{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,27]],"date-time":"2026-10-27T17:07:46Z","timestamp":1793120866072,"version":"4.5.0"},"reference-count":44,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Intern Med"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"\n Importance<\/jats:title>\n Programs to improve access to healthy foods for people with diabetes exist in some jurisdictions but not others, and their effects on disease control are not established.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To measure the effect of a monthly grocery store voucher that allows access to healthy foods on diabetes control in patients experiencing food insecurity.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, and participants<\/jats:title>\n \n This randomized parallel-arm clinical trial was conducted from March 21, 2023, to April 1, 2025, at 7 sites in Toronto, Canada. Patients were randomly allocated to a monthly voucher or usual access to healthy foods. Eligibility required hemoglobin A\n 1c<\/jats:sub>\n (HbA\n 1c<\/jats:sub>\n ) levels from 6.0% to 11% and food insecurity. Data analysis was conducted in May 2025.\n <\/jats:p>\n <\/jats:sec>\n \n Intervention<\/jats:title>\n A $65 monthly voucher ($85 for those in households with 6 or more individuals) for 6 months.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n \n The primary outcome was change in HbA\n 1c<\/jats:sub>\n levels from baseline to 6 months. Secondary outcomes included levels of \u03b2-carotene and ascorbic acid, self-reported fruit and vegetable consumption, financial security, food security, and general health.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 1061 patients approached, 390 were enrolled (mean [SD] age, 60 [13] years; 191 [49%] men, 198 [51%] women); 81 (21%) identified as Black, 93 (24%) identified as South Asian, and 105 (27%) identified as White. Overall, 194 (50%) were randomly allocated to receive the voucher and 196 (50%) to control. The nonsignificant mean difference between voucher and control in the change in HbA\n 1c<\/jats:sub>\n was \u22120.18% (95% CI, \u22120.41 to 0.05;\n P<\/jats:italic>\n \u2009=\u2009.13; mean difference adjusted for baseline HbA\n 1c<\/jats:sub>\n , age, sex, household size, and condition, \u22120.10%; 95% CI, \u22120.33 to 0.12;\n P<\/jats:italic>\n \u2009=\u2009.35). The voucher improved self-reported vegetable consumption (44.7% vs 21.5% 2 or more times per day), fruit consumption (42.6% vs 22.7% 2 or more times per day), food insecurity (risk difference, \u22120.10; 95% CI, \u22120.18 to \u22120.02), and general health (odds ratio, 1.6; 95% CI, 1.1-2.3) but not financial insecurity (risk difference, \u22120.07; 95% CI, \u22120.16 to 0.02) or \u03b2-carotene level (mean difference, 0.01 \u00b5mol\/L; 95% CI, \u22120.08 to 0.06) and ascorbic acid level (mean difference, \u22120.18 \u00b5mol\/L; 95% CI, \u22124.3 to 4.7).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n \n In this randomized clinical trial, a monthly food voucher did not have an effect on HbA\n 1c<\/jats:sub>\n control or objective measures of diet quality but the voucher did increase self-reported vegetable and fruit consumption.\n <\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT05776420<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamainternmed.2025.5420","type":"journal-article","created":{"date-parts":[[2025,10,20]],"date-time":"2025-10-20T15:30:52Z","timestamp":1760974252000},"page":"1434","source":"Crossref","is-referenced-by-count":11,"title":["Voucher for Healthy Foods and Diabetes Control"],"prefix":"10.1001","volume":"185","author":[{"given":"Nav","family":"Persaud","sequence":"first","affiliation":[{"name":"Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St Michael\u2019s Hospital, Unity Health Toronto, Toronto, Ontario, Canada"},{"name":"Department of Family and Community Medicine, St Michael\u2019s Hospital, Unity Health Toronto, Ontario, Canada"},{"name":"Dalla Lanna School of Public Health, University of Toronto, Toronto, Ontario, 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