Journal of General Internal Medicine

, Volume 34, Issue 3, pp 396–404 | Cite as

Medically Tailored Meal Delivery for Diabetes Patients with Food Insecurity: a Randomized Cross-over Trial

  • Seth A. BerkowitzEmail author
  • Linda M. Delahanty
  • Jean Terranova
  • Barbara Steiner
  • Melanie P. Ruazol
  • Roshni Singh
  • Naysha N. Shahid
  • Deborah J. Wexler
Original Research



Food insecurity, defined as inconsistent food access owing to cost, leads to poor health.


To test whether a medically tailored meal delivery program improved dietary quality in individuals with type 2 diabetes and food insecurity.


Randomized cross-over clinical trial.


Forty-four adults with diabetes, hemoglobin A1c > 8.0%, and food insecurity (defined as at least one positive item on the two-item “Hunger Vital Sign”).


In the Community Servings: Food as Medicine for Diabetes cross-over clinical trial (NCT02426138), conducted from June 2015 to July 2017, we randomly assigned the order of “on-meals” (home delivery of 10 meals/week for 12 weeks delivered by Community Servings, a non-profit organization) and “off-meals” (12 weeks usual care and a Choose MyPlate healthy eating brochure) periods.

Main Measures

The primary outcome was Healthy Eating Index 2010 score (HEI), assessed by three 24-h food recalls in both periods. Higher HEI score (range 0–100; clinically significant difference 5) represents better dietary quality. Secondary outcomes included food insecurity and self-reported hypoglycemia.

Key Results

Mean “on-meal” HEI score was 71.3 (SD 7.5) while mean “off-meal” HEI score was 39.9 (SD 7.8) (difference 31.4 points, p < 0.0001). Participants experienced improvements in almost all sub-categories of HEI score, with increased consumption of vegetables, fruits, and whole grains and decreased solid fats, alcohol, and added sugar consumption. Participants also reported lower food insecurity (42% “on-meal” vs. 62% “off-meal,” p = 0.047), less hypoglycemia (47% “on-meal” vs. 64% “off-meal,” p = 0.03), and fewer days where mental health interfered with quality of life (5.65 vs. 9.59 days out of 30, p = 0.03).


For food-insecure individuals with diabetes, medically tailored meals improved dietary quality and food insecurity and reduced hypoglycemia. Longer-term studies should evaluate effects on diabetes control (e.g., hemoglobin A1c) and patient-reported outcomes (e.g., well-being).


type 2 diabetes mellitus food insecurity dietary quality hypoglycemia 



The authors thank the participants of the study and the Diabetes Research Center at Massachusetts General Hospital for serving as the study site.

Author Information

SAB and DJW conceived of the study and drafted the manuscript. JT and LMD conceived of the study and revised the manuscript critically for intellectual content. BS, MR, RS, and NS assisted with collection and interpretation of the data and revised the manuscript critically for intellectual content. All authors give approval of the manuscript version to be submitted.

Funding Information

Funding for this study was provided by the Blue Cross Blue Shield Foundation of Massachusetts, BNY Mellon, the Diabetes Research Center and Division of General Internal Medicine at Massachusetts General Hospital, and the National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health under Award Number K23DK109200. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with Ethical Standards

Conflict of Interest

Jean Terranova is an employee of Community Servings. All other authors declare they have nothing to disclose.

Prior Presentation

An interim version of these findings was reported at the 2017 Society for General Internal Medicine annual meeting, in Washington, DC.


Seth A. Berkowitz had full access to all of the data in the study and takes full responsibility for the work as a whole, including the study design, access to data, the integrity of the data, the accuracy of the data analysis, and the decision to submit and publish the manuscript.

Supplementary material

11606_2018_4716_MOESM1_ESM.docx (109 kb)
ESM 1 (DOCX 109 kb)


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Copyright information

© Society of General Internal Medicine 2018

Authors and Affiliations

  • Seth A. Berkowitz
    • 1
    • 2
    • 3
    • 4
    Email author
  • Linda M. Delahanty
    • 2
    • 3
  • Jean Terranova
    • 5
  • Barbara Steiner
    • 2
  • Melanie P. Ruazol
    • 2
  • Roshni Singh
    • 2
  • Naysha N. Shahid
    • 1
  • Deborah J. Wexler
    • 2
    • 3
  1. 1.Division of General Internal MedicineMassachusetts General HospitalBostonUSA
  2. 2.Diabetes UnitMassachusetts General HospitalBostonUSA
  3. 3.Harvard Medical SchoolBostonUSA
  4. 4.Division of General Medicine and Clinical Epidemiology, Department of Medicine University of North Carolina School of MedicineChapel HillUSA
  5. 5.Community Servings, INCJamaica PlainUSA

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