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A Preview: The Effect of Income Cycling on Hypoglycemia Incidence The Roosevelt Institute

The following is a preview of a policy initiative written by members of the Roosevelt Institute at the University of Chicago. Initiatives usually address a specific problem, outlined below, and posit a progressive policy idea (the “answer”) and analysis. The Roosevelt Institute is a national network of clubs and think tanks at various undergraduate institutions. Roosevelt institute members conceive and writer progressive, non partisan, public policy. For more information, please see p. 34.

Background and Context: A 2014 study from the University of California at San Francisco is titled “Exhaustion of Food Budgets at Month’s End and Hospital Admissions for Hypoglycemia”. The study finds that the frequency of patients presenting in hospitals with hypoglycemia fluctuates throughout the month. Hypoglycemia is a condition where blood glucose drops below normal levels, and it can be precipitated by inadequate nutritional intake and/or poor insulin management. Hospital admissions for hypoglycemia increase steadily from 230 per 100,000 hospital admissions during the first week of the month to 290 per 100,000 during the last week of the month, although importantly, only among low-income patients [1]. High- income patient admissions for hypoglycemia are stable throughout the month [1]. Researchers at UCSF attribute the trend to income and benefit cycles. The “SNAP cycle” is a relatively well-documented phenomenon among families receiving welfare benefits [2]. SNAP, or the Supplemental Nutrition Assistance Program, provides millions of low income families and individuals with the resources to afford a nutritionally adequate diet- it is the largest program in the domestic hunger safety net. The structure of the program varies based upon state implementation; most states, including 36

THE TRIPLE HELIX Spring 2016

California (where the study took place) and Illinois, issue benefits as a once-a-month injection of funds via Electronic Benefit Transfer (EBT) to a debit-like card which may be used at many grocery stores and food outlets. The “SNAP cycle” describes the potential for a cyclic caloric intake to result from one-time disbursals of benefits at the beginning of the month. Like most households, SNAP households use the majority of their funds at the beginning of the month [2]; however, because SNAP households face greater-than-normal difficulties in achieving food security, the resulting decrease in funds at the end of the month may result in poor nutritional consumption. The 2014 study posits that the SNAP cycle, among other income cycles (imagine a scenario where the majority of a family’s income is taken up by rent; in this case, the food budget might be highest in between rent payments, and lowest in the days leading up to or following payment) may be driving low-income patients to hospitals to be treated for hypoglycemia at the end of the month. It is likely that the effect is preferentially affecting diabetic low-income patients, for whom food insecurity is associated with a two- to three-fold increase in risk for hypoglycemia [3]. This is particularly concerning considering the strong positive correlation between poverty and diabetes [4]. © 2016, The Triple Helix, Inc. All rights reserved.

Science in Society Review - Spring 2016  
Science in Society Review - Spring 2016  
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