In 2020 more than 38.5 million (10.5%) U.S. households were without reliable access to sufficient quantities ofaffordable nutritious food due to limited money or other resources. Food insecurity poor nutrition and economicdisadvantage are critical social determinants of health that contribute to disparities in type 2 diabetes mellitus(T2DM) a serious diet-sensitive chronic disease affecting more than 20% of food insecure adults. Copingstrategies favor inexpensive ultra-processed foods that substantially diminish diet quality and are associatedwith increased incidence and severity of T2DM including poorer glycemic control and excess body weight. Giventhat numerous social factors and systems contribute to and perpetuate food insecurity and poor diabetesoutcomes there is a demonstrable need for multilevel (individual household community) food-focusedinterventions to effectively and sustainably address the diet quality of persons with or at risk of T2DM. To ourknowledge no studies have rigorously tested whether intervention programs explicitly designed to improve bothfood and nutrition security of low-income persons with T2DM are feasibly delivered by personnel at a FederallyQualified Health Center (FQHC) acceptable to patients seeking care in their medical home or are capable ofproducing clinically relevant changes in T2DM endpoints. These are questions we will explore in our proposedrandomized wait-list controlled pilot study Food and Resources Expanded to Support Health and Type2 Diabetes (FRESH-T2DM) in which our previously developed food and diabetes self-management education(DSME) intervention (FRESH) will be delivered to 50 adult FQHC patients with T2DM and food insecuritytwice monthly for 6 months. The FRESH intervention consists of bimonthly food provision; a series of recipesthat feature FRESH foods; diabetes self-management education (DSME) resources; and four 30-minute visitswith an FQHC Registered Dietitian Nutritionist and Certified Diabetes Educator who will help participants utilizeFRESH resources to meet personalized treatment goals. We will build upon our prior work and existingcollaborations with colleagues at El Rio Community Health Center a Federally Qualified Health Center serving>110000 underinsured uninsured patients and the Community Food Bank of Southern Arizona a regionalfood bank serving 180000 Arizonans across 5 counties to: (Specific Aim 1) Assess the feasibility acceptabilityand participant uptake of our FRESH intervention delivered to 50 food insecure adults with T2DM at their medicalhome El Rio Community Health Center and (Specific Aim 2) Explore changes in blood glucose control dietquality food security diabetes self-care behaviors and health-related quality of life among participants at 3 and6 months. Completion of our pilot study submitted in response to NIDDK PAS-20-160 will produce data toinform the rationale and design of a future definitive randomized controlled clinical trial including recruitmentretention adherence and cost data. Our long-term goal is to produce a tested efficacious model of coordinatedcare capable of replication and scaling across other FQHCs and food bank networks.