Dietary, Food Security and Diabetes Outcomes Associated with Food Is Medicine Programs among Adults with Type 2 Diabetes in the United States: A Rapid Systematic Review

Background: Food is medicine (FIM) interventions are designed to help manage diet-sensitive diseases. Despite their popularity, it is unclear whether FIM programs significantly impact nutritional and clinical outcomes among adults with type 2 diabetes (T2DM), a highly prevalent chronic disease in the United States. Objectives: This study aimed to evaluate FIM programs focused on diabetes management, dietary intake, and food security outcomes among adults with T2DM. Methods: A systematic search was completed in September 2025. Eligible studies were in English and conducted in the US. FIM interventions provided food or increased access to food. Study assessments included diabetes outcomes, diet, and food security. Risk of bias was evaluated. Results: Twenty-three studies were included (21 quantitative, 1 qualitative, and 1 mixed methods). Of 21 quantitative studies, 9 observed statistically significant reductions in hemoglobin A1c (-0.1% to -3.0%); however, only 2 were clinically significant improvements. Improved dietary habits were observed in 14 of 19 studies assessing vegetable and fruit intake (+0.2 to +0.9 mean servings/d) and 4 of 6 studies assessing diet quality (+0.04 to +31.8 points). Of 10 studies, 8 found significant reductions in food insecurity (-8.9% to -53.5%). Qualitative studies suggested perceived improvement in diet quality, food security, and diabetes management by participants. Risk of bias was "fair" for most studies. Conclusions: Modest improvements in dietary intake, food security status, and diabetes management were observed in 43% of studies; however, most were not clinically significant changes. The low rigor of many studies suggests caution against drawing conclusions regarding FIM program efficacy. This review was registered at PROSPERO (CRD42021284000).