Kaiser Permanente Evaluating Nutritional Interventions in Food-Insecure High-Risk Adults Study

Eligible Kaiser Permanente adult members will be randomized to one of two groups:

• Intervention arm, in which subjects will receive 6 months of monetary support (with up to 4 free home deliveries and no service fees) through the Instacart platform to select and receive healthy foods (e.g., vegetables and fruit).
• Control arm, in which subjects will receive 6 months of free home deliveries and no service fees for up to 4 deliveries each month through the Instacart platform.

Glycosylated hemoglobin level will be assessed at baseline and at 6 months after enrollment. Medical resource utilization will be evaluated at 3 months, 6 months, and 12 months after enrollment. Patient-reported outcomes (i.e., diabetes quality of life, nutrition security, dietary habits, social needs, and food security) will also be assessed at baseline, 6 months, and 12 months after enrollment.

Inclusion criteria

• Adults aged ≥18 years old at enrollment
• Active membership in Kaiser Permanente with Medi-Cal insurance and no additional private or commercial insurance
• Diagnosis of Type II diabetes mellitus (not including Type I diabetes mellitus or gestational diabetes mellitus)
• At least 2 outpatient glycosylated hemoglobin measures ≥7.5% in the prior 18 months
• Current access to the internet via computer or mobile device
• No interpreter needed

Exclusion criteria

• Advanced or end-stage kidney disease (estimated glomerular filtration rate ≤15 ml/min/1.73m^2 or receiving outpatient dialysis or having a prior kidney transplant)
• Known pregnancy at time of identification