Produce Prescription Program Shows Limited Impact on Cardiometabolic Health in Diabetes

Patients with diabetes who face food insecurity are at heightened risk for poor cardiometabolic outcomes, including elevated blood glucose, obesity, and increased health care utilization.¹ To address this, produce prescription (PRx) programs have emerged as a potential intervention, providing financial support for fresh fruits, vegetables, and legumes.

A recent study conducted in the southeastern US evaluated the effectiveness of a 12-month PRx program in improving health outcomes for patients with diabetes at risk of food insecurity.

The pragmatic, randomized clinical trial was published in JAMA Internal Medicine.

“In this large RCT [randomized clinical trial], a PRx subsidy did not improve cardiometabolic and health care utilization outcomes,” wrote the researchers of the study. “The findings suggest that there may be opportunities to improve PRx enrollment and adherence and target patient populations that stand to benefit the most.”

Addressing food insecurity is critical for improving health outcomes, particularly for individuals with chronic conditions such as diabetes, hypertension, and obesity.² Food insecurity—defined as the lack of consistent, reliable access to enough nutritious food—creates a significant barrier to maintaining a healthy diet, even when financial resources are provided through interventions like produce prescriptions.

The study recruited participants from an integrated academic health system between June and August 2023.¹ Eligible adults had a diagnosis of type 2 diabetes (T2D) and were identified as being at risk for food insecurity. Participants were randomized into 2 groups: the treatment group received a debit card loaded with $80 monthly for up to 12 months to purchase eligible fresh, frozen, or canned fruits, vegetables, and legumes, while the comparison group continued to receive usual care.

Randomization was stratified by prior-year mean hemoglobin A_1c (HbA1_c) levels (less than 8% vs greater than or equal to 8%). Both groups also received diabetes self-management educational materials.

The primary outcomes were HbA_1c levels and emergency department visits at 12 months; secondary outcomes included body mass index (BMI), blood pressure, and inpatient visits. Data were analyzed from October 2024 to April 2025.

Of 9608 patients assessed for eligibility, 2155 consented and were randomized, with a mean (SD) age of 56 (14) years and 71% female participants. The cohort included 5.3% Hispanic, 61% non-Hispanic Black, and 32% non-Hispanic White participants, with mean baseline HbA_1c levels of 7.48% (SD, 1.77%). Benefit use was moderate; only 30% of participants used 80% or more of their monthly $80 allocation.

At 12 months, the adjusted between-arm difference in HbA_1c favored usual care by 0.20 percentage points (95% CI, 0.05%-0.35%). No statistically significant differences were observed in emergency department visits, BMI, blood pressure, or inpatient visits.

Similar findings were reported in the subgroup of participants with elevated HbA_1c levels (greater than or equal to 8%; n = 651), suggesting a limited effect of the PRx intervention on individuals with higher baseline glycemic risk.

However, the researchers noted the study had limitations. Adherence to the PRx program was moderate, potentially reducing the intervention’s effectiveness. The trial relied on a single health system in the southeastern US, limiting generalizability. Additionally, food access, dietary behaviors, and social determinants of health beyond the $80 monthly subsidy were not controlled, which may have influenced outcomes.

Despite these limitations, the researchers believe the study finds that a produce prescription program did not improve cardiometabolic health outcomes or reduce health care utilization among patients with diabetes at risk for food insecurity over 12 months.

“While our study contributes to the PRx evidence base, it also invites reflection on how and whether to prioritize FIM [Food Is Medicine] interventions in the health care setting vs other clinical interventions to improve diabetes care or more equitable policy changes to address root causes of FI [food insecurity],” wrote the researchers.

References

1. Drake C, Buckman C, Brucker A, et al. Produce prescription subsidy for patients with diabetes. A pragmatic randomized clinical trial. JAMA Intern Med. doi:10.1001/jamainternmed.2025.8008

2. Hung A, Durant RW, Corbie G. Addressing food insecurity is complicated but needed. JAMA Intern Med. Published online February 16, 2026. doi:10.1001/jamainternmed.2025.8008