Improvements in glycosylated hemoglobin A1c and blood pressure as measured through electronic health records across four produce prescription projects in the northeastern and Western United States

Objective: We examined changes in glycosylated hemoglobin A1c (HbA1c) and blood pressure among 2218 participants in four produce prescription programs (PRx) across nine clinics in the northeastern and western United States. Methods: PRx enrolled participants with food insecurity and/or diet-related chronic disease conditions between 2023 and 2024. This multi-site, single cohort study used paired t-tests to examine changes in HbA1c and blood pressure after program participation. Blood sugar control category at baseline and hypertension category at baseline were examined to understand changes among categories. Results: For all participants, a clinically and statistically significant decline in HbA1c was observed (mean = -0.5; 95% CI: -0.6, -0.5). Participants with >9% baseline HbA1c experienced the largest decreases (1.9 units). Both systolic blood pressure (SBP) (mean = -1.77) and diastolic blood pressure (DBP) (mean = -2.03) decreased significantly. Decreases in blood pressure were most substantial for participants with stage two hypertension at baseline; SBP decreased by 10.7 mmHg and DBP decreased by 5.7 mmHg. Conclusions: These data provide needed estimates of biomarker improvement during participation in heterogeneous real-world PRx, reinforcing the generalizable potential for positive health impact from improved access to fresh fruits and vegetables. Further research is needed to understand program impacts relative to standard care.