Researchers studied 278 low-income adults in Boston who had prediabetes or type 2 diabetes to understand what helps them eat better. They found that being older, female, Hispanic, not smoking, getting good sleep, having less stress, and having supportive friends and family all connected to eating healthier diets. The study also showed that things like trying different foods, moving around more, and managing stress are changes people can actually make. These findings could help doctors and health programs create better support for low-income people trying to manage their diabetes through diet.

The Quick Take

  • What they studied: What factors help or hurt low-income adults with prediabetes and type 2 diabetes eat healthier foods?
  • Who participated: 278 low-income adults (average age 52) from health centers in Boston. About 58% were Hispanic, 42% had prediabetes, and 58% had type 2 diabetes.
  • Key finding: Older age, being female, Hispanic ethnicity, not smoking, better sleep, lower stress, more friend/family support, and fewer depression symptoms were all connected to eating healthier diets. Things people can change—like trying new foods, moving more, and reducing stress—were especially important.
  • What it means for you: If you’re managing diabetes on a limited budget, focusing on changeable habits like reducing stress, improving sleep, eating a variety of foods, and building your support network may help you eat better. However, this study shows connections, not proof that these changes will definitely improve your diet.

The Research Details

This was a secondary analysis, meaning researchers looked at information already collected from a group of low-income patients at health centers in Boston. They examined 278 adults who either had prediabetes (early warning signs of diabetes) or type 2 diabetes. The researchers measured diet quality using a standard scoring system called the Healthy Eating Index-2020, which rates diets from 0 to 100, with higher scores meaning healthier eating patterns.

The researchers then used a computer method called random forests to figure out which factors were most important in predicting who ate healthier diets. This method is like asking many yes-or-no questions to find patterns in the data. They looked at both things people can’t change (like age and ethnicity) and things they can change (like stress levels, sleep quality, and social support).

The study was designed to identify which changeable factors could be targeted in diabetes education and support programs specifically for low-income communities.

Understanding what factors connect to better eating in low-income adults with diabetes is important because these communities often face extra challenges—like limited money for food, less access to healthy options, and higher stress. By identifying which factors matter most, health programs can focus their efforts on things people can actually change, rather than wasting resources on things that don’t help as much.

This study has some strengths: it focused on a real-world population that’s often underrepresented in research, and it looked at both unchangeable factors and changeable ones. However, because it’s a secondary analysis (using data collected for another purpose), it may not have captured all the information researchers would have liked. The study shows connections between factors and diet quality, but doesn’t prove that changing one thing will definitely improve another. The results are from one city (Boston) and may not apply exactly the same way to other areas.

What the Results Show

The study found that several factors were connected to eating healthier diets in this group. The strongest connections were with older age, being female, and being Hispanic. These are things people can’t change, but they help explain who tends to eat better.

More importantly, the researchers identified several changeable factors that connected to better eating: people who ate a greater variety of foods, didn’t smoke, got better quality sleep, had lower stress levels, had more social support from friends and family, and had fewer depression symptoms all tended to have healthier overall diets.

Among the changeable factors, eating a variety of different foods was especially important. This makes sense because when people try different healthy foods, they naturally eat better overall. Social support also stood out—people with friends and family who encouraged healthy eating did better.

The study also found that sitting less (moving around more) and having lower stress levels were connected to better diet quality, suggesting that overall lifestyle factors work together to support healthy eating.

The research highlighted that depression symptoms and stress were particularly important barriers to healthy eating in this low-income population. Sleep quality also emerged as significant—people who slept better tended to eat healthier. These findings suggest that addressing mental health and sleep problems might be just as important as nutrition advice when helping people with diabetes eat better. The study also showed that smoking was connected to poorer diet quality, suggesting that smoking cessation programs might help improve overall health habits.

This research builds on existing knowledge that low-income adults face unique barriers to healthy eating and diabetes management. Previous studies have shown that stress, depression, and lack of social support are problems in low-income communities. This study confirms those findings and adds new information by showing specifically how these factors connect to diet quality in people with diabetes. The emphasis on modifiable factors (things people can change) aligns with current thinking in diabetes care, which focuses on practical, achievable changes rather than just telling people what they should do.

This study has several important limitations. First, it only included people from health centers in Boston, so the results may not apply the same way in other cities or rural areas. Second, the study shows that certain factors are connected to better eating, but it doesn’t prove that changing one thing will definitely improve diet quality—there could be other explanations for the connections. Third, because this was a secondary analysis using data collected for another purpose, some important information might be missing. Finally, the study is a snapshot in time and doesn’t follow people over months or years to see if changes actually stick.

The Bottom Line

If you’re a low-income adult managing prediabetes or type 2 diabetes, consider focusing on these changeable factors (moderate to strong evidence): (1) Eat a variety of different healthy foods—this showed the strongest connection to better overall diet quality; (2) Build your support network—talk to friends, family, or support groups about your eating goals; (3) Manage stress through activities you enjoy, meditation, or counseling if available; (4) Improve your sleep by keeping a regular bedtime schedule; (5) Move your body more throughout the day, even with short walks. These changes may help you eat healthier, though individual results vary.

These findings are most relevant for low-income adults with prediabetes or type 2 diabetes, especially those in urban areas. Healthcare providers and diabetes educators should pay attention because it suggests they should address stress, depression, sleep, and social support alongside nutrition advice. People with higher incomes or different living situations may find some recommendations helpful but shouldn’t assume the results apply exactly the same way to them. If you have depression or serious stress, talk to a healthcare provider before making major changes.

Realistic expectations: small changes in diet quality might appear within 2-4 weeks if you focus on eating more variety and building support. Bigger improvements in overall diet quality typically take 2-3 months of consistent effort. Sleep and stress improvements may take 4-8 weeks to notice. Remember that progress isn’t always straight—some weeks will be better than others, especially when dealing with stress or limited resources.

Want to Apply This Research?

  • Track daily: (1) Number of different food groups eaten (aim for 5+), (2) Stress level on a scale of 1-10, (3) Sleep hours and quality rating, (4) Social support interactions (calls, visits, or messages with supportive people). Weekly: calculate your average stress and sleep scores to see trends.
  • Start with one small change: Pick one day this week to try a new healthy food you’ve never eaten before. Log it in the app with how you felt about it. Next week, try another new food. This builds dietary variety—the strongest factor in the study—without feeling overwhelming. Use the app’s reminder feature to prompt you to reach out to one supportive friend or family member each week about your health goals.
  • Use the app to create a ‘Diabetes Wellness Dashboard’ tracking four areas: (1) Food variety score (different foods per week), (2) Stress and sleep quality (weekly averages), (3) Social support check-ins (frequency of supportive interactions), (4) Overall diet quality rating (self-assessed 1-10). Review trends monthly. If stress or depression scores stay high, use the app to schedule a conversation with your healthcare provider.

This research shows connections between certain factors and diet quality in low-income adults with diabetes, but does not prove cause-and-effect relationships. Individual results vary based on personal circumstances, genetics, and other health factors. This information is educational and should not replace advice from your doctor, registered dietitian, or healthcare team. If you have diabetes, depression, or serious stress, consult with a healthcare provider before making significant dietary or lifestyle changes. People with different income levels, geographic locations, or health conditions may experience different results than those in this study.