Kaiser Permanente Evaluating NutRitional Interventions in food-inseCure High-risk adults (KP ENRICH) Study

Diabetes mellitus affects more than 37 million adults in the US, confers a nearly two-fold increased risk of death, and is responsible for approximately $237 billion in health care costs nationally each year. Since the landmark Diabetes Prevention Program trial in 2002, which found that diet and exercise had a greater impact on reducing diabetes incidence than metformin, lifestyle factors have been increasingly incorporated into diabetes management guidelines and patient education efforts. However, diabetes disproportionally affects marginalized communities, and significant structural, social, and economic barriers exist for individuals in those communities to adhere consistently to healthy lifestyle recommendations. Systematically addressing social determinants of health, particularly food and nutrition insecurity, can be an effective mechanism for improving outcomes and reducing health care costs among those with diabetes. Produce prescription projects and medically-tailored meal (MTM) delivery programs are the most widely studied interventions to address food insecurity and improve dietary habits. Growing evidence suggests these interventions may be beneficial in a number of ways, by reducing food insecurity, decreasing healthcare costs, improving patient experiences, and improving clinical outcomes.

Preliminary data is highly promising for the potential benefits of dietary interventions within low-income diabetic populations. However, the specific effects of these interventions remain unclear and inconsistent. Thus, there is strong rationale for a large scale, uniquely designed intervention to improve dietary and clinical outcomes in individuals with diabetes, especially among low-income and food-insecure populations within Kaiser Permanente (KP). The Kaiser Permanente Evaluating NutRitional Interventions in food-inseCure High-risk adults (KP ENRICH) Study will compare 2 groups with suboptimal glycemic control diabetes mellitus type II and Medi-Cal insurance. Participants will be randomized to 2 groups. One group will receive monthly financial support to purchase healthy food with free grocery delivery, and one group will receive free grocery delivery via Instacart.

Aim One

To evaluate whether providing monthly financial support for home-delivered healthy food vs. only free food delivery through the Instacart platform reduces HbA1c levels within 6 months among Medi-Cal-insured KP adult members with diabetes mellitus and suboptimal glycemic control.

Aim Two

To evaluate whether providing monthly financial support for home-delivery healthy food vs. only free food delivery through the Instacart platform reduces medical resource utilization within 6 months among Medi-Cal-insured KP adult members with diabetes mellitus and suboptimal glycemic control.