescription (PRx) group, receiving a $80 monthly debit card for fruits, vegetables, and legumes, or a usual care group. Both groups received diabetes self-management educational materials. The primary outcomes were changes in HbA1c levels and emergency department visits at 12 months.
Key Findings
The study found no significant improvement in HbA1c levels among participants in the PRx group compared to usual care, with an adjusted difference of just 0.20 percentage points (95% CI, 0.05%-0.35%) favoring usual care. There were also no significant differences in secondary outcomes, including body mass index, blood pressure, or inpatient visits. Subgroup analysis of participants with elevated HbA1c (≥8%) similarly showed no benefit.
Expert Commentary
“While produce prescriptions are a well-intentioned strategy, this study suggests that financial subsidies alone may not be sufficient to improve cardiometabolic health in high-risk diabetic patients,” noted Dr. Michael Pignone, a co-author of the study. The moderate utilization of the benefit—only 30% of participants used 80% or more of the monthly allowance—highlights potential barriers such as transportation or cooking skills that may limit the program’s effectiveness.
Conclusion
This trial demonstrates that a produce prescription subsidy, without additional support, does not significantly improve health outcomes in diabetic patients at risk for food insecurity. Future interventions may need to incorporate more comprehensive approaches, including nutrition education and addressing systemic barriers to healthy food access.
Funding and Trial Registration
This study was supported by the National Institutes of Health and registered on ClinicalTrials.gov (NCT05896644).
References
Drake C, et al. JAMA Intern Med. 2026;186(4):416-424. PMID: 41697676.
