News | April 2022

Major Grocery Chains Failing to Meet the Needs of People With Diabetes

A large, nationally representative survey shows that people with diabetes believe that there is a wide variation in grocery store quality. This is not surprising since not all stores treat people with diabetes equally. The diabetes Net Promoter Score® – the willingness to recommend a store to another person with diabetes – ranged from 63 for the best grocery store to zero for the worst. Although people with diabetes choose roughly the same primary grocery stores as the general population, the size of a grocery chain was not related to their perception of quality. The stores that were most popular and had the highest willingness to recommend were Aldi, Publix, Costco, Hy-Vee and H-E-B.

SAN FRANCISCO, California, April 7, 2022 — dQ&A, the leader in diabetes research, released selected results from its US Diabetes Connections survey related to grocery shopping. Over five thousand respondents with diabetes (n=5,481) disclosed their primary grocery store and rated their willingness to recommend that store to another person with diabetes. The data was statistically representative of all people with diabetes in the United States.

Grocery shopping has particular significance to people with diabetes because of the important role of diet and nutrition in the management of the disease. There is also a strong emotional and psychosocial component to eating well and maintaining blood glucose control – particularly if needs are not being met. In dQ&A’s studies, more than half of people with diabetes did not feel very supported in maintaining their preferred eating habits at home. What’s more, 28% of low-income people with diabetes find it somewhat or very challenging to find their preferred foods when grocery shopping.

In this nationwide study, we received n=3,494 written comments concerning dozens of grocery stores. Respondents unimpressed by how well their primary grocery store serves people with diabetes were usually not impressed with selection and didn’t think that the store had considered their needs. For example:

“It’s mostly heavily-processed foods. There’s no dedicated section for low-carb or low-sugar. You have to hunt-and-peck, read every label.”

“The produce selection is limited & not very fresh…lower carb products are not offered.”

“Nothing is labeled for diabetics, and if you don’t know how to read food labels, that’s an additional issue.”

In our study, we organized stores by popularity with our community of respondents (n=5,481) and by willingness to recommend. Broadly speaking, popularity was in line with the general population. Although convenience or lack of local choice determines most people’s primary store, some habitually visit other stores to find what they need.

We measured ‘willingness to recommend to another person with diabetes as a place to shop for food’ for 29 grocery stores, (for which the average number of shoppers per store was n=150). We calculated the diabetes Net Promoter Score® (NPS) in the usual manner by subtracting the percentage of ‘detractors’ from the ‘promoters.’ At the top end, with a strong NPS of 63, were H-E-B, Publix and Wegmans. At the bottom end, Safeway, Vons and Ralphs all scored below 18.

In the figure below we rank the stores on both dimensions. In NPS, we show three distinct tiers, which could be statistically distinguished at a 90% confidence level.

Figure 1: Chart showing the best places for people with diabetes to shop for groceries

The most popular and most highly recommended stores were Aldi, Publix, Costco, H-E-B and Hy-Vee. For this group, respondent comments included:

“They have a registered dietician in the store to help answer any questions you have about foods.”

“Excellent low carb and high protein food choices, plus a nice variety of treats that have little impact on blood sugar.”

“They stock a lot of fresh fruits and vegetables at a low price.”

“‘What should I eat?’ is one of the most searched terms in diabetes,” said Richard Wood, dQ&A’s CEO. “This study highlights the huge variation in quality of grocery stores from the perspective of people with diabetes. Although some stores get it right, many don’t seem to be aware of the issue and how they are serving people with diabetes. Across the nation, 12% of adults have diabetes and, in some cities, it’s even higher. Given the scale of the problem, it’s time that grocery stores directly responded by making people with diabetes feel heard, and making it easier to shop for foods that won’t negatively impact diabetes management.”

Please contact us at for more information about this piece of research, or for inquiries into dQ&A’s industry-leading services.

dQ&A would like to express its sincere gratitude to all of the community members who participated in these research studies.

“Net Promoter®, and NPS® are registered trademarks of Bain & Company, Inc., Satmetrix Systems, Inc., and Fred Reichheld. Net Promoter Score℠ and Net Promoter System℠ are service marks of Bain & Company, Inc., Satmetrix Systems, Inc., and Fred Reichheld.”

About dQ&A – The Diabetes Research Company

dQ&A is a social enterprise committed to making life better for people with diabetes. We harness patient voices to drive better business results and better health outcomes. For over 14 years, we have been comprehensively tracking the diabetes experience in the United States, Canada, and Europe. We are trusted by diabetes industry leaders for our independence, commitment, and expertise. Our team has decades of experience in quantitative and qualitative research with a deep knowledge of diabetes. We’re efficient and effective; our insights are actionable and accessible. To learn more, send us an email at For research highlights, visit us at and follow us on LinkedIn (dQ&A – The Diabetes Research Company)