Free Healthy Food Access May Reduce Food Insecurity, Not Significantly Improve HbA1c

Free access to healthy food may reduce food insecurity among people with prediabetes or type 2 diabetes, but a living systematic review found only a small reduction in HbA1c that was not statistically significant. The review included seven trials, all judged to have a high risk of bias, limiting confidence in the findings. The review focused on interventions that provided healthy food options at no cost to people with type 2 diabetes or prediabetes who had low incomes or were experiencing food insecurity.

Researchers searched seven electronic databases on July 30, 2025, for controlled trials and quasi-experimental studies published from 1980 through the search date. Two independent reviewers screened titles, abstracts and full texts in Covidence. Two authors then independently extracted data and assessed bias and certainty.

Clinical trials were assessed with the ROB 2 tool, and results were pooled using random-effects meta-analyses. The review examined HbA1c, fruit and vegetable consumption, food security, financial security, health-care utilization, overall health and quality of life. For HbA1c, the pooled mean difference was −0.10, with a 95% confidence interval of −0.36 to 0.17.

The estimate was not statistically significant (p = 0.48), and the certainty of evidence was rated low. The result is consistent with a possible small reduction in HbA1c, but the review does not establish that free healthy-food access produces a meaningful improvement in this outcome. Food insecurity was the outcome with a statistically significant pooled association.

Interventions were associated with a risk ratio of 0.87, with a 95% confidence interval of 0.80 to 0.95 (p = 0.0013). The authors rated the certainty of this evidence as low, so the result supports a possible reduction in food insecurity rather than a definitive conclusion. The review also reported that interventions providing free access to healthy foods may improve diet quality, increase fruit and vegetable consumption, reduce blood pressure and improve overall health.

These findings were based on a small number of trials, and the authors emphasized that the data were limited. The review therefore does not provide firm evidence for these broader outcomes. All seven included studies had a high risk of bias, according to the review’s assessment.

Taken together, the findings suggest that free healthy-food access may help people facing food insecurity, while any effect on HbA1c appears small and uncertain. The review’s overall conclusion is that the interventions reduced food insecurity and may improve glycemic control, but the reduction in HbA1c was neither statistically significant nor large.

Subject of Research: Effects of free healthy-food access on diabetes outcomes in people with prediabetes or type 2 diabetes

Article Title: Effect of free healthy food access on diabetes control: a living systematic review

Article References: Muhiuddin, M., Ul Haq, M. Z., Workentin, A., Sinha, L., Ziegler, C., & Persaud, N. (2026). Effect of free healthy food access on diabetes control: a living systematic review. BMC Public Health. https://doi.org/10.1186/s12889-026-29337-2

Image Credits: AI Generated

DOI: 10.1186/s12889-026-29337-2

Keywords: type 2 diabetes, prediabetes, food insecurity, healthy food access, HbA1c, systematic review, meta-analysis, public health, glycemic control, Effect, free, healthy