Mode
Text Size
Log in / Sign up

Produce Prescription Program Shows No Benefit for Cardiometabolic Outcomes in Food-Insecure Diabetes PatientsProduce prescription program did not improve health outcomes for patients with diabetes facing food insecurity

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway
Consider that produce prescription subsidies alone may not improve diabetes outcomes in food-insecure patients.

This randomized clinical trial evaluated the effectiveness of a produce prescription program on cardiometabolic health outcomes and healthcare utilization among patients with diabetes at risk for food insecurity. Conducted within an integrated academic health system in the southeastern United States, the study enrolled 2,155 participants who were randomized to receive either the intervention or usual care. The trial followed participants for 12 months, with both groups receiving diabetes self-management educational materials as a baseline component of care.

The intervention consisted of a produce prescription (PRx) program providing participants with a debit card loaded with $80 monthly for up to 12 months to purchase eligible fresh, frozen, or canned fruits, vegetables, and legumes from grocery retailers. The comparator group received usual care plus the same diabetes self-management educational materials. This pragmatic design aimed to test the real-world effectiveness of a food subsidy program within existing healthcare delivery systems.

For the primary outcomes at 12 months, the study found no benefit from the produce prescription program. For HbA1c levels, the adjusted between-arm difference was 0.20 percentage points (95% CI, 0.05%-0.35%) favoring usual care, indicating slightly better glycemic control in the control group. For emergency department visits, the study found no significant between-group differences, though specific effect sizes, absolute numbers, and confidence intervals were not reported for this outcome.

All secondary outcomes similarly showed no significant between-group differences. This included body mass index, blood pressure, and inpatient visits. For each of these outcomes, the study reported no significant differences but did not provide specific effect sizes, absolute numbers, or confidence intervals. The consistent lack of benefit across both primary and secondary outcomes suggests the intervention did not produce measurable improvements in cardiometabolic health or healthcare utilization.

Safety and tolerability findings were not reported in the available data. The study did not provide information on adverse events, serious adverse events, discontinuations, or tolerability issues related to the intervention. This represents a significant gap in the evidence, particularly for a program involving dietary changes and financial incentives that could potentially have unintended consequences.

When compared to prior research on food insecurity interventions for diabetes management, these results contrast with some smaller studies that have shown benefits from food assistance programs. However, this larger, more rigorous trial suggests that simply providing financial resources for healthy foods may not be sufficient to overcome the complex barriers to diabetes management faced by food-insecure populations. The findings align with growing recognition that multifaceted interventions addressing structural, educational, and behavioral factors may be necessary.

Key methodological limitations include moderate benefit use, with only 433 participants (30%) using 80% or more of their monthly allocation. This low utilization rate may have diluted any potential treatment effect and raises questions about implementation barriers. The single-site design in the southeastern US may limit generalizability to other regions or healthcare systems. Additionally, the lack of reported safety data and detailed utilization patterns represents a significant evidence gap.

Clinical implications suggest that clinicians should not expect produce prescription subsidies alone to improve diabetes outcomes in food-insecure patients. While addressing food insecurity remains important for comprehensive diabetes care, this trial indicates that financial assistance for healthy foods may need to be combined with more intensive support, education, or structural interventions to produce measurable clinical benefits. Healthcare systems considering similar programs should anticipate potential implementation challenges and moderate utilization rates.

Unanswered questions include whether higher subsidy amounts, different food categories, or longer intervention durations might yield different results. The optimal combination of food assistance with other support services remains unclear. Future research should explore why utilization was moderate despite financial need, investigate potential subgroup effects, and examine longer-term outcomes beyond 12 months. Additionally, qualitative research could help understand participant experiences and barriers to program use.

This research matters to people with diabetes who struggle to afford healthy food. Many face the difficult choice between paying for medication, rent, or groceries. Programs that help people buy nutritious food could potentially improve health and reduce medical costs, but we need evidence to know if they actually work. This study provides important information about whether one specific approach—a produce prescription—makes a measurable difference in health outcomes for this vulnerable group.

The researchers conducted a randomized clinical trial with 2,155 adults who had diabetes and were at risk for food insecurity. All participants received diabetes self-management educational materials. Half were randomly assigned to also receive a special debit card loaded with $80 each month for 12 months to buy fresh, frozen, or canned fruits, vegetables, and legumes at grocery stores. The other half received only the educational materials (usual care). The study took place within an integrated health system in the southeastern United States. Researchers tracked participants for a full year to see if the extra money for healthy food changed their health.

After 12 months, the researchers found no meaningful health improvements from the produce prescription program. Blood sugar levels (measured by HbA1c) were actually slightly higher—by about 0.20 percentage points—in the group that received the debit card compared to the usual care group. While this difference is small, it suggests the program did not help lower blood sugar as hoped. There were also no differences between the two groups in emergency department visits, hospital admissions, blood pressure, or body weight. Essentially, adding the produce prescription to diabetes education did not lead to better health outcomes than education alone.

Regarding safety, the study did not report any specific safety concerns or adverse events related to the produce prescription program. Since the intervention involved providing money specifically for purchasing fruits, vegetables, and legumes, there were likely minimal direct physical risks. However, the study did note an important implementation challenge: only about 30% of participants who received the debit card used 80% or more of their monthly $80 benefit. This moderate usage rate means many people did not fully take advantage of the offered support, which could affect the results.

There are several reasons not to overreact to these findings. First, this is just one study, and its results need to be confirmed by other research. Second, the fact that most participants didn't use the full benefit suggests the program design or barriers to grocery shopping might have limited its effectiveness, not necessarily the idea of food assistance itself. Third, the study measured outcomes at 12 months—some health benefits might take longer to appear. Finally, the program provided a fixed amount ($80 monthly) and specific food restrictions; different amounts or more flexible approaches might yield different results.

For patients with diabetes facing food insecurity right now, this study suggests that a produce prescription program alone, as tested here, may not be enough to significantly improve blood sugar control or reduce hospital visits within a year. It does not mean that eating fruits and vegetables is unimportant for diabetes management—nutrition remains crucial. Rather, it indicates that simply providing funds for produce, without addressing other barriers like transportation, cooking facilities, or comprehensive dietary support, may not lead to measurable health improvements in the short term. Patients should continue working with their healthcare providers on personalized diabetes management plans that include nutrition, while researchers continue to explore the most effective ways to support food-insecure individuals.

What this means for you:
A produce prescription program did not improve health outcomes in a one-year study of adults with diabetes facing food insecurity.

Study Details

Study typeRct
Sample sizen = 9,608
EvidenceLevel 2
Follow-up12.0 mo
PublishedApr 2026
View Original Abstract ↓
IMPORTANCE: Patients with diabetes and food insecurity are at greater risk of adverse health outcomes. Effective strategies to promote healthy food access are urgently needed. OBJECTIVE: To evaluate the effect of a produce prescription (PRx) program on cardiometabolic health outcomes and health care utilization among patients with diabetes who were at risk of food insecurity. DESIGN, SETTING, AND PARTICIPANTS: This 2-arm, pragmatic, randomized clinical trial was conducted in an integrated academic health system in the southeastern US, and patients were recruited from June to August 2023 and followed up for 12 months. Patients were randomly assigned to be offered a PRx (treatment group) or continued to receive usual care (comparison group). Inclusion criteria included a diabetes diagnosis and being at risk for food insecurity. Randomization was stratified by mean hemoglobin A1c (HbA1c) level during the past year (≥8% vs <8%). Data were analyzed from October 2024 to April 2025. INTERVENTION: The PRx arm received a debit card loaded with $80 monthly for up to 12 months. The card was valid to purchase eligible fresh, frozen, or canned fruits, vegetables, and legumes from grocery retailers. Both arms received diabetes self-management educational materials. MAIN OUTCOMES AND MEASURES: Primary outcomes were HbA1c levels and emergency department visits at 12 months following randomization. Secondary outcomes included body mass index, blood pressure, and inpatient visits. RESULTS: Of 9608 patients assessed for eligibility, 2155 provided consent and were randomized and studied. The mean (SD) age was 56 (14) years, 1524 (71%) were female, 112 (5.3%) were Hispanic, 1272 (61%) were non-Hispanic Black, 663 (32%) were non-Hispanic White, and mean (SD) baseline HbA1c levels were 7.48% (1.77%; to convert to the proportion of total hemoglobin, multiply by 0.01). Benefit use was moderate, with only 433 participants (30%) using 80% or more per month. At 12 months, the treatment (n = 1450) and usual care comparison arm (n = 705) participants had an adjusted between-arm difference in HbA1C levels of 0.20 percentage points (95% CI, 0.05%-0.35%), favoring usual care. There were no significant between-group differences in emergency department visits, blood pressure, body mass index, and inpatient visits. Results were similar in the subgroup (n = 651) with elevated HbA1c levels (≥8%). CONCLUSIONS AND RELEVANCE: This randomized clinical trial found that the PRx program did not improve cardiometabolic health or health care utilization at 12 months. A produce prescription subsidy alone did not improve outcomes among patients with diabetes at risk for food insecurity. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT05896644.
Free Newsletter

Clinical research that matters. Delivered to your inbox.

Join thousands of clinicians and researchers. No spam, unsubscribe anytime.