Food Is Medicine Trial Improves Glycemic Control in T2D

Adults with type 2 diabetes (T2D) and Medicaid coverage who received weekly medically tailored grocery (MTG) deliveries achieved significantly better glycemic control than those receiving usual care, according to a randomized controlled trial published in Circulation. For pharmacists, the finding reframes food access as a modifiable driver of hemoglobin A1c (HbA1c) that belongs alongside pharmacotherapy in the care of patients facing economic and social barriers.¹

What the Trial Tested

Investigators enrolled 460 Medicaid-insured adults with T2D and elevated HbA1c between November 2021 and July 2022 at Kaiser Permanente Southern California. Eligibility required at least 2 HbA1c measurements of 7.5% or higher in the prior year, and the population was notably high-risk at baseline: mean HbA1c was 9.40, and 254 participants (58%) reported food insecurity. The mean age was 59.2 years; 284 participants (64.8%) were women, and 373 (85.2%) reported Hispanic ethnicity.¹

Participants were randomized 1:1:1 to usual care (n=153), lower-dose MTG (n=153), or higher-dose MTG (n=154) for 6 months, with the prespecified primary analysis comparing the combined MTG groups against control. MTG was delivered weekly as healthy produce scaled to household size—$100 to $170 per month for the lower dose and $135 to $210 per month for the higher dose—along with matched recipes and telenutrition counseling. The primary outcome was change in HbA1c at six months.¹

What the Deliveries Did to A1C

HbA1c declined by 0.66 points in the intervention group and 0.25 points in the control group, yielding a treatment difference of −0.40 points (95% CI, −0.73 to −0.08; P = .016). Higher-dose and lower-dose MTG produced similar reductions, a dose-response signal relevant to programs weighing per-patient benefit design against reach.¹

Adherence to the food itself was high—244 intervention participants (83.3%) reported eating most or all of the food provided—though engagement with telenutrition counseling was limited, at 63 participants (21.5%).¹

Food Security Gains and Null Findings

The intervention substantially improved food-related outcomes. Odds of food security increased by 2.12 (95% CI, 1.13 to 3.99; P = .020) and odds of nutrition security by 3.65 (95% CI, 1.84 to 7.25; P < .001), the kind of upstream change that can influence the medication adherence and self-management behaviors pharmacists encounter at the counter. Results held across prespecified subgroups defined by sex, education, baseline food security, nutrition security, and HbA1c.¹

Not every end point moved: hypertension and body mass index did not change significantly over the 6 months, tempering any expectation that grocery support alone addresses the full cardiometabolic picture.¹

Why it Matters for Pharmacists

The results argue for treating unmet food needs as a clinical variable rather than a background condition. "A clinician shouldn't just consider, 'Which medication should I add?'" said senior author Dariush Mozaffarian, MD, DrPH, director of the Food is Medicine Institute at the Friedman School of Nutrition Science and Policy at Tufts University. "They should ask, 'What's getting in the way of healthy eating?' The answer may be cost, but it could just as easily be transportation, mobility, time, cooking ability, or simply not knowing what foods will help manage diabetes."

Food insecurity is independently associated with worse glycemic management, lower engagement in self-care, and reduced medication use, and the American Diabetes Association's 2026 Standards of Care in Diabetes recommends screening for it as a social determinant of health, with referral to local resources. Pharmacists, often the most accessible member of the care team, are well positioned to make that screening routine.²

Mozaffarian pointed to 2 brief, validated tools: the 2-question Hunger Vital Sign, which flags patients struggling to get enough food, and a newer 2-question Nutrition Security Screener, which surfaces barriers to eating nourishing food.

"Importantly, screening should trigger action—a referral to a health system or community-based Food Is Medicine (FIM) program," he said. "The goal is for nutrition assessment and nutrition care to be as routine as every other part of clinical practice." He noted that the Food is Medicine Institute's CP3 (Community Pharmacies Produce Prescriptions) study is testing that framework directly in community pharmacies, in collaboration with Walmart, Kroger, and Hy-Vee.¹

REFERENCES

1. Nau C, Wu JHY, Han B, et al. Effects of a "Food Is Medicine" intervention on glucose control among Medicaid-insured patients with type 2 diabetes: a randomized controlled trial. Circulation. Published online July 21, 2026. doi:10.1161/CIRCULATIONAHA.125.077982

2. American Diabetes Association Professional Practice Committee. 1. Improving care and promoting health in populations: Standards of Care in Diabetes—2026. Diabetes Care. 2026;49(Suppl 1):S13-S26. doi:10.2337/dc26-s001