AI DETECT

“Exploring the Syndemic Relationship Between Food Insecurity, Sleep Quality, and Type 2 Diabetes in Rural Georgia.”

 

 

 

Latasha Felder

MPH Research Development Summer Cohort

Fort Valley State University

September 30, 2025

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Chapter 1: Introduction

A chronic illness that is becoming a bigger global public health concern is type 2 diabetes (T2D). T2D management necessitates regular access to wholesome food and restful sleep, two necessities that are frequently disturbed in marginalized communities. People have a difficult time meeting these health needs in many low-income and rural locations, like Southwest Georgia. In these communities, food insecurity which is characterized as having limited or unpredictable access to enough food is especially common and has a detrimental effect on both physical and mental health outcomes. In addition to inadequate nutrition, food insecurity raises stress levels and interferes with sleep cycles, both of which can worsen diabetic symptoms and make treatment more difficult.

In Southwest Georgia, an area characterized by ingrained poverty, restricted access to healthcare, and health inequalities, this study aims to investigate the connection between food insecurity and sleep quality among persons with Type 2 diabetes. To produce knowledge that can direct focused public health actions, the study will examine the ways in which these socioeconomic variables interact to affect the outcomes of chronic diseases. Addressing the larger issues of diabetes prevention and control in underserved, rural communities require an understanding of the connection between poor sleep quality and limited access to food.

1.1 Background of the Problem

  USDA said in 2021 that roughly 10.2% of U.S. households didn’t have enough food. The CDC also said that more than 37 million Americans have T2D. Georgia has a lot of problems because 13.3% of adults there have diabetes, which is higher than the national average. In Southwest Georgia, rural areas have food insecurity rates of 11% to 16% and sometimes don’t have enough healthcare facilities. People who live in these places have trouble getting healthy food, have fewer healthcare options, and are more likely to have trouble sleeping. These problems make it harder to take care of and control diabetes on your own.

1.2 Problem Statement

This study examines whether food insecurity adversely affects sleep quality, thereby exacerbating diabetes outcomes in persons with Type 2 Diabetes (T2D). Although previous studies have individually investigated the impacts of food insecurity and sleep disruptions, there is a paucity of research exploring their interaction, particularly in rural or economically poor regions. This disparity is significant as inhabitants of Southwest Georgia face elevated rates of food insecurity and diabetes. The interplay may exacerbate adverse health effects, rendering it essential to investigate the correlation between the two elements.

1.3 Purpose of the Study

This research aims to examine the correlation between food insecurity and sleep quality in persons with Type 2 Diabetes in Southwest Georgia. This study seeks to elucidate the connection to inform interventions aimed at enhancing chronic illness outcomes in rural communities. The objective is to endorse policies that mitigate health inequities and enhance public health initiatives in the most vulnerable populations. Clarifying the study’s objective also focuses attention on the precise research questions and hypotheses that will steer the investigation.

 
1.4 Research Questions and Hypothesis

The study is guided by the following research question:

· What is the relationship between food insecurity and sleep quality in adults with Type 2 diabetes in Southwest Georgia?

Hypothesis: Adults with Type 2 diabetes who experience greater food insecurity will report lower sleep quality than those with more secure access to food.

1.5 Significance of the Study

This discovery holds significant ramifications for public health practice and policy. The study elucidates critical social determinants influencing health disparities by analyzing the intersection of food access, sleep quality, and chronic illness. The findings can assist local health departments, clinics, legislators, and nonprofit organizations in enhancing food security and sleep health for those with diabetes. Families impacted by T2D may also find the results beneficial for promoting enhanced community support. This research may facilitate targeted interventions, enhance equity, and elevate the quality of life in rural Georgia over the long term. Defining important terms clearly is essential for establishing the study’s significance and ensuring consistent comprehension throughout the research.

1.6 Definition of Key Terms

· Food insecurity: Restricted or uncertain access to sufficient food resulting from financial or social obstacles (USDA).

· Type 2 diabetes (T2D): A persistent metabolic disorder characterized by insulin resistance and increased blood glucose levels (CDC).

· Sleep quality: The profundity, duration, and restorative nature of sleep, commonly assessed using instruments like the Pittsburgh Sleep Quality Index (PSQI).

· Authenticated survey tools: Research instruments evaluated for precision and dependability, include the USDA Food Security Survey Module and the Pittsburgh Sleep Quality Index (PSQI).

To fully contextualize this issue, it is important to review the existing body of research on food insecurity, sleep quality, and Type 2 diabetes.

Chapter 2: Literature Review

Introduction

Researchers have called the relationship between food insecurity and Type 2 diabetes a “syndemic,” which means that social and biological factors make each other worse. An expanding corpus of literature elucidates the intricate relationship among food insecurity, sleep quality, and Type 2 diabetes (T2D), constituting what researchers term a syndemic, wherein concurrent factors interact and exacerbate health disparities. Walker, Smalls, and Egede (2017) discovered that persons with diabetes residing in low-resource communities are far more prone to skipping meals or depending on calorie-dense, nutrient-deficient diets due to economic insecurity, hence exacerbating glycemic control. Seligman, Jacobs, and López (2012) corroborate this trend by illustrating that food insecurity in patients with T2D elevates the likelihood of inadequate HbA1c control, resulting in increased hospitalization and emergency department visit rates. These results highlight the essential need of consistent availability to nutritious food in the self-management of diabetes.

The Syndemic of Food Insecurity and Type 2 Diabetes

An expanding corpus of literature emphasizes the intricate relationship among food insecurity, sleep quality, and Type 2 diabetes (T2D), constituting what researchers term a “syndemic,” wherein numerous coexisting diseases interact and exacerbate health disparities. Walker, Smalls, and Egede (2017) discovered that persons with diabetes in economically disadvantaged communities are far more prone to omit meals or depend on calorie-rich, nutrient-deficient foods, exacerbating glycemic control. This theme is substantiated by Seligman, Jacobs, and López (2012), who illustrated that food insecurity in patients with T2D elevates the risk of inadequate HbA1c control and results in increased hospitalizations and emergency room visits. These findings highlight the essential need of consistent, nutritious food access in diabetic self-management. This introduction establishes the framework for analyzing the role of sleep quality as a significant behavioral risk factor.

 
Sleep Quality as a Behavioral Risk Factor

In addition to dietary habits, researchers are investigating how the psychological stress associated with food insecurity affects sleep, which is increasingly acknowledged as a modifiable risk factor for chronic disease. Grandner (2017) contended that the stress stemming from uncertainty regarding the next meal can induce hyperarousal, resulting in persons remaining up at night, preoccupied with concerns about sustenance and financial matters. This chronic stress reaction interferes with sleep structure and adversely impacts metabolic health. Spiegel, Tasali, and Van Cauter (2005) corroborate his observations, demonstrating that sleep loss alone can diminish insulin sensitivity, even in healthy adults. Knutson and Van Cauter (2008) similarly shown that insufficient sleep time and subpar sleep quality independently forecast an elevated risk for insulin resistance and type 2 diabetes. Identifying sleep quality as a risk factor inherently prompts an examination of the chronic and structural influences that determine these outcomes.

 
The Role of Chronic Stress and Structural Inequity

Mongelli, Georgakakou-Koutsonikou, and Keenan (2020) expanded this discourse by contending that the persistent stress associated with food insecurity affects not just nutrition but also mental health and sleep, so establishing a feedback loop that sustains adverse metabolic consequences. They stressed that the problem is not only about the amount or quality of food, but also about the mental pain that comes from not knowing if you can get food. Johnson, Thomas, and Brown (2021) corroborated this viewpoint by associating environmental stresses, including hazardous areas, housing instability, and insufficient social support, with interrupted sleep and maladaptive eating practices. Their research emphasized the role of systemic structural injustices in exacerbating sleep disruptions and adversely affecting diabetes outcomes. Comprehending these structural effects offers a framework for analyzing their distinct manifestations within rural health inequalities. 

Rural Health Disparities and the Black Belt Region

These findings are consistent across urban and national research; nevertheless, rural communities, especially in the Southeastern United States, are still not well represented in the literature. Feeding America (2022) said that the rate of food insecurity in rural Southwest Georgia is two to three percentage points greater than the national average. Their paper doesn’t really talk about sleep quality, but it does support the idea that being poor and living in a bad area makes food insecurity worse. In 2022, the Centers for Disease Control and Prevention (CDC) said that African American individuals in Georgia are more likely to be food insecure and have type 2 diabetes (T2D), which makes things worse in rural areas. Hill, Nielsen, and Fox (2013) underscored that individuals residing in rural areas encounter distinct challenges in diabetes management, such as restricted access to healthcare services, limited transportation alternatives, and increased distances to food retailers, all of which adversely affect health outcomes and compromise sleep hygiene. Rural settings underscore significant differences, although the research presents contradictory findings that necessitates reconciliation. 

Conflicting Evidence and Nuanced Findings

Berkowitz, Meigs, and Wexler (2018) established the correlation between food insecurity and inadequate diabetes management, although observed that interventions targeting only food access may not completely address the fundamental health inequities. They advocated for comprehensive programs that tackle both behavioral health and environmental obstacles. Conversely, Nelson et al. (2020) discovered that although food pantry utilization enhanced fruit and vegetable intake in low-income households, it did not lead to improved glycemic indicators in individuals with diabetes, indicating that dietary interventions must also consider psychosocial stress and lifestyle factors such as sleep and physical activity. Research on sleep corroborates this comprehensive perspective. Patel et al. (2015) investigated more than 1,400 adults with type 2 diabetes and identified conflicting associations between sleep duration and glycemic control after adjusting for confounding variables, including medication adherence and physical activity. The conflicting results suggest that although sleep is a significant variable, its impact on diabetes outcomes is affected by other interacting factors. Summary of Key Findings and Gaps While these findings provide valuable insights, they also highlight areas where significant gaps remain, particularly in relation to rural and underserved populations.

Collectively, this research repeatedly underscores the adverse effects of food insecurity and inadequate sleep on diabetes treatment. Nonetheless, they also reveal significant deficiencies. Much research relies on metropolitan or national databases, frequently neglecting rural areas such as Georgia’s Black Belt, where African American adults encounter systemic health challenges. Furthermore, the interplay between food insecurity and inadequate sleep is never examined concurrently in rural populations, resulting in a notable deficiency in comprehending how these elements coalesce and influence chronic disease inequalities. This study seeks to address a significant gap by examining the correlation between food insecurity and sleep quality in adults with T2D in Southwest Georgia, thereby enhancing the comprehension of chronic disease disparities and guiding more focused public health initiatives. These findings offer helpful insights but also underscore substantial gaps, especially with rural and marginalized communities.

 
Gap in Literature

Even while more people are looking at how food insecurity and sleep problems affect chronic disease, not much study has been done on how these two things work together to make diabetes control harder, especially in rural areas. Many current research concentrates on urban populations or utilize national datasets, thus neglecting the distinct social, economic, and geographic obstacles encountered by persons with Type 2 diabetes in rural Southwest Georgia. Moreover, whereas food insecurity has been correlated with unhealthy dietary practices and psychological distress, and inadequate sleep has been connected to insulin resistance and glucose instability, limited research investigates the cumulative consequences of both stressors in at-risk populations. The rural Black Belt region, characterized by disproportionately elevated incidence of diabetes, poverty, and restricted healthcare access, remains markedly underrepresented in the existing literature. This study seeks to address a significant gap by examining the correlation between food insecurity and sleep quality in adults with T2D in Southwest Georgia, thereby enhancing the comprehension of chronic disease disparities and guiding more focused public health initiatives. To fill this gap, we need a well-planned study that can capture the distinctive experiences of rural communities. The following methodology explains how this will be done.

Theoretical Framework

This research is informed by two interconnected frameworks: the Social Determinants of Health (SDOH) and Syndemic Theory. Collectively, these frameworks offer a perspective for comprehending the interplay of structural, social, and biological elements that influence health outcomes in patients with Type 2 diabetes in rural Georgia. The SDOH paradigm highlights the impact of non-medical determinants, including food accessibility, socioeconomic position, and geographic location, on overall health and well-being. Food insecurity, a significant social determinant, directly impacts nutritional quality and indirectly affects sleep quality by increasing stress and restricting coping resources. In rural communities, these characteristics are exacerbated by obstacles to healthcare access and insufficient community resources.

Syndemic Theory further elucidates the interactions of co-occurring disorders within a community that amplify disease burden. Within the framework of this investigation, food insecurity and suboptimal sleep quality do not function independently; instead, they cooperate synergistically to exacerbate the risk and progression of Type 2 diabetes. This approach emphasizes the necessity of tackling interrelated health and social concerns concurrently rather than separately. This study utilizes both Social Determinants of Health (SDOH) and Syndemic Theory to acknowledge the complex factors contributing to health disparities in rural Georgia. These frameworks not only help us understand the results, but they also affect the way we undertake research, making sure that theory and practice are in sync.

Chapter 3: Methodology

This study employs a cross-sectional, quantitative approach to investigate the correlation between food insecurity and sleep quality in persons with Type 2 diabetes in Southwest Georgia. A cross-sectional technique gathers data at one moment in time, which makes it possible to find connections between important factors. This approach is suitable considering the study’s objective of examining correlations rather than determining causality.

3.2 Study Population and Setting

The study population comprises persons aged 18 and above who have received a clinical diagnosis of Type 2 diabetes and currently inhabit Southwest Georgia. Participants will be recruited via purposive sampling, focusing on persons from local clinics, community health organizations, and diabetic support groups, including the Phoebe Putney Memorial Hospital diabetic Resource Center and the Southwest Georgia Area Health Education Center (SOWEGA AHEC). The eligibility criteria encompass proficiency in reading and comprehending English, as well as the ability to furnish informed consent. Establishing the research population forms the foundation for choosing suitable instruments to gather valid and reliable data.

3.3 Data Collection Instruments

Two validated survey instruments will be used:

· USDA Six-Item Short Form Food Security Survey Module: Assesses food security status, categorizing households as food secure, low food security, or very low food security.

· Pittsburgh Sleep Quality Index (PSQI): Measures sleep quality over the past month, generating a global score where higher values indicate poorer sleep.

In addition, participants will complete a brief demographic questionnaire to capture age, gender, education, income, and length of diabetes diagnosis.

3.4 Data Collection Procedures

Participants will have the option to complete the survey electronically via Qualtrics or in person using paper forms, contingent upon accessibility and individual desire. Before taking part, people will have to give their informed consent. The clinics and community partners will work together to collect data over the course of two months.

 
3.5 Data Analysis Plan

After data collection is finished, descriptive statistics will be utilized to sum up the survey results and demographic information. The study will employ Pearson’s correlation to investigate the relationship between food insecurity and sleep quality scores. A multiple regression analysis will also be conducted to ascertain if food insecurity significantly predicts sleep quality. We will use SPSS to analyze the data. Choosing the right ways to analyze the data also shows how important it is to follow ethical guidelines during the whole study process.

3.6 Ethical Considerations

This study will adhere to ethical standards for human subject’s research. Participants will be informed about the purpose of the study, their right to withdraw at any time, and assurances of confidentiality. No identifying information will be linked to survey responses. Data will be stored securely with access limited to the research team. An application will be submitted to the Institutional Review Board (IRB) at Fort Valley State University for approval before data collection begins.

Conclusion

This thesis proposal tackles a significant deficiency in existing research by investigating the interplay between food insecurity and sleep quality and their impact on health outcomes in persons with Type 2 diabetes in rural Southwest Georgia. The evidence indicates that food insecurity leads to inadequate nutrition and heightened stress, as well as disturbed sleep, both of which impair the management of diabetes. This study utilizes a syndemic paradigm to underscore the interrelatedness of these difficulties and the necessity of simultaneous intervention. The findings of this research may contribute to public health initiatives, assist healthcare providers in customizing diabetes management, and bolster policies that enhance food accessibility and encourage sleep health. The study’s goal is to enhance quality of life and diminish health inequalities among persons disproportionately impacted by chronic disease in underserved rural regions.

References

American Diabetes Association. (2022). Standards of medical care in diabetes 2022. org/10.2337/dc22

Berkowitz, S. A., Meigs, J. B., & Wexler, D. J. (2018). Food insecurity, cost-related medication underuse, and unmet needs for care: Results from the National Health Interview Survey. American Journal of Medicine, 131(4), 401–407. org/10.1016/j. amjmed.2017.11.036

Buysse, D. J., Reynolds, C. F., Monk, T. H., Berman, S. R., & Kupfer, D. J. (1989). The Pittsburgh Sleep Quality Index: a new instrument for psychiatric practice and research. Psychiatry Research, 28(2), 193-213.

Centers for Disease Control and Prevention. (2022). National Diabetes Statistics Report 2022. cdc. gov/diabetes/data/statistics-report/index. html

Feeding America. (2022). Map the meal gap: Food insecurity in Georgia. feedingamerica. org/

Grandner, M. A. (2017). Sleep, health, and society. Sleep Health, 3(6), 413–414. org/10.1016/j. sleh.2017.10.003

Hill, J. O., Nielsen, K. M., & Fox, M. A. (2013). Health disparities in rural America. Annual Review of Public Health, 34, 203–221. org/10.1146/annurev-publhealth-031912-114938

Johnson, D. A., Thomas, S. J., & Brown, T. H. (2021). Sleep disparities in the U. S.: An overlooked public health concern. Annual Review of Public Health, 42, 81–99. org/10.1146/annurev-publhealth-090419-102522

Knutson, K. L., & Van Cauter, E. (2008). Associations between sleep loss and increased risk of obesity and diabetes. Annals of the New York Academy of Sciences, 1129(1), 287–304. org/10.1196/annals.1417.033

Mongelli, F., Georgakakou-Koutsonikou, N., & Keenan, K. (2020). The double burden of food insecurity and mental health: Pathways and potential targets. Appetite, 150, 104646. org/10.1016/j. appet.2020.104646

Nelson, B. W., Phillips, A., & Derry, H. (2020). Food pantry utilization and dietary intake among adults with diabetes: A randomized pilot study. Journal of Nutrition Education and Behavior, 52(2), 124–130. org/10.1016/j. jneb.2019.09.002

Patel, S. R., Malhotra, A., White, D. P., Gottlieb, D. J., & Hu, F. B. (2015). Association between reduced sleep and weight gain in women. American Journal of Epidemiology, 164(10), 947–954. org/10.1093/aje/kwj280

Seligman, H. K., Jacobs, E. A., & López, A. (2012). Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care, 35(2), 233–238. org/10.2337/dc11-1627

Spiegel, K., Tasali, E., & Van Cauter, E. (2005). Sleep and metabolic function. PLOS Medicine, 2(8), e62. org/10.1371/journal. pmed.0020062

U. S. Department of Agriculture. (2012). U. S. Household Food Security Survey Module: Six-Item Short Form. ers. usda. gov/media/8279/short2012. pdf

Walker, R. J., Smalls, B. L., & Egede, L. E. (2017). Food insecurity and glycemic control in individuals with diabetes: A systematic review and meta-analysis. Primary Care Diabetes, 11(5), 389–396. org/10.1016/j. pcd.2017.04.001