This work started with a deceptively simple question: ‘How do clinicians identify food insecurity in people living with type 2 diabetes, and what actually helps once they do?’
To explore this, I reviewed published research from across the world. Over many coffees, I read and debated papers, regularly asking other colleagues: ‘Is this really a pattern, or am I reading too much into it?’
What came through very clearly were the human stories beneath the data. Clinicians wanting to help, but constrained by time and systems. People with diabetes trying to manage blood glucose, while also worrying about whether there is enough food at home.
Asking about food only works if there’s something to offer next
Many clinicians want to ask patients about access to food and some already do, but the evidence shows that screening alone is not enough.
Without time, clear processes, or obvious referral routes, screening often stalls. I repeatedly came across similar experiences: ‘I asked the question. They said yes. And then I didn’t know what to do’. That moment matters. It can leave clinicians feeling stuck and distressed, and patients feeling exposed and unsupported.
One of the key messages from the evidence is that this isn’t about individual clinicians doing more. Food insecurity needs to be part of everyday systems, with prompts, shared responsibility across teams, and links to support that actually exists. Without that organisational backing, raising the issue of food tends to fall down the priority list, especially on busy clinic days.
Trust makes disclosure possible
You can’t script disclosure about food insecurity. People tend to talk when they feel listened to and not judged.
Shifts in practice, even just small changes in language came up repeatedly. A nurse replacing ‘Why aren’t you following the diet?’ with ‘What gets in the way?’ or a GP explaining ‘We ask everyone about access to food, because it can affect diabetes management.’
These shifts matter, they help move conversations away from blame and towards problem‑solving.
There was also a consistent tension between dietary advice and financial reality. Guidance may be clinically sound but still impossible to follow when money is tight. Recommended foods and ideal meal plans don’t always match what someone can afford or access.
Across the evidence, one message stood out, ‘Starting where people are really matters’. Advice framed around better, not perfect is far more likely to support engagement than aiming for an ideal that feels unreachable.
This isn’t something clinicians can fix alone
Many clinicians described feeling unsure where to send people for help. Knowledge of local food support was often limited or quickly out of date. Some avoided the conversation altogether, worried about raising an issue they couldn’t help with.
Where things seemed to work better was in areas with strong links between health services and community organisations such as food banks, pantries, community kitchens, and social prescribers. Not just signposting, but relationships and connection.
Another common theme was confidence and skills. Here, even when people accessed food support, they didn’t always feel able to turn unfamiliar ingredients into meals that worked for diabetes. Practical, community‑based support, including cooking sessions or simple recipe swaps helped bridge that gap.
What did I learn?
One of the biggest surprises was how rarely food insecurity appeared on its own. Transport costs, prepayment meters, missed appointments, and medication routines were often part of the same picture.
Stigma also ran throughout the existing research. Many people felt blamed for their diabetes and ashamed of needing help with food. Seen in that light, it becomes easier to understand why disclosure feels risky.
Perhaps most surprising was the impact of small system changes. Adding two evidence-based questions to patient records and a clear referral route doesn’t sound transformative. In practice, it can change conversations and access to support in very real ways.
Where I’ve landed
I started with the academic literature. I ended with a clearer sense that while food insecurity shows up in clinical settings, it isn’t something clinicians can or should be expected to solve alone.
If we want better diabetes outcomes, we need systems that make it:
- easier to ask about food
- realistic to respond to what we hear, and
- normal to work alongside community organisations beyond clinic walls.
If you’ve tried something that worked, or something that didn’t, I’d really like to hear about it. Being open about the messy space between screening and support feels like a good place to start.
