{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:06:33Z","timestamp":1790010393073,"version":"4.0.1"},"reference-count":28,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Form Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Type 2 diabetes mellitus (T2D) is one of the most significant chronic health challenges in Michigan, especially for individuals with food insecurity. Improving nutrition, including lowering carbohydrate intake, is foundational to T2D prevention and management. Grocery delivery paired with low-carbohydrate education has the potential to reduce logistical barriers to dietary change but is not well understood in individuals with food insecurity.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n The objective of our study was to evaluate changes in clinical metrics of hemoglobin A\n 1c<\/jats:sub>\n (HbA\n 1c<\/jats:sub>\n ), weight, and diabetes medication use after a paired grocery delivery and low-carbohydrate education program.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n The Healthy Eating Jumpstart Program (hereafter, Jumpstart) enrolled adult Michiganders with T2D and low income or food insecurity from 21 Michigan primary care practices between October 2022 and May 2023. Jumpstart was a 3-month, nonrandomized grocery delivery and low-carbohydrate education quality improvement program without a control group. Participants received US $80 every month through Shipt to purchase eligible healthy foods, along with low-carbohydrate educational materials. Clinical metrics of HbA\n 1c<\/jats:sub>\n , weight, and diabetes medication use were collected from medical records from 6 months before enrollment through 12 months after enrollment. Changes in HbA\n 1c<\/jats:sub>\n and weight from baseline were evaluated at 3, 6, 9, and 12 months, with stratification by baseline glycemic control and glucagon-like peptide-1 receptor agonist (GLP-1 RA) medication use, respectively. Overall change was assessed with paired\n t<\/jats:italic>\n tests comparing baseline values to each participant\u2019s latest value for HbA\n 1c<\/jats:sub>\n and weight. Medication changes were assessed by comparing baseline and 12-month dosing to categorize changes as increased, decreased, eliminated, or unchanged.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n A total of 83 patients participated in Jumpstart. Participants were primarily female (57\/79, 72%), White (70\/79, 89%), and had a high school degree or less (35\/79, 44%). At baseline, the average HbA\n 1c<\/jats:sub>\n was 7.6% (SD 2%), average weight was 105 (SD 25.8) kg, and average BMI was 38.2 (SD 8.8) kg\/m\n 2<\/jats:sup>\n . The overall reduction in HbA\n 1c<\/jats:sub>\n from baseline was 0.4% (SD 1.4%;\n P<\/jats:italic>\n =.02; n=68), and this reduction was greater when limited to individuals with uncontrolled HbA\n 1c<\/jats:sub>\n at baseline (mean 0.7%, SD 1.8;\n P<\/jats:italic>\n =.02; n=38). The overall percent reduction in weight from baseline was 1.7% (SD 4.4%;\n P<\/jats:italic>\n =.002; n=66), but this change was not significant when limited to non\u2013GLP-1 RA users. Most medications had no change in dosing (77\/166, 46%), and slightly more medications were increased or added (n=52, 31%) than decreased or discontinued (n=37, 22%).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n The results from this clinical evaluation suggest that the Jumpstart quality improvement program was associated with improvements in HbA\n 1c<\/jats:sub>\n that persisted beyond 6 months and small reductions in weight among participants. A low-burden program such as Jumpstart may be a feasible approach to support long-term dietary change in patients with T2D and food insecurity or low income.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/89459","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:22:06Z","timestamp":1790007726000},"page":"e89459-e89459","source":"Crossref","is-referenced-by-count":0,"title":["Hemoglobin A1c and Weight Changes Associated With Grocery Delivery and Low-Carbohydrate Education in Adults With Type 2 Diabetes and Food Insecurity: Observational Quality Improvement Cohort Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4332-1974","authenticated-orcid":false,"given":"Marika","family":"Waselewski","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2695-3566","authenticated-orcid":false,"given":"Eric","family":"Waselewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7134-970X","authenticated-orcid":false,"given":"Lauren","family":"Oshman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8732-4831","authenticated-orcid":false,"given":"Kaitlyn","family":"Hatch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3580-9438","authenticated-orcid":false,"given":"Tammy","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"key":"R1","unstructured":"Statistics about diabetes. American Diabetes Association. URL: https:\/\/diabetes.org\/about-diabetes\/statistics\/about-diabetes [Accessed 09-09-2026]"},{"key":"R2","unstructured":"The burden of diabetes in Michigan. American Diabetes Association. URL: https:\/\/diabetes.org\/sites\/default\/files\/2023-09\/ADV_2023_State_Fact_sheets_all_rev_Michigan.pdf [Accessed 09-09-2026]"},{"issue":"9","key":"R3","doi-asserted-by":"publisher","first-page":"1599","DOI":"10.2337\/dci23-0002","article-title":"Food insecurity and diabetes: overview of intersections and potential dual solutions","volume":"46","author":"Levi","journal-title":"Diabetes Care"},{"issue":"5","key":"R4","doi-asserted-by":"publisher","first-page":"731","DOI":"10.2337\/dci19-0014","article-title":"Nutrition therapy for adults with diabetes or prediabetes: a consensus report","volume":"42","author":"Evert","journal-title":"Diabetes Care"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4743","article-title":"Efficacy and safety of low and very low carbohydrate diets for type 2 diabetes remission: systematic review and meta-analysis of published and unpublished randomized trial data","volume":"372","author":"Goldenberg","journal-title":"BMJ"},{"issue":"4","key":"R6","doi-asserted-by":"publisher","first-page":"874","DOI":"10.2337\/dc22-2310","article-title":"Low-carbohydrate diet scores and mortality among adults with incident type 2 diabetes","volume":"46","author":"Hu","journal-title":"Diabetes Care"},{"key":"R7","unstructured":"Charts of note: nearly 20 percent of U.S. shoppers bought groceries online in 2022. USDA Economic Research Service. 2024. URL: https:\/\/www.ers.usda.gov\/data-products\/charts-of-note\/chart-detail?chartId=108618 [Accessed 09-09-2026]"},{"key":"R8","unstructured":"Grocers see record-high 80M households buy groceries online in February. Grocery Dive. 2025. URL: https:\/\/www.grocerydive.com\/news\/online-grocery-sales-february-delivery-pickup-service\/742246 [Accessed 09-09-2026]"},{"key":"R9","unstructured":"Online grocery shopping statistics (2026): yearly data & summary. WAVE Grocery. URL: https:\/\/www.wavegrocery.com\/blogpost\/online-grocery-shopping-statistics-latest-data-summary [Accessed 09-09-2026]"},{"key":"R10","unstructured":"Food is Medicine. URL: https:\/\/odphp.health.gov\/foodismedicine [Accessed 09-09-2026]"},{"issue":"4","key":"R11","doi-asserted-by":"publisher","first-page":"611","DOI":"10.1016\/j.amepre.2020.04.011","article-title":"The right to food: building upon \u201cfood is medicine\u201d","volume":"59","author":"Barnidge","journal-title":"Am J Prev Med"},{"issue":"14","key":"R12","doi-asserted-by":"publisher","first-page":"2797","DOI":"10.1007\/s11606-024-08768-w","article-title":"Implementation of food is medicine programs in healthcare settings: a narrative review","volume":"39","author":"Houghtaling","journal-title":"J Gen Intern Med"},{"issue":"4","key":"R13","doi-asserted-by":"publisher","first-page":"398","DOI":"10.1377\/hlthaff.2024.00585","article-title":"\u2018Food is medicine\u2019 in the US: a national survey of public perceptions of care, practices, and policies","volume":"44","author":"Ridberg","journal-title":"Health Aff (Millwood)"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.2196\/54043","article-title":"Grocery delivery to support individuals with type 2 diabetes: protocol for a pilot quality improvement program","volume":"13","author":"Oshman","journal-title":"JMIR Res Protoc"},{"issue":"1","key":"R15","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-024-11520-z","article-title":"The Michigan Collaborative for Type 2 Diabetes (MCT2D): development and implementation of a statewide collaborative quality initiative","volume":"24","author":"Oshman","journal-title":"BMC Health Serv Res"},{"issue":"12","key":"R16","doi-asserted-by":"publisher","first-page":"986","DOI":"10.1136\/bmjqs-2015-004411","article-title":"SQUIRE 2.0 (Standards for QUality Improvement Reporting Excellence): revised publication guidelines from a detailed consensus process","volume":"25","author":"Ogrinc","journal-title":"BMJ Qual Saf"},{"issue":"Supplement_1","key":"R17","doi-asserted-by":"publisher","first-page":"S132","DOI":"10.2337\/dc26-S006","article-title":"6. Glycemic goals, hypoglycemia, and hyperglycemic crises: Standards of Care in Diabetes-2026","volume":"49","author":"American Diabetes Association Professional Practice Committee for Diabetes","journal-title":"Diabetes Care"},{"issue":"1","key":"R18","doi-asserted-by":"publisher","DOI":"10.2196\/diabetes.6981","article-title":"A novel intervention including individualized nutritional recommendations reduces hemoglobin A1c level, medication use, and weight in type 2 diabetes","volume":"2","author":"McKenzie","journal-title":"JMIR Diabetes"},{"key":"R19","unstructured":"GLP-1RA and dual GLP-1RA\/GIP: conversions and therapy gap management guide. Beth Israel Lahey Health. URL: https:\/\/www.bilhpn.org\/wp-content\/uploads\/2022\/12\/BILH-GLP1RA-Conversion-Guide.pdf [Accessed 09-09-2026]"},{"issue":"7","key":"R20","doi-asserted-by":"publisher","first-page":"e1677","DOI":"10.1093\/nutrit\/nuae123","article-title":"Low-carbohydrate dietary interventions for metabolic control in individuals with type 2 diabetes mellitus: an overview of systematic reviews","volume":"83","author":"Beretta","journal-title":"Nutr Rev"},{"issue":"11","key":"R21","doi-asserted-by":"publisher","first-page":"1375","DOI":"10.1007\/s00592-020-01568-8","article-title":"Low-carbohydrate diets and type 2 diabetes treatment: a meta-analysis of randomized controlled trials","volume":"57","author":"Silverii","journal-title":"Acta Diabetol"},{"issue":"3","key":"R22","doi-asserted-by":"publisher","DOI":"10.5812\/ijem.108170","article-title":"Common limitations and challenges of dietary clinical trials for translation into clinical practices","volume":"19","author":"Mirmiran","journal-title":"Int J Endocrinol Metab"},{"issue":"10","key":"R23","doi-asserted-by":"publisher","first-page":"2904","DOI":"10.1016\/j.tjnut.2024.08.024","article-title":"Perspective: key considerations when developing and publishing dietary interventions for human clinical trials","volume":"154","author":"Leidy","journal-title":"J Nutr"},{"issue":"11","key":"R24","doi-asserted-by":"publisher","first-page":"989","DOI":"10.1056\/NEJMoa2032183","article-title":"Once-weekly semaglutide in adults with overweight or obesity","volume":"384","author":"Wilding","journal-title":"N Engl J Med"},{"issue":"4","key":"R25","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1177\/87551225221092681","article-title":"Once-weekly semaglutide for weight management: a clinical review","volume":"38","author":"Fornes","journal-title":"J Pharm Technol"},{"key":"R26","doi-asserted-by":"publisher","DOI":"10.1016\/j.obpill.2025.100195","article-title":"Diet quality and nutrient distribution while using glucagon-like-peptide-1 receptor agonist: a secondary cross-sectional analysis","volume":"16","author":"Johnson","journal-title":"Obes Pillars"},{"issue":"3","key":"R27","doi-asserted-by":"publisher","DOI":"10.3390\/biom15030408","article-title":"Weight reduction with GLP-1 agonists and paths for discontinuation while maintaining weight loss","volume":"15","author":"Reiss","journal-title":"Biomolecules"},{"key":"R28","doi-asserted-by":"publisher","DOI":"10.1016\/j.eclinm.2026.103796","article-title":"Trajectory of weight regain after cessation of GLP-1 receptor agonists: a systematic review and nonlinear meta-regression","volume":"93","author":"Budini","journal-title":"EClinicalMedicine"}],"container-title":["JMIR Formative Research"],"original-title":[],"language":"en","deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:22:09Z","timestamp":1790007729000},"score":1,"resource":{"primary":{"URL":"https:\/\/formative.jmir.org\/2026\/1\/e89459"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":28,"URL":"https:\/\/doi.org\/10.2196\/89459","relation":{},"ISSN":["2561-326X"],"issn-type":[{"value":"2561-326X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]},"article-number":"v10i9e89459"}}