Genetic risk scores (GRSs) for type 1 diabetes (T1D) may assist T1D classification and prediction but are often developed from European populations. To improve health outcomes, it is important to understand the performance and utility of GRSs in diverse ancestry populations; we therefore assessed the capacity of three previously published T1D GRSs at differentiating people with and without type 1 diabetes in African (with/without T1D=194/235), European (n=1109/125), and Hispanic (266/170) ancestry populations in the USA, and from Cameroon and Uganda (n=144/5001).

Introduction and Objective: We explored whether and how depressive symptoms in youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) mediate the effects of household food insecurity (HFI) on hemoglobin A1c (HbA1c). Methods: Cross-sectional data from the SEARCH for Diabetes in Youth Study (2016-2019) included 1,093 YYA with T1D. We applied causal mediation modeling to estimate the effects of HFI (measured with the Household Food Security Survey Module) on HbA1c (measured from whole blood samples) mediated by depressive symptoms (measured with the Centre for Epidemiologic Studies Depression Scale). Results: Overall, HFI was associated with a one percentage point higher average HbA1c (mean Hb1Ac, HFI 9.91% vs. 8.88%) and 19% of this association was mediated by depressive symptoms. Irrespective of level of confounder adjustment, both the direct effect (range 0.43-0.69) and the indirect effect (range 0.12-0.17) remained significant and the percent mediation ranged from 18 to 21%. Conclusion: These results highlight the importance of depressive symptoms as a key pathway between HFI and HbA1c, with consistent direct and indirect effects observed even after adjustment for factors as clinically relevant. Future studies should examine whether mental health interventions are an effective strategy to mitigate the effects of HFI on HbA1c. A.M. Alfalki: None. E.F. Julceus: None. F. Malik: None. T.A. Bekelman: None. A. Merchant: None. J.A. Mendoza: None. A.D. Liese: None. the National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461, 1R01DK127208, 1UC4DK108173); National Institute of General Medical Sciences (T32-GM081740)

Introduction and Objective: Discrimination can lower self-esteem and undermine self-care and health seeking behaviors, but its impact on young people with diabetes is poorly studied. We assessed if perceived discrimination was associated with diabetes management among youth and young adults (YYA) with youth-onset type 1 (T1D) and type 2 diabetes (T2D). Methods: We conducted a cross-sectional analysis of the multicenter SEARCH Food Security Cohort (2018-2023) among 782 YYA with youth-onset T1D and 110 with T2D (age range 11-37 years). The 10-item Everyday Discrimination Scale, hemoglobin A1c (HbA1c), and self-reported diabetes management were analyzed using logistic regression models adjusted for age, sex, race/ethnicity, study site, education, income, health insurance, food insecurity, diabetes duration, insulin regimen, and continuous glucose monitor use. Results: Overall, 57.7% of YYA (T1D 59.0%, T2D 49.1%) reported experiencing discrimination. Of YYA who reported discrimination, 41.8% (T1D 40.6%, T2D 51.9%) experienced it a few times a year or more. Among YYA with T1D who reported discrimination, the most mentioned reasons were gender (36%), age (33%), weight (24%) and race/ethnicity (21%); among YYA with T2D they were race/ethnicity (59%), weight (54%), and education or income (33%). Each one-point increase in the mean discrimination summary score was associated with greater odds of elevated HbA1c ≥ 7% (OR=1.9, 95% CI = 1.3-2.8), missing diabetes medication(s) (OR=1.6, 95% CI = 1.2-2.0) and severe hypoglycemia (OR=1.5, 95% CI = 1.1-1.9) in YYA with T1D. No associations were found in YYA with T2D. Conclusion: Most YYA with diabetes reported experiencing some form of discrimination but the reasons differed by diabetes type. Among participants with T1D, experiencing more discrimination was associated with poorer diabetes management and higher HbA1c levels. The reasons for the differences between diabetes types need to be further explored. E.F. Julceus: None. A.D. Brown: None. J.A. Mendoza: None. F. Malik: None. D.M. Krobath: None. A. Bellatorre: None. T.A. Bekelman: None. L. Knight: None. C. Pihoker: None. A.D. Liese: None. National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461); National Institute of General Medical Sciences (T32-GM081740)

BACKGROUND:Food insecurity (FI) is linked to mental health outcomes cross-sectionally, but little is known about temporal patterns of FI and changes in mental health. FI can exacerbate the mental health challenges of managing diabetes, creating a vicious cycle that worsens youth and young adults' (YYAs) mental well-being. PURPOSE:We investigated the association of temporal patterns of FI with symptoms of depression, anxiety, and stress, and changes therein in YYAs with youth-onset type 1 (T1D) and type 2 diabetes (T2D). METHODS:Longitudinal data (2016-2022) including three time points (t1, t2, and t3) from 747 YYAs with T1D and 97 YYAs with T2D were analyzed using multivariable linear regression. Ascertained with the Household Food Security Survey Module, food security was classified as persistently food secure, persistently food insecure (PFI), and intermittently food insecure (IFI). Mental health at t3 and changes from t2 to t3 were characterized with the Center for Epidemiologic Studies Depression Scale, the Generalized Anxiety Disorder Scale, and Cohen's Perceived Stress Scale. FINDINGS:Among YYAs with T1D and T2D, 6.6% and 16.5% were PFI, 20.3% and 42.3% were IFI, respectively. In YYA with T1D, PFI and IFI were associated with greater depressive, anxiety, and stress symptoms at t3, and with increased symptoms over time. In YYA with T2D, PFI was associated with greater depressive symptoms at t3 but not with changes over time. INTERPRETATION:The study identified a previously unrecognized link between prolonged exposure to FI and increased incidence of mental health issues. Both persistent and intermittent FI were associated with adverse mental health symptoms in YYA with diabetes, more so for those with PFI. Subsequent research should prioritize interventions that address FI in this population to evaluate their effectiveness in enhancing both physical and psychological well-being. It should be designed to not only address FI, but also comprehensive support, including mental health services and education.

Introduction and Objective: Natural disasters can disrupt critical health-related resources for individuals with chronic conditions like diabetes. This study examines the experiences of young adults with youth-onset diabetes during and immediately after Hurricane Helene. Methods: Thematic analyses were conducted on data obtained from interviews with 9 participants in the ongoing SEARCH Food Security 2 Cohort study (7 participants with type 1 diabetes, 2 with type 2 diabetes, 7 classified as food insecure) from September to December 2024. Results: Some of the participants shared that they were unprepared for the storm's severity. The resulting power outages, property damage, limited access to food and closed pharmacies challenged their diabetes self-management. One challenge mentioned by participants was a decreased importance of a nutritious diet since they were in “survival mode,” which led to unregulated blood sugar levels from limited eating or eating processed, unhealthy foods. Another challenge identified was difficulty monitoring their blood sugar levels and adjusting insulin since some participants did not have means to charge the technology they relied on for regular management. This challenge resulted in more “roller-coastery” levels since they were relying on bodily symptoms to identify blood sugar abnormalities. The final key challenge mentioned by participants was the ability to access and store medication since power was out and there was not cold storage easily available. This limited the amount of insulin participants were willing to administer, and one of the participants ran out of insulin and was unable to access more since pharmacies were closed. Conclusion: This study highlights the vulnerabilities of people with diabetes during a hurricane. Emergency preparedness planning involving patients, clinicians, and the healthcare system may enhance diabetes management during crisis situations. S. Sultana: None. M.E. Austin: None. R.E. Davis: None. T.A. Bekelman: None. J.A. Mendoza: None. M.T. Pruitt: None. M. Parker: None. A.D. Liese: None. National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461)

Background The U.S. Dietary Guidelines (USDG) serve as a foundational public health resource, yet their cultural applicability to underserved populations, including Black and African American (AA) adults, remains limited. The AA population is disproportionately affected by obesity and type 2 diabetes mellitus (T2DM), highlighting the need for culturally tailored interventions. Objectives To describe the design and methodology of the Dietary Guidelines: 3 Diets (DG3D) study, aimed at evaluating the effectiveness of culturally adapted USDG dietary patterns in improving diet quality and reducing risk factors associated with T2DM among AA adults. The intervention focuses on nutritional education and the promotion of healthy eating behaviors to support sustainable dietary change. Methods The DG3D study is a 12-month, single-masked, three-arm randomized behavioral nutrition intervention designed to evaluate three culturally adapted USDG dietary patterns: Healthy US, Mediterranean, and Vegetarian. The study recruited AA adults with overweight or obesity and at least three additional risk factors for T2DM. Participants were randomized to one of three dietary patterns and received group-based classes, cooking demonstrations, and web-based educational content. Primary outcomes include changes in diet quality (Healthy Eating Index [HEI]), body weight, and hemoglobin A1c (HbA1c), assessed at baseline, 6 months, and 12 months. Conclusion The DG3D study is a novel and comprehensive randomized trial evaluating culturally tailored dietary patterns in the AA population, a high-risk population. Findings are expected to inform inclusive dietary policy and contribute to reducing health disparities related to obesity and T2DM.Trial registration: ClinicalTrials.gov identifier NCT05254496

OBJECTIVE The Diabetes in Children, Adolescents, and Young Adults (DiCAYA) network seeks to create a nationwide electronic health record (EHR)-based diabetes surveillance system. This study aimed to develop a DiCAYA-wide EHR-based computable phenotype (CP) to identify prevalent cases of diabetes. RESEARCH DESIGN AND METHODS We conducted network-wide chart reviews of 2,134 youth (aged <18 years) and 2,466 young adults (aged 18 to <45 years) among people with possible diabetes. Within this population, we compared the performance of three alternative CPs, using diabetes diagnoses determined by chart review as the gold standard. CPs were evaluated based on their accuracy in identifying diabetes and its subtype. RESULTS The final DiCAYA CP requires at least one diabetes diagnosis code from clinical encounters. Subsequently, diabetes type classification was based on the ratio of type 1 diabetes (T1D) or type 2 diabetes (T2D) diagnosis codes in the EHR. For both youth and young adults, the sensitivity, specificity, and positive and negative predictive values (PPV and NPV, respectively) in finding diabetes cases were >90%, except for the specificity and NPV in young adults, which were slightly lower at 83.8% and 80.6%, respectively. The final DiCAYA CP achieved >90% sensitivity, specificity, PPV, and NPV in classifying T1D, and demonstrated lower but robust performance in identifying T2D, consistently maintaining >80% across metrics. CONCLUSIONS The DiCAYA CP effectively identifies overall diabetes and T1D in youth and young adults, though T2D misclassification in youth highlights areas for refinement. The simplicity of the DiCAYA CP enables broad deployment across diverse EHR systems for diabetes surveillance.

INTRODUCTION:This study prospectively evaluated the association of household food insecurity with acute care costs and productivity loss in youth and young adults with Type 1 and Type 2 diabetes. METHODS:This observational cohort study included 1,256 youth and young adults with Type 1 and Type 2 diabetes from the SEARCH for Diabetes in Youth Food Security Study, with data collected at 3 time points between 2015 and 2022. Both household food insecurity (measured using the U.S. Household Food Security Survey Module) and costs (measured using survey responses on utilization and productivity losses) were self-reported by young adult participants or the caregivers of adolescents. The relationship between household food insecurity and costs was analyzed using generalized adjusted linear regression. The authors also analyzed the moderating role of continuous health insurance coverage. RESULTS:Each additional 1-point increase in the household food insecurity score was associated with a $1,077 (95% CI=663; 1,491) increase in measured 12-month costs. Costs were $4,384 (95% CI=2,635; 6,133) higher in households that were experiencing household food insecurity than in those that were not. Youth and young adults with continuous health insurance coverage saw smaller increases in costs ($864, 95% CI=461; 1,267) than those without continuous coverage ($1,820; 95% CI=379; 3,261). CONCLUSIONS:This study found a positive association between household food insecurity and costs for youth and young adults with diabetes, and this relationship was modified by continuous health insurance coverage. Future work should use linked claims and electronic health record data to better inform efforts aimed at reducing household food insecurity burden and improving the continuity of insurance coverage for this population.

Introduction: Whereas marginal food insecurity (FI) has been recognized as important in Canadian food security policy, the category of marginal food security (MFS) is often ignored in US food security research. Methods: Prevalence of FI was estimated according to the conventional and an alternate classification of MFS with FI among 938 youth and young adults (YYA) with youth-onset type 1 diabetes (T1D) and 156 with youth-onset type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study (2018-2021). Multivariable regression was used to estimate the association of MFS and conventionally defined FI ascertained with diabetes-related outcomes, including acute diabetes complications, health-care utilization, and diabetes self-management among YYA with T1D. Results: MFS affected 10% of participants with T1D and 20% of participants with T2D. Classifying MFS with FI increased FI prevalence from 18.0% to 27.8% in participants with T1D and 34.6% to 55.1% in participants with T2D. Compared to T1D with high food security, YYA with T1D who were experiencing FI had higher odds of hypoglycemia (2.1, 95% confidence interval [CI] 1.2 to 3.6) and ketoacidosis (1.6, 95% CI 1.0 to 2.6), but no association was seen in MFS. The FI group also had higher odds of emergency department use and hospitalization (2.3, 95% CI 1.5 to 3.4; 2.4, 95% CI 1.5 to 3.9) and lower odds of technology use and checking glucose (0.6, 95% CI 0.4 to 0.9; 0.3, 95% CI 0.1 to 0.6). The MFS group exhibited associations of similar directions. Conclusion: Health-care providers should consider care of individuals with T1D and MFS in the same way as care for those with FI. (c) 2025 Canadian Diabetes Association.

OBJECTIVE:To examine the relationship between levels of household food insecurity and disordered eating behaviors (DEB) among youth and young adults with youth-onset type 1 (T1D) and type 2 diabetes (T2D). METHOD:We used cross-sectional data from the multicenter SEARCH for Diabetes in Youth Study (2015-2020). The Household Food Security Survey Module and the Diabetes Eating Problem Survey-Revised (DEPS-R) were utilized to measure household food insecurity and continuous scores for DEB. In each stratum of diabetes type, we evaluated the association of household food insecurity levels with DEB through linear regression adjusting for potential confounders. RESULTS:Participants (n = 2669) were on average 21.5 ± 5.1 years old and had a mean diabetes duration of 11.2 ± 3.3 years; 54.2% were female, 64.0% non-Hispanic white, and respectively 12.9%, 11.1%, and 8.43% experienced marginal, low, and very low food security. The overall unadjusted mean DEPS-R score was 13.5 ± 9.5, with scores of 18.6 ± 11.8 and 21.1 ± 11.7 among T1D and T2D participants with very low food security, and scores of 11.5 ± 8.9 and 15.2 ± 8.8 among T1D and T2D participants with high food security. Compared to participants who reported high food security, adjusted DEPS-R scores among those with very low food security were 5.8 points (95% CI: 4.3, 7.4) and 6.6 points (95% CI: 3.3, 9.2) higher, respectively, in those with T1D (n = 2274) and T2D (n = 395). Less severe levels of household food insecurity showed similar associations with smaller effect sizes. DISCUSSION:Addressing household food insecurity may decrease DEB and future adverse health outcomes for youth and young adults with diabetes.

Objective: We assessed if food insecurity (FI) is associated with not obtaining recommended diabetes medications, technology, and multidisciplinary services, and explored the most common reasons for not obtaining recommended treatments in youth and young adults (YYA) with diabetes. Methods: In this cross-sectional study, among 911 YYA with type 1 diabetes (T1D) and 144 with type 2 diabetes (T2D) from the SEARCH Food Security Cohort Study Follow-up 1(2018-2021), FI (>= 3 items affirmed from the 18-item Household Food Security Survey module), and inability to obtain recommended treatments were self-reported. Results: Almost 30% of YYA with T1D and FI and 20% of YYA with T2D and FI did not obtain 1 or more recommended treatments. Participants with T1D who reported FI had higher odds of not obtaining insulin (OR 3.2, 95% CI 1.2-8.4), mental health counseling (OR 3.3, 95% CI 1.3-8.2), diabetes education (OR 3.6, 95% CI 1.4-9.3), an insulin pump (OR 2.2, 95% CI 1.2-4.4), and a continuous glucose monitor (OR 2.5, 95% CI 1.5-4.4) compared to those who reported food security. Among participants with T2D, FI was related to not obtaining dietician services (OR 8.1, 95% CI 1.2-53.8). Participants with T1D and FI reported more financial reasons for not obtaining a continuous glucose monitor compared to food secure participants. Conclusion: YYA with diabetes and FI face constraints in obtaining medications, diabetes technology, and multidisciplinary services, largely due to financial and structural reasons. New strategies are needed to bridge the gap between medical care required vs obtained by YYA with diabetes. (c) 2024 AACE. Published by Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Introduction and Objective: Various health-related social needs (HRSNs) are associated with diabetes outcomes, but little is known about their joint effects. We evaluated the association of the number of unmet HRSNs with hemoglobin A1c (HbA1c), acute diabetes complications, and healthcare utilization among youth and young adults (YYA) with youth-onset type 1 diabetes (T1D), and whether the associations are buffered by food assistance. Methods: Using cross-sectional data of 814 YYA with T1D from the multicenter SEARCH Food Security Cohort study (2019-2021), logistic regression models were performed to test associations between the sum of self-reported unmet HRSNs and HbA1c, self-reported acute diabetes complications and health care utilization in the past 12 months, adjusting for demographic and clinical variables. Results: The percentage of YYA affected by HRSNs included 22.4% with health care insecurity, 15.1% with food insecurity, 7.1% with unreliable transportation, and 2.4% with unstable housing. Only 9.8% received food assistance. About 66%, 23%, 9%, and 2% of YYA with T1D had 0, 1, 2, or 3 unmet HRSNs, respectively. Each additional unmet HRSN was associated with higher odds of HbA1c >9.0% (OR 1.7, 95% CI 1.3-2.2), diabetic ketoacidosis (OR 1.8, 95% CI 1.4-2.3), emergency room visit (OR 1.5, 95% CI 1.2-1.8), urgent care visit (OR 1.3, 95% CI 1.0-1.6), and hospitalization (OR 1.5, 95% CI 1.2-2.0). Food assistance buffered the association between the number of unmet HRSNs with hospitalization (p=0.03); odds ratios for those with and without food assistance were 0.9 (95% CI 0.5-1.6) and 1.8 (95% CI 1.3-2.5). Conclusion: Each additional unmet HRSN in YYA with T1D was associated with 30-80% higher odds of poor diabetes management and non-routine health care utilization, food assistance buffered the association with hospitalization, showing the benefit of identifying and addressing HRSNs jointly. E.F. Julceus: None. J.A. Mendoza: None. E.A. Frongillo: None. C. Rudisill: None. A. Bellatorre: None. F. Malik: None. T.A. Bekelman: None. C. Pihoker: None. A.D. Liese: None. National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461)

Introduction & Objective: Studies on resilience in youth and young adults (YYA) with diabetes are scarce. We assessed if resilience was associated with hemoglobin A1c (HbA1c), depressive symptoms, anxiety, and disordered eating behaviors in YYA with type 1 (T1D) and type 2 diabetes (T2D). Methods: A cross-sectional analysis of the multicenter SEARCH Food Security Cohort study follow-up 2 (2019-2021) was conducted including 762 YYA with T1D and 103 YYA with T2D. Resilience was assessed with the Connor-Davidson Resilience scale; depressive symptoms, anxiety and disordered eating behaviors were assessed with the Center for Epidemiological Studies-Depression scale (clinical cutoff of ≥24 for youth and ≥16 for young adults), the Generalized Anxiety Disorder screener (≥10), and the Diabetes Eating Problem Survey-Revised (≥20). Logistic regression models were performed to examine associations between resilience and the above diabetes-related outcomes, adjusting for sociodemographic and clinical factors. Results: YYA were on average 25.1 years old, 60.0% female, 71.2% Non-Hispanic White, and classified by tertiles of resilience into low (n=276), intermediate (n=316) and high (n=273) resilience. Among YYA with T1D, compared to those with high resilience, those with low resilience had elevated odds of HbA1c >9% (OR 2.3, 95% CI 1.3-4.1), depressive symptoms (OR 16.5, 95% CI 10.0-27.2), anxiety (OR 7.9, 95% CI 4.8-12.9) and disordered eating behaviors (OR 8.7, 95% CI 4.5-16.6), likewise for those with intermediate resilience. Among YYA with T2D, those with low resilience had higher odds of depressive symptoms (OR 6.5, 95% CI 1.4-29.1) than those with high resilience, but no difference in odds of HbA1c >9%, anxiety or disordered eating behaviors. Conclusion: Given the potentially cross-cutting impact of resilience on quality of life, mental health, and diabetes self-management in YYA with diabetes, strategies to enhance resilience should be explored. Disclosure E.F. Julceus: None. J.A. Mendoza: None. K. Flory: None. E.A. Frongillo: None. A. Merchant: None. F. Malik: None. D.K. Cooper: None. B.A. Reboussin: None. K.A. Sauder: None. A. Bellatorre: None. A.D. Liese: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK117461)

Introduction Traditional survey-based surveillance is costly, limited in its ability to distinguish diabetes types and time-consuming, resulting in reporting delays. The Diabetes in Children, Adolescents and Young Adults (DiCAYA) Network seeks to advance diabetes surveillance efforts in youth and young adults through the use of large-volume electronic health record (EHR) data. The network has two primary aims, namely: (1) to refine and validate EHR-based computable phenotype algorithms for accurate identification of type 1 and type 2 diabetes among youth and young adults and (2) to estimate the incidence and prevalence of type 1 and type 2 diabetes among youth and young adults and trends therein. The network aims to augment diabetes surveillance capacity in the USA and assess performance of EHR-based surveillance. This paper describes the DiCAYA Network and how these aims will be achieved.Methods and analysis The DiCAYA Network is spread across eight geographically diverse US-based centres and a coordinating centre. Three centres conduct diabetes surveillance in youth aged 0–17 years only (component A), three centres conduct surveillance in young adults aged 18–44 years only (component B) and two centres conduct surveillance in components A and B. The network will assess the validity of computable phenotype definitions to determine diabetes status and type based on sensitivity, specificity, positive predictive value and negative predictive value of the phenotypes against the gold standard of manually abstracted medical charts. Prevalence and incidence rates will be presented as unadjusted estimates and as race/ethnicity, sex and age-adjusted estimates using Poisson regression.Ethics and dissemination The DiCAYA Network is well positioned to advance diabetes surveillance methods. The network will disseminate EHR-based surveillance methodology that can be broadly adopted and will report diabetes prevalence and incidence for key demographic subgroups of youth and young adults in a large set of regions across the USA.

The aim of the study was to develop and evaluate a novel dietary index for gut microbiota (DI-GM) that captures dietary composition related to gut microbiota profiles. We conducted a literature review of longitudinal studies on the association of diet with gut microbiota in adult populations and extracted those dietary components with evidence of beneficial or unfavorable effects. Dietary recall data from the National Health and Nutrition Examination Survey (NHANES, 2005–2010, n = 3812) were used to compute the DI-GM, and associations with biomarkers of gut microbiota diversity (urinary enterodiol and enterolactone) were examined using linear regression. From a review of 106 articles, 14 foods or nutrients were identified as components of the DI-GM, including fermented dairy, chickpeas, soybean, whole grains, fiber, cranberries, avocados, broccoli, coffee, and green tea as beneficial components, and red meat, processed meat, refined grains, and high-fat diet (≥40% of energy from fat) as unfavorable components. Each component was scored 0 or 1 based on sex-specific median intakes, and scores were summed to develop the overall DI-GM score. In the NHANES, DI-GM scores ranged from 0–13 with a mean of 4.8 (SE = 0.04). Positive associations between DI-GM and urinary enterodiol and enterolactone were observed. The association of the novel DI-GM with markers of gut microbiota diversity demonstrates the potential utility of this index for gut health-related studies.

In the abstract cited above, author Nadine El Kalach was inadvertently omitted from the author list. The full, correct author list is as follows: Nadine El Kalach, Emmanuel F. Julceus, Caroline Rudisill, Faisal Malik, Kate Flory, Edward A. Frongillo, Katherine A. Sauder, Jason A. Mendoza, and Angela D. Liese. All authors approve the addition and the order of the revised author list. The authors apologize for the omission. The online version of the abstract (https://doi.org/10.2337/db24-189-OR) has been updated to correct the error.

Introduction & Objective: Little evidence exists on how household food insecurity (FI) affects youth and young adults (YYA) obtaining medical care related to diabetes. We assessed if FI is cross-sectionally associated with not obtaining recommended diabetes medications, technology, and multidisciplinary services, and explored the most common reasons for not obtaining recommended treatments in YYA with diabetes. Methods: Using data from 911 YYA with type 1 diabetes (T1D) and 144 YYA with type 2 diabetes (T2D) in the SEARCH Food Security Cohort Study Follow-up 1 (2018-2021) and logistic regression, we evaluated the association of FI and the inability to obtain recommended treatments and tabulated the reasons reported. Results: Almost 30% of YYA with T1D and FI and 20% of YYA with T2D and FI did not obtain one or more recommended treatment (15.8% and 14.4% in food secure YYA, respectively). YYA with T1D and FI had higher odds of not obtaining insulin (OR 3.2, 95% CI 1.2-8.4), an insulin pump (OR 2.2, 95% CI 1.2-4.4), a continuous glucose monitor (OR 2.5, 95% CI 1.5-4.4), mental health counseling (OR 3.3, 95% CI 1.3-8.2), and diabetes education (OR 3.6, 95% CI 1.4-9.3), adjusted for demographics, household income, food assistance, and diabetes duration. Among YYA with T2D, FI was related to not obtaining dietician services (OR 8.1, 95% CI 1.2-53.8). YYA with T1D mostly reported financial reasons (e.g., unable to afford, insurance issues) for not obtaining diabetes technology and medications, followed by structural reasons (e.g., lack of time, not allowed time off) for not obtaining services such as diabetes education or mental health counseling. Conclusion: YYA with diabetes and FI face constraints in obtaining medications, diabetes technology, and multidisciplinary services, largely due to financial and structural reasons. New strategies are needed to bridge the gap between medical care required versus obtained by YYA with diabetes. Disclosure N. El Kalach: None. E.F. Julceus: None. C. Rudisill: None. F. Malik: None. K. Flory: None. E.A. Frongillo: None. K.A. Sauder: None. J.A. Mendoza: None. A.D. Liese: None. Funding 1R01DK1174611R01DK12720811UC4DK108173