Meals for Me: Drop Shipment Versus Personally-delivered Meals for Diabetes Management

This study aims to:

1. Assess the impact of medically-tailored meals program on diabetes management and mental health in comparison to usual care without such program. 2. Assess the differential impact of two delivery models being considered for payment by the health system on diabetes management and mental health: once-a-week frozen drop shipment model versus daily warm meal delivery model that is more complex to implement but allows for human connection and easier meal preparation.

Implementation of program:

Meals on Wheels (MoW) of Central Texas (MOWCTX) in Austin, Texas, will provide the meals and delivery service in this study. Meals are all medically tailored (diabetes friendly) and design by MOWCT's team of Registered Dietitians.

Participants:

Older adults, 55 and over, living in the Austin city limits with poorly controlled diabetes; Inclusion criteria:

* Adult 55-90 * Hemoglobin A1C \>=7.5 (as measured at baseline) * Living in Austin city limits and within a MOWCTX daily delivery route * Interested and available to receive meals during delivery window time * Has access to a freezer and a microwave * Pass a MOWCTX background check

Trial:

Eligible participants will be recruited from selected Federally Qualified Health Centers in the Austin area, MOWCTX clients on waitlist, and other (e.g. Medicaid recipients).

Participants will be randomized to one of three arms: 1) Waitlisted control; 2) Weekly frozen drop shipment of MTM 3) Daily Warm delivery of MTM with in-person check-ins during delivery.

Phase 1 (first 6 months) The intervention arms will receive their assigned method of meal delivery (weekly frozen or daily warm), for a total of 10 meals a week, including two main meals per day and snacks. The control arm will not receive any meals during this phase. All arms will receive printed educational materials at baseline.

Phase 2 (month 6 to 12) All arms will receive 2-4 meals a week (depending on participant's availability) delivered via the traditional meal services from MOWCTX, which includes one hot meal plus a snack delivered daily. Meal delivery can also include 1 or more frozen meals to account for a total of 5 meals per week.

Primary outcome is Hemoglobin A1C and secondary outcomes include depression as measured by PHQ-8 and other mental health measures.

• Change in Hemoglobin A1C [Срок оценки: Baseline to 9 &12 months, 6 months to 12 months.]
• Program meal consumption [Срок оценки: 6 months, 12 months]
• Diet quality as assessed by NHANES DSQ [Срок оценки: 6 months, 12 months]
• Loneliness as assessed by scores on the 3-item UCLA Loneliness Scale [Срок оценки: 6 months, 12 months]
• Depressive symptoms as assessed by scores on the the 8-item Depression Health Questionnaire (PHQ-8) [Срок оценки: 6 months, 12 months]
• Anxiety symptoms as assessed by the 7-item Generalized Anxiety Disorder Scale (GAD-7) [Срок оценки: 6 months]
• Diabetes Self-Efficacy as assessed by scores on the Stanford Self-Efficacy for Diabetes Scale 8-item [Срок оценки: 6 months, 12 months]
• Food security status as assessed by the USDA Food Security Survey Module: Six-Item Short Form [Срок оценки: 6 months, 12 months]
• Health Status and Quality of Life as assessed by scores on Short-form 12-item (SF-12) [Срок оценки: 6 months, 12 months]
• Healthcare delay due to cost [Срок оценки: 6 months, 12 months]
• Emergency room visits [Срок оценки: 6 months, 12 months]
• Food-basic needs trade-offs (3 items) [Срок оценки: 6 months, 12 months]