Inequities in diabetes diagnosis, management, and outcomes are deeply rooted in social determinants of health and structural racism. Historical policies such as redlining and concentrated poverty in low-income neighborhoods have shaped environments characterized by limited access to healthy food and proper healthcare, which ultimately led to a disproportionate burden of diabetes in these populations. The consequences of these disparities for racial and ethnic minoritized groups include a lower ability to achieve glycemic targets, receive novel glucose-lowering agents, and/or have access to diabetes technology. The downstream effect is that this population experiences worse health outcomes from complications (i.e., amputation, blindness, end-stage renal disease) and mortality. This narrative review synthesizes current literature on racial/ethnic inequities in diabetes care, highlighting differences in screening, glycemic control, complication rates, and mortality in people living with diabetes from diverse racial and ethnic backgrounds, but also identifies opportunities for intervention to ensure equitable access to evidence-based care.

Introduction: Diabetic foot ulcers (DFUs) are a debilitating complication of diabetes, and management by multidisciplinary foot teams has been shown to reduce serious sequelae, such as amputations. There are stark racial and ethnic disparities in morbidity and mortality from DFUs, and multidisciplinary care has been shown to reduce lower extremity amputations, length of hospital stays and readmissions. This is a review of the impact of multidisciplinary care on DFUs, particularly regarding social determinants of health, with an illustrative case. Case Presentation: This is a case of a 32-year-old African American male with Type 1 Diabetes, a history of poor glycemic control, attention deficit hyperactivity disorder, tobacco and marijuana use disorder, and multiple social and structural barriers to care. He presented with bilateral Wagner grade 3 DFUs with osteomyelitis to the emergency department, requiring hospitalization. Upon discharge, he was referred to a multidisciplinary diabetes clinic and received coordinated support from endocrinology, podiatry, vascular surgery, infectious disease, pedorthics, and behavioral health. Comprehensive evaluation, intensive wound care with adjuvant hyperbaric oxygen therapy, offloading, blood glucose management and medical source control of infection were established for his treatment plan. At the three-month follow-up, the patient’s wound beds had significantly improved, and his Hemoglobin A1c declined from 12.6% to 9.3%. The right plantar wound completely epithelialized, and the left foot wound showed 90% contracture. Review and Discussion: This case highlights the importance of integrated, multidisciplinary care for DFUs, particularly in addressing both the clinical and social drivers of complications from diabetes.

Abstract Background: Diabetic foot infections (DFIs) are a major cause of hospitalization and antibiotic use, yet variation in diagnostic sampling and empiric therapy persists. We evaluated microbiologic findings and antibiotic utilization in hospitalized patients with DFIs over a five-year period. Methods: We conducted a retrospective cohort study of adults hospitalized with diabetic foot ulcers who received systemic antibiotics at Montefiore Medical Center (Bronx, NY) from 2016–2021. We assessed timing of wound culture collection, microbiologic results, and antibiotic use. Associations between time to culture and length of stay (LOS), and temporal trends in prescribing, were analyzed using linear regression. Results: Among 637 patients (mean age 59 ± 13 years; 70% male; 53% Hispanic), median LOS was 7 days (IQR 4–11). Wound cultures were obtained in 450 patients (71%), typically on hospital day 1 (IQR 0–2). Time to first culture was positively associated with LOS (Pearson r = .47, P < .001) with each additional day associated with 1.18 day increase in LOS (P < .001). Methicillin susceptible Staphylococcus aureus (MSSA) and Streptococcus species predominated in wound cultures, while methicillin resistant S. aureus (MRSA) and Pseudomonas aeruginosa were each identified in <10% of cases. Among patients with blood cultures, 26% had bacteremia, most commonly MSSA and MRSA bacteremia occurred in 6.5%. Despite this, empiric anti-MRSA and antipseudomonal therapy were initiated in 91% and 80% of patients, respectively. Over the study period, vancomycin use declined (P < .01), and the use of non-antipseudomonal cephalosporins increased (P = .04). Conclusions: In this large cohort of hospitalized patients with DFIs, MSSA predominated and resistant organisms were infrequent; however, empiric broad-spectrum antibiotic use was common. Earlier culture acquisition and alignment of empiric therapy with local microbiologic epidemiology represent key opportunities for antimicrobial stewardship.

Globally, a lower-extremity amputation occurs every 20 s as a complication of a diabetic foot ulcer, underscoring the urgent need for effective preventive strategies. Previous studies have shown that temperature-based foot monitoring can reduce both the incidence and severity of diabetic foot ulcers. However, real-world adherence data for remote temperature monitoring remain limited, particularly in diverse or resource-constrained communities. We conducted a pilot implementation study of 20 adults with diabetes and a history of diabetic foot ulcers to assess adherence to a remote foot temperature monitoring mat within the context of receiving podiatric care. Participants are instructed to stand on the mat for 20 s daily, and data are transmitted wirelessly for remote monitoring. Adherence was defined as use of the mat at least four times a week. Participants demonstrated high adherence to the foot monitoring mat, averaging 6 scans per week, with sustained adherence over the 6-month study period. These findings suggest that high-risk patients with diabetes can reliably engage with the foot temperature monitoring technology, supporting its potential as a management tool to improve outcomes and reduce the burden of diabetic foot ulcer-related complications in high-risk, resource constrained patient populations.

Summary:Lower extremity amputation secondary to diabetic foot ulcers (DFU) is associated with a 50% mortality rate within 5 years. The aim of this case series is to understand the risk factors and management of DFU leading to above-knee or below-knee amputation at an urban medical center. We conducted a retrospective review of the medical history, foot examination findings, noninvasive vascular studies, angiographic imaging, and radiology results from hospital stays during which patients underwent amputation. A total of 35 patients with DFU who underwent amputation between 2016 and 2021 were evaluated. Of these, 16 ambulatory patients had complete medical data and were included in the analysis. Risk factors for amputation, clinical presentation, diagnostic findings (e.g. vascular studies or imaging), and amputation approaches were analyzed. Our study found significant variability in the medical history, presentation, and management of patients with DFU who underwent lower extremity amputations, including differences in vascular abnormalities and the timing of care. Poor glucose control (median HbA1c of 10.3%) and delayed presentation likely contributed to tissue loss and amputation. Understanding the individual medical presentations and management of patients undergoing leg amputation secondary to DFU may inform the development of more effective strategies to prevent this complication in patients with diabetes. Learning points:There is significant variability in the presentation and progression of diabetic foot ulcers (DFUs). Diagnostic evaluation of DFU varies between patients; a more standardized evaluation to inform best practices could be useful. Socioeconomic status (SES) plays a role in the increased risk of amputations among DFU patients, including delay in care and access to limb salvage programs. Multidisciplinary care, including early detection of DFU, patient education, and routine screenings, is essential for improving outcomes and reducing the risk of amputations in high-risk DFU patients.

Despite decades of ongoing efforts to address gender equality, female physicians, particularly women of color, continue to face significant barriers in medicine, which are exacerbated by microaggressions. In this qualitative study, 133 female physicians recalled experiences with microaggressions and the impact of these experiences on their professional identities and career progression. Thematic analysis revealed four major themes: (1) disregard for professional status; (2) undermining contributions; (3) intersectionality; (4) impact on career mobility and professional confidence. Further, there was one emerging theme: leadership and culture. The results underscore the compounding effects of microaggressions for female physicians with intersecting identities. Highlighting the application of social identity theory, intersectionality, and organizational justice, this study provides a comprehensive view of the impact of microaggressions on female physicians, offering new perspectives on the intersectional nature of discrimination and its effects on professional identity and career satisfaction.

Disclosure: K. Yang: None. G. Rothenberg: Podimetrics. R. Lopez Fanas: None. L. Rincon Rueda: None. A.K. Myers: Eli Lilly & Company, ROM Technologies. D. Levy: None. J. Daily: None. Globally, a lower extremity limb is amputated every 30 seconds due to the increasing burden of diabetic foot ulcers (DFU). Prior studies have demonstrated that foot temperature monitoring is a preventive modality that can reduce the incidence of DFU and health resource utilization. To test the uptake of a foot monitoring mat (Podimetrics SmartMatTM, Somerville Mass) in an urban setting, we conducted a pilot study of 20 adult high-risk patients living with diabetes, peripheral neuropathy, a history of prior DFUs, and previous hospitalization(s) due to DFU-related complications. Participants were recruited from a referral podiatry clinic in the Bronx, NY with an exclusion criterion of prior above or below the knee amputation. All participants were mailed a Podimetrics mat and were trained to use the mat. Podimetrics team monitored daily usage to generate descriptive data on daily usage. The primary outcome was adherence to stepping on the monitoring mat (defined as stepping on the mat at least 4 times a week) over a six-month period. Majority of patients were male (85%) with an average age of 62 years, and Black (60%). They had an average HbA1c of 6.9%, 19/20 had peripheral neuropathy, 16/20 patients had a prior history of DFU-related amputations, and 13/20 had peripheral arterial disease. Our data showed both a high average adherence (using the mat 6.0 days per week) and a high overall adherence (range of 4.1-6.9 days of use per week). There was one participant lost to follow-up due to non-study related death. Our findings indicate the uptake of a foot temperature monitoring device can be highly adherable for patients living with diabetes and can be useful in high-risk patients to prevent DFU and enhance limb salvage in patients living with diabetes. Presentation: Monday, July 14, 2025

Abstract Disclosure: A. Herrera Chancay: None. R. Lopez Fanas: None. H. Tabassum: None. J. Daily: None. A. Myers: None. Background: Diabetic Foot Ulcer (DFU) is a severe complication of diabetes mellitus and is associated with high rates of morbidity and mortality. The incidence of DFUs and amputation disproportionately impact Black and Hispanic populations. DFU is also associated with a high rate of hospital readmissions and prolonged length of stay (LOS). The goal of this study was to examine 1-year mortality data, LOS and readmission rate. Methods: This study was a retrospective chart review of 1348 patients admitted to three hospitals in our system in the Bronx from 6/1/16 to 5/31/21. Data was extracted from the EPIC® electronic health records, based on the diagnoses ICD 10 codes, E10.621 and E11.622. Inclusion criteria was patients admitted with an active DFU regardless of other admission diagnosis, age 18 years or above. The index admission was defined as the first admission in our medical records within the date range. Patients were excluded if their index admission was not accessible through our EMR. Simple logistic regression and multiple logistic regression were used to analyze the association between variables of interest and mortality at index admission and at 1-year, LOS and re admissions. Results: Of the 650 eligible patients, the mean age was 59 + 13 years, 70% of patients were male, and majority were non-White (88%). Mortality was 1% during the index admission and the risk increased to 6% at 1 year after the index admission. Readmission with an active DFU from the index admission occurred in 15% of patients within 30-days, 32% of patients within 90 days, and 55% of patients within 1 year. The mean length of stay was 9 +7.5 days. Discussion: Our study in an urban region has identified high rates of mortality and costs associated with DFU, which has been reported in many settings. This patient population is high risk for poor outcomes and targeted programs are needed to reduce mortality and provide care to reduce readmissions. Future studies that explore the challenges of DFU health care and that test interventions are needed to improve DFU related health outcomes. Presentation: 6/2/2024

Abstract Disclosure: M. Hashmi: None. C. Schechter: None. A. Herrera Chancay: None. H. Tabassum: None. N. Shiraliyeva: None. J. Daily: None. A.K. Myers: None. Objective Diabetes complications, especially diabetic foot ulcers (DFU), are a leading cause of health care expenditures. This study examined the total cost of amputations and subsequent procedures in Health First insured (HF) patients initially treated at Montefiore Medical Center (MMC) for DFU. Using the database of HF, a large-scale Medicaid managed insurance organization, we captured healthcare utilization beyond the scope of one hospital system, obtaining a more comprehensive understanding of expenditures. We also explored the associations of demographic and lab values with expenditures. Methods The HF data extraction covered calendar years 2021 and 2022 plus YTD 2023. Amputations were identified by CPT codes 27880, 27590, 28810, and 28820. One hundred twenty patients were included in the sample as they had HF insurance and their initial admission for DFU was at one of three hospitals at MMC. Demographic and laboratory data were extracted from the EHR. Demographics, lab values within 3 months of the index admission, and total costs were summarized, and paid amounts per capita per year were calculated. Expenditures included amputation, labs, wound care, surgery, hyperbaric therapy, interpreter services, emergency department visits, home care visits, and outpatient follow-up (in-person and telehealth). We explored demographic, comorbidity, and lab values as predictors of expenditure levels using a bivariate analysis. Results The mean age was 60.6 ± 12 years with majority being male (n=79, 65.3%) and having Type 2 Diabetes (n=103, 96.3%). A significant portion identified their race as other (n=58, 53.7%) or ethnicity as Hispanic-Latino (n=60, 56.1%). Common comorbidities in this group were current or former tobacco use (n=64, 59.2%), chronic kidney disease (n=62, 57.9%), and hypertension (n=94, 86.2%). Glycemic control was suboptimal with an average Hemoglobin A1c of 9.1% (SD 3.1%) and average admission glucose of 232.2 mg/dL. C-reactive protein 17.1 (SD 34.1) and erythrocyte sedimentation rate 88.8 (SD 36.3) were both elevated for most patients. The DFU-related amputation cost was higher for Hispanic-Latino individuals, RR 1.97 (CI 1.04, 3.71) and for those with chronic kidney disease, RR 1.36 (1, 1.86). Female sex, serum glucose and BMI were moderately associated with increased relative cost. The study was limited by not having access to subsequent visits outside our health system and the retrospective nature of the study. Conclusions Our study highlights disparities among patients who underwent a DFU related amputation, with higher costs for Hispanic-Latino individuals, those with chronic kidney disease , and women, emphasizing the need for tailored interventions for these populations to ameliorate the high cost of DFU-related care. Presentation: 6/2/2024

This study reports on the development and testing of a comprehensive diabetes telemonitoring program tailored to meet the needs of underserved Hispanic/Latino patients with diabetes. Individuals participating in the culturally tailored program had significantly better 6-month outcomes than those receiving comprehensive outpatient management for A1C, blood pressure, and diabetes self-efficacy, with no differences between groups in quality of life, medication adherence, emotional functioning, patient activation, or unscheduled physician visits. These findings suggest that culturally congruent diabetes telemonitoring may be effective for this underserved population.

Background: Inpatient use of insulin pump therapy has been increasing due to greater availability of this technology, however there is a paucity of research that investigates glycemic control of inpatient insulin pump users. Objective: To compare the glycemic control of hospitalized patients with type 1 diabetes (T1D) who used insulin pump vs. multiple daily injections (MDI). Design: Retrospective chart review. Participants: Patients with T1D who were hospitalized between January 1, 2017, and December 31, 2019, in an academic medical center in the New York metropolitan area. Main Measures: Patients were categorized into three groups based on their method of insulin administration: "pump only" group used insulin pump exclusively, "MDI only" group used MDI only, and "intermittent pump" group used a combination of both methods. The primary endpoints are mean blood glucose, rates of hypoglycemic events (blood glucose < 70 mg/dL), and rates of hyperglycemic events (blood glucose > 250 mg/dL). Separate multivariable Poisson regressions were performed to determine the association between the type of insulin administration and rate outcomes (i.e., rate of hypoglycemic events and rate of hyperglycemic events). Results: The study included 78 patients with a mean age of 51, who were mostly male (54%), and white (72%). The average proportion of glucose measurements that were hyperglycemic for the "pump only", "MDI only", and "intermittent pump" groups were 0.11 (SD = 0.11), 0.25 (SD = 0.19), and 0.24 (SD = 0.25), respectively. The "pump only" group has a significantly lower proportion of hyperglycemic events as compared to the "MDI only" group (p = 0.0227). Conclusions: In this sample, patients who exclusively used their insulin pump while inpatient had a lower rate of hyperglycemic events than patients who used MDI only; suggesting that select patients can safely continue their insulin pump therapy in the inpatient setting.

BackgroundThe Hispanic/Latino population has greater risk (estimated >50%) of developing type 2 diabetes (T2D) and developing it at a younger age. The American Diabetes Association estimates costs of diagnosed diabetes in 2017 was $327 billion; with medical costs 2.3x higher than patients without diabetes. The purpose of this manuscript is to describe the methodology utilized in a randomized controlled trial aimed at evaluating the efficacy of a diabetes telemanagement (DTM) program for Hispanic/Latino patients with T2D. The intent is to provide information for future investigators to ensure that this study can be accurately replicated.MethodsThis study was a randomized controlled trial with 240 participants. Eligible patients (Hispanic/Latino, aged 18+, living with T2D) were randomized to Comprehensive Outpatient Management (COM) or DTM. DTM was comprised of usual care, including routine clinic visits every three months, as well as: Biometrics (a tablet, blood glucose meter, blood pressure monitor, and scale); Weekly Video Visits (facilitated in the patient’s preferred language); and Educational Videos (including culturally congruent diabetes self-management education and quizzes). COM consisted of usual care including routine clinic visits every three months. For this study, COM patients received a glucometer, glucose test strips, and lancets. Establishing a therapeutic nurse-patient relationship was a fundamental component of our study for both groups. First contact (post-enrollment) centered on ensuring that patients and caregivers understood the program, building trust and rapport, creating a non-judgmental environment, determining language preference, and establishing scheduling availability (including evenings and weekends). DTM were provided with a tablet which allowed for self-paced education through videos and weekly video visits. The research team and Community Advisory Board identified appropriate educational video content, which was incorporated in diabetes educational topics. Video visits allowed us to assess patient involvement, motivation, and nonverbal communication. Communicating in Spanish, and awareness of diverse Hispanic/Latino backgrounds was critical, as using relevant and commonly-used terms can increase adherence and improve outcomes. Shared decision-making was encouraged to make realistic health care choices.ConclusionKey elements discussed above provide a framework for future dissemination of an evidence-based DTM intervention to meet the needs of underserved Hispanic/Latino people living with T2D.

Abstract Disclosure: R. Lopez Fanas: None. A. Herrera Chancay: None. H. Tabassum: None. J. Milosavljevic: None. S. Xu: None. J. Daily: None. A.K. Myers: None. Introduction: Diabetic foot ulcers (DFU) are associated with poor outcomes including lower extremity amputations and death in individuals with diabetes. Our study aims to define health outcomes and explore the association of sociodemographic and clinical factors on amputation rates in patients hospitalized with DFU addressing an existing knowledge gap in our population. Methods: This was a retrospective review of the electronic health record of adult patients hospitalized with DFU at one of the three major Montefiore Medical Center hospitals in the Bronx, New York between 06/01/2016 and 05/30/2021. Patient data extracted from the index admission included demographics, comorbidities, and laboratory values. Survival and amputation rates were calculated for each patient over the five-year study period. Results: In our analysis of 650 patients, 88% self-identified as non-white, and only 23% had commercial insurance. The amputation rate during the initial DFU admission was 44%, with 76% experiencing at least one amputation over five years. Male sex, low BMI, and smoking were associated with amputation during the study period, with an OR of 0.62 (p=0.01), 0.98 (p=0.05), and 1.45 (p=0.05) respectively. Patients with history of osteomyelitis had a higher risk of any amputation during the index admission (OR 2.05, p<0.0001), and the 5-year study period (OR 3.03, p<0.0001). PAD or prior history of amputation increased the risk of any amputation during the study period, OR 2.11 (p=0.0002) and OR 7.92 (p<0.001) ESRD was associated with a higher risk of AKA and BKA during the index admission (OR 2.31, p=0.05). Elevated ESR, CRP, WBC, and low albumin were associated with amputation during admission, with ORs of 1.01 (p=0.0006), 1.05 (p<0.0001), 1.11 (p<0.0001), and 0.41 (p<0.0001), respectively. Discussion: This study revealed a 44% amputation rate during the initial DFU admission, with 76% experiencing at least one amputation within five years. Bivariate analyses identified male sex, lower BMI, and smoking as correlated with a heightened amputation risk, consistent with previous studies. Prior amputation, PAD, ESRD, and osteomyelitis were also associated with an increased risk. Multiple regression analysis found significant associations between elevated ESR, CRP, WBC, and low albumin with amputations. As a result, interventions need to be devised for patients with these characteristics to prevent this high rate of amputation. Presentation: 6/2/2024

Objective: Diabetic foot ulcers (DFUs) are a leading cause of morbidity and mortality, which disproportionately impacts underserved populations. This study aimed to provide data regarding the rates and outcomes of amputation in patients admitted with DFU in our health system, which cares for an ethnically diverse and underserved population. Methods: This retrospective study examined the electronic medical records of adult patients hospitalized with DFU at 3 hospitals in our health system between June 1, 2016, and May 31, 2021. Results: Among 650 patients admitted with DFU, 88% self-identified as non-White race. Male sex (odds ratio [OR], 0.62), low body mass index (OR, 0.98), and history of smoking (OR, 1.45) were significantly associated with amputation during the study period. A higher erythrocyte sedimentation rate (OR, 1.01), C-reactive protein level (OR, 1.05), and white blood cell count (OR, 1.11) and low albumin level (OR, 0.41) were found to be significantly associated with amputation versus no amputation during admission. The amputation risk during the index admission for DFU was 44%. Conclusion: Our study identified a high DFU-related amputation risk (44%) among adult patients who were mostly Black and/or Hispanic. The significant risk factors associated with DFU amputation included male sex, low body mass index, smoking, and high levels inflammation or low levels of albumin during admission. Many of these patients required multidisciplinary care and intravenous antibiotic therapy, necessitating a longer length of stay and high readmission rate. (c) 2024 AACE. Published by Elsevier Inc. This is an open access article under the CC BY license (http:// creativecommons.org/licenses/by/4.0/).

In June, 2023, overturning more than 40 years of precedent, the US Supreme Court ruled against the use of race as a factor in college admissions. Past analyses have shown that since the 1970s, generally, gender parity in medical schools has increased, while the same is not true for under-represented in medicine and science (URiMS) students, especially Black students.1 However, affirmative action, also known as social inclusion policies, is still relevant; despite URiMS individuals being underrepresented in institutions of higher learning, following state-wide affirmative action bans, the enrolment of URiMS students dropped approximately 5 percentage points from 14·8% to 10%.

Diabetes has been identified as a risk factor for inpatient admission in persons with novel coronavirus 2019 (COVID-19). Managing patients with diabetes and COVID-19 is complicated by the use of steroid therapy as well as the immense inflammatory response seen in persons with COVID-19. Insulin management has been found to be the most effective therapy due to its ability for dose adjustment and anti-inflammatory properties. Studies using non-insulin therapies in the inpatient setting have been limited by small sample sizes. This chapter provides an overview of the inpatient care of those with diabetes and COVID-19.

Aims: To describe the relationship between race/ethnicity and adverse outcomes related to coronavirus disease 2019 (COVID-19) in adults with T2DM admitted to hospital in the UK, France and USA. Methods: Study data from the UK ABCD nationwide COVID- 19 audit, the French CORONADO nationwide initiative and the USA AMERICADO multi-centre study were analysed to assess the association between race/ethnicity and severe COVID-19. Severe COVID-19 was defined as death in hospital and/or admission to the intensive care unit (ICU). Logistic regression models were used to generate age-adjusted odds ratios. Results: Data from 3,471 patients in the ABCD audit, from 2,451 CORONADO patients and from 9,321 AMERICADO patients admitted with COVID-19 and T2DM were analysed. Race/ethnicity data were available for 3,410 (98%), 2,173 (89%) and 8,893 (95%) patients, respectively. In the UK ABCD audit cohort, Asian and Black race/ethnicity were associated with an increased risk of death/ICU admission compared to White when adjusted for age and sex (OR 2.14; 1.38-3.29 and OR 2.09; 1.17-3.74, respectively). When adjusted for additional confounders the association was stronger (Asian OR 2.88; 1.72-4.82 and Black OR 2.20; 1.12-4.30). In the CORONADO cohort Middle Eastern/North African race/ethnicity was protective against death/ICU admission (OR 0.57; 0.36-0.91). There was no association between ethnicity and death alone in the AMERICADO dataset. Conclusion: In those with T2DM admitted to hospital with COVID-19, a non-White race/ethnicity was associated with higher risk of death/ICU admission in the UK ABCD data but not in French CORONADO or USA AMERICADO datasets. Further research is required to improve our understanding of the observed discrepancies in outcomes.

Background and aim:During the early stages of the COVID-19 pandemic, nationwide lockdowns caused disruption in the diets, physical activities, and lifestyles of patients with type 2 diabetes. Previous reports on the possible association between race/ethnicity, COVID-19, and mortality have shown that Hispanic/Latino patients with type 2 diabetes who are socioeconomically disadvantaged are disproportionately affected by this novel virus. The aim of this study was to explore stressors associated with changes in diabetes self-management behaviors. Our goal was to highlight the health disparities in these vulnerable racial/ethnic minority communities and underscore the need for effective interventions.Methods and participants:Participants were enrolled in part of a larger randomized controlled trial to compare diabetes telehealth management (DTM) with comprehensive outpatient management (COM) in terms of critical patient-centered outcomes among Hispanic/Latino patients with type 2 diabetes. We conducted a thematic analysis using patient notes collected from two research nurses between March 2020 and March 2021. Two authors read through the transcripts independently to identify overarching themes. Once the themes had been identified, both authors convened to compare themes and ensure that similar themes were identified within the transcripts. Any discrepancies were discussed by the larger study team until a consensus was reached.Results:Six themes emerged, each of which can be categorized as either a source or an outcome of stress. Sources of stress associated with the COVID-19 pandemic were (1) fear of contracting COVID-19, (2) disruptions from lockdowns, and (3) financial stressors (e.g., loss of income). Outcomes of COVID-19 stressors were (1) reduced diabetes management (e.g., reduced diabetes monitoring and physical activity), (2) suboptimal mental health outcomes (e.g., anxiety and depression), and (3) outcomes of financial stressors.Conclusion:The findings indicated that underserved Hispanic/Latino patients with type 2 diabetes encountered a number of stressors that led to the deterioration of diabetes self-management behaviors during the pandemic.