OBJECTIVES: Being physically active and eating healthy food have many health benefits for those with type 2 diabetes (T2D). Individuals participating in Diabetes Self-Management Education and Support (DSMES) programs are encouraged to engage in regular physical activity and healthy eating behaviors. In this study, we examined the characteristics and associations between food insecurity, participation of DSMES, and physical activity engagement among Medicare beneficiaries with reported T2D.

METHODS: Using the nationally representative 2017 Medicare Current Beneficiary Survey Public Use File, we analyzed 1,263 Medicare beneficiaries aged ≥65 years with reported T2D. Based on the Physical Activity Guidelines for Americans 2nd edition, we created an outcome variable to reflect the engagement in recommended weekly physical activity (EIRWPA) (1=engaged, 0=not engaged). Additionally, a binary variable was created to represent food insecurity (1=food insecurity, 0=no food insecurity) with ≥ 2 affirmative responses based on established algorithm on 4 questions (of the USDA’s food security questionnaire). A survey-weighted logistic model adjusted for socio-demographics and co-morbidities was performed to examine the characteristics and associations between food insecurity, DSMES, and EIRWPA.

RESULTS: Approximately 51.0% of Medicare beneficiaries with T2D reported EIRWPA. Among those with and without EIRWPA, 51.1% and 41.0% had DSMES (p=0.002). Furthermore, those with and without EIRWPA, 4.6% and 9.4% had food insecurity (p=0.005). Beneficiaries who attended DSMES were more likely to report EIRWPA than their counterparts (Odds ratio= 1.54; 95% CI = 1.11,2.16; p<0.010). Food insecurity was not associated with EIRWPA. Factors such as age, marital status, education level, BMI, instrumental and/or activities of daily living limitations, and general health status were associated with EIRWPA.

CONCLUSIONS: Our findings reveal that participation of DSMES has a positive effect on EIRWPA for Medicare beneficiaries with T2D. However, many factors also affect EIRWPA; therefore, additional outreach efforts are needed to increase EIRWPA.