PROJECT SUMMARY/ABSTRACT Food insecurity disproportionately affects people with diabetes mellitus and is associated with suboptimal diabetes self-management behaviors and poor diabetes outcomes including hypoglycemia, poor glycemic control, and increased acute healthcare utilization. Standardized diabetes self-management education and support (DSMES) services designed to improve health behaviors of people with diabetes are associated with improved diabetes outcomes but have rarely been studied in people experiencing food insecurity, who face unique challenges in diabetes self-management. The proposed research aims to adapt and develop a DSMES intervention for people with food insecurity. The candidate will use formative mixed methods research to determine the nutritional, behavioral, and psychological barriers to diabetes self-management for people with food insecurity and type 2 diabetes (T2D) to inform the development of the intervention, which will focus on strategies to improve nutrition and mitigate medication-related barriers relevant to this population. Results of this study will contribute to the limited body of research centered on DSMES services for people with health- related social needs and provide preliminary data for a future career development award to test whether the adapted intervention improves the effectiveness of DSMES for people with food insecurity. The three-part aim will (a) use quantitative methods to identify demographic, psychosocial, and behavioral factors associated with low dietary quality in a cohort of low-income patients with T2D (N=161); (b) use qualitative methods to interview patients (n=25) and providers (n=5) to explore key barriers in this population; and (c) adapt a DSMES intervention to the specific needs of this population using findings from (a) and (b). The candidate will complete the proposed work under the mentorship of Drs. Anne Thorndike, an expert in behavioral interventions for cardiometabolic disease prevention and management, and Deborah Wexler, an expert in T2D and intervention design. In addition to their direct mentorship, the candidate will pursue formal coursework in qualitative research methods and design and evaluation of health interventions and will participate in regular collaborative research meetings related to diabetes, qualitative research, and health behavior interventions. The Divisions of Endocrinology, Diabetes, and Metabolism and General Internal Medicine at Massachusetts General Hospital will provide an unparalleled environment for trainee learning. This application represents a comprehensive plan to develop an intervention to improve equity in diabetes management for people experiencing health-related social needs, and to prepare the candidate to apply for a career development award with the ultimate goal of becoming an independent clinical investigator.