A new qualitative study suggests that for African American adults living with type 2 diabetes and food insecurity, “self-management” rarely happens in isolation. Instead, it plays out inside families, where daily decisions about meals, schedules, caregiving, and stress can either support diabetes care or quietly undermine it.

The findings arrive as both diabetes and hunger remain widespread in the United States. CDC estimates that 40.1 million people in the U.S. had diabetes in 2023, about 12% of the population. Meanwhile, USDA data show 13.7% of U.S. households experienced food insecurity in 2024. The burden is not evenly shared: in 2024, about 25.4% of Black, non-Hispanic households were food insecure, compared with 10.6% of White, non-Hispanic households, according to USDA’s statistical supplement.

Health experts have long linked food insecurity with diabetes risk and worse outcomes, in part because limited budgets can push households toward cheaper, calorie-dense foods and make it harder to follow nutrition guidance or keep up with medications. The CDC notes that food insecurity can increase the risk of developing type 2 diabetes and can also make it harder to manage diabetes once someone has it. The American Diabetes Association defines food insecurity as “a lack of consistent access to enough food for an active, healthy life.”

Against that backdrop, the new study—published in Patient Education and Counseling—examined a more intimate layer of the problem: family dynamics. Researchers Sandra Iregbu, Rebekah J. Walker, and Leonard E. Egede reanalyzed qualitative data from two focus groups that included 16 African American adults with type 2 diabetes who also reported food insecurity. The original research used a grounded theory approach to explore broader barriers and supports in diabetes care.

n the reanalysis, the research team identified four themes describing how families influenced diabetes self-management across diet, exercise, stress, and routines. The themes captured both practical support—like help obtaining food or making meals—and the ways family obligations and household norms can complicate diabetes goals.

When family support helps—and when it complicates care

One theme focused on changes in diet and exercise routines. For people trying to manage blood sugar on a limited food budget, even small household patterns can carry weight: who buys groceries, what foods are considered “normal,” and whether the household is willing to modify shared meals. If a family embraces changes—such as cooking differently or choosing lower-sugar beverages—it can reduce the day-to-day burden on the person with diabetes. But when family members prefer different foods or resist changes, individuals may feel pressure to eat what is available rather than what aligns with diabetes guidance, particularly when options are scarce.

A second theme described direct family assistance with diabetes self-management. In many families, support is practical and immediate: relatives may help with transportation to appointments, share food, remind someone about routines, or provide encouragement to stay active. In households experiencing food insecurity, this kind of help can be the difference between following a care plan and falling behind. USDA’s data underscore how often food insecurity clusters with other resource constraints; among households below 130% of the poverty line, food insecurity was far more common, and the rate among Black, non-Hispanic households in this low-income group was even higher.

But the study also highlights the tension that can arise when diabetes self-care collides with family responsibilities. A third theme described conflict between self-care and family roles. For adults who are caregivers—whether for children, grandchildren, or older relatives—time, money, and emotional energy are often pulled in several directions at once. In these situations, diabetes routines like meal planning, exercise, and stress reduction may be treated as optional or delayed, even when a person understands their importance. This theme is especially relevant in communities facing structural inequities, where caregiving responsibilities and financial strain are more likely to be layered together.

A fourth theme focused on adapting to family situations. Rather than describing self-management as a fixed set of behaviors, participants’ experiences reflected constant adjustment—responding to shifting household needs, unexpected expenses, family gatherings, and the realities of making meals work for everyone. That adaptive approach can be a strength, but it can also leave people feeling that diabetes care is perpetually negotiable, shaped by what the household can absorb in a given week.

The implications go beyond family relationships themselves. Diabetes self-management education and support—often referred to as DSMES—is designed to help people build skills and confidence for daily care, and national guidance emphasizes that effective diabetes management includes clinical, behavioral, and psychosocial support. The new findings suggest that for food-insecure African American adults, education and support may be more effective when it explicitly accounts for who shares the kitchen, who controls food purchases, and who depends on the person with diabetes for caregiving.

Public health agencies increasingly encourage clinicians and health systems to screen for food insecurity and connect patients to resources, recognizing that nutrition guidance is difficult to follow without reliable access to food. Research over the past several years has also pointed to “food-is-medicine” approaches and nutrition assistance programs as potential tools for improving both food security and diabetes-related outcomes, particularly when targeted toward communities facing disproportionate burdens.

For families, the study’s message is straightforward: support does not only mean motivation or reminders—it can include making diabetes-friendly choices easier at home, reducing stress, and helping protect routines. For health providers, it is a reminder that diabetes plans that ignore household realities may be harder to sustain, especially when food budgets are tight. And for policymakers and community organizations, it adds evidence that hunger and chronic disease are intertwined in ways that show up at the dinner table, not just in clinics. Diabities Care

As food costs remain a strain for many households and diabetes continues to affect millions, the researchers argue that family-inclusive approaches tailored to food-insecure African American adults could help close gaps in support and make self-management more realistic.

Source: Patient Education and Counseling — “Family influences on type 2 diabetes self-management: Perspectives of African American adults with food insecurity”

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