Voucher for Healthy Foods and Diabetes Control
Bibliographic record
Abstract
Importance: 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. Objective: To measure the effect of a monthly grocery store voucher that allows access to healthy foods on diabetes control in patients experiencing food insecurity. Design, setting, and participants: 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 A1c (HbA1c) levels from 6.0% to 11% and food insecurity. Data analysis was conducted in May 2025. Intervention: A $65 monthly voucher ($85 for those in households with 6 or more individuals) for 6 months. Main Outcomes and Measures: The primary outcome was change in HbA1c levels from baseline to 6 months. Secondary outcomes included levels of β-carotene and ascorbic acid, self-reported fruit and vegetable consumption, financial security, food security, and general health. Results: 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 HbA1c was -0.18% (95% CI, -0.41 to 0.05; P = .13; mean difference adjusted for baseline HbA1c, age, sex, household size, and condition, -0.10%; 95% CI, -0.33 to 0.12; P = .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, -0.10; 95% CI, -0.18 to -0.02), and general health (odds ratio, 1.6; 95% CI, 1.1-2.3) but not financial insecurity (risk difference, -0.07; 95% CI, -0.16 to 0.02) or β-carotene level (mean difference, 0.01 µmol/L; 95% CI, -0.08 to 0.06) and ascorbic acid level (mean difference, -0.18 µmol/L; 95% CI, -4.3 to 4.7). Conclusions and Relevance: In this randomized clinical trial, a monthly food voucher did not have an effect on HbA1c control or objective measures of diet quality but the voucher did increase self-reported vegetable and fruit consumption. Trial Registration: ClinicalTrials.gov Identifier: NCT05776420.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".