Objective:

To examine the association between food insecurity (FI) status and youth-onset diabetes mellitus (DM) among adolescents, and to evaluate the role of preventive care in this association.

Approach:

• Study Design: Repeated cross-sectional analysis using data from the National Survey of Children’s Health (2016–2021).
• Data Analysis: Propensity score weighting (PSW) was employed to balance confounders across FI groups, followed by logistic regression for variable selection and analysis.

Key Findings:

• Moderate-to-severe FI was associated with higher odds of youth-onset DM (OR 1.55, 95% CI 1.35 to 1.77; p<0.0001).
• Mild FI was not associated with youth-onset DM.
• Among adolescents with preventive care visits, both mild FI (OR 1.19, 95% CI 1.04 to 1.37; p=0.0126) and moderate-to-severe FI (OR 1.67, 95% CI 1.46 to 1.92; p<0.0001) were linked to higher odds of DM.
• Among those without preventive care visits, moderate-to-severe FI was associated with lower odds of reported DM diagnosis (OR 0.11, 95% CI 0.03 to 0.35; p=0.0002).

Interpretation:

The relationship between FI and youth-onset DM varies based on access to preventive care, indicating that adolescents with FI lacking regular preventive care may have fewer opportunities for DM diagnosis.

Limitations:

• The study relies on self-reported data, which may introduce reporting bias.
• The cross-sectional design limits causal inferences.

Conclusion:

Moderate-to-severe FI is associated with youth-onset DM, and access to preventive care influences the detection of diabetes in adolescents.