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

<b>Objective:</b> 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. <b>Methods:</b> 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 <i>t</i>-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. <b>Results:</b> 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. <b>Conclusions:</b> 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.