Emily Soriano, PhD
Whittier Diabetes Institute

“Dynamics of Change in a Randomized Controlled Trial of Two Interventions for Type 1 Diabetes Distress”

Diabetes distress (DD), defined as the negative emotional burden of living with a demanding chronic condition, is highly prevalent and has demonstrated stronger associations with important diabetes outcomes (e.g., HbA1c) than depression. Although psychological interventions for DD were developed based on the premise that reducing DD will improve clinical diabetes outcomes, empirical tests of these treatments have shown dramatic improvements in DD with little to no evidence for significant change in HbA1c. Furthermore, cognitive behavioral therapy (CBT) has not shown a clear advantage over diabetes self-management education and support (DSME/S; the current standard of care) in terms of DD reduction. This pattern of findings points to critical gaps in our understanding of the (a) causal pathways between DD and clinical outcomes and (b) the processes of change over the course of DD interventions. To address this gap, the proposed research will conduct the first intensive longitudinal assessment of causal links between DD, diabetes self-management, glycemic control, and purported treatment mechanisms over the course of two DD interventions, one novel and one established: ACT1VATE, a group-based Acceptance and Commitment Therapy approach, and DSME/S (usual care). A recent RCT (1R01DK127491; mPIs Philis-Tsimikas/Fortmann) compares ACT1VATE vs. DSME/S in improving glycemic control in N=484 diverse adults with poorly controlled type 1 diabetes and significant DD. The proposed work builds upon this RCT to include a 7-week period of ecological momentary assessment (EMA) and continuous glucose monitoring (CGM) over the course of both DD treatments (n=50 per condition). By leveraging the resources of a well-timed R01, the proposed study is the first to investigate processes of change in symptoms, behaviors, and glycemic control over the course of two DD treatments. These data will be used to accomplish the following Specific Aims: 1) Examine trajectories of within-person change in daily DD, purported treatment mechanisms, diabetes self-care behavior, and CGM metrics over the course of DD treatment; 2) Examine these trajectories as predictors of HbA1c and global DD improvement 6 months later; 3) Explore relationships between characteristics of change in daily DD, purported treatment mechanisms, diabetes self-care behavior, and CGM metrics over the course of DD treatment. Results will inform potential common treatment ingredients, ideal targets to optimize treatment, and causal pathways linking DD, self-care, and glycemic control—all critical steps toward translation of RCT findings to the “real world.” The proposed work will be used as foundational data from which to build a novel, more effective, brief, optimized, targeted intervention for DD, which will serve as the basis of proposed PI Soriano’s subsequent submission of a larger, more definitive, powered R01 application.

Claire Hoogendoorn, PhD
Albert Einstein College of Medicine/Montefiore Health Systems

“Daily Assessment of Adherence to Diabetes Medication in the Einstein Aging Study (EAS)”

Diabetes and suboptimal glycemic control are common in older adults and are major risk factors for cognitive decline. To better measure glycemic control and assess its influence on cognitive performance in the recently renewed Einstein Aging Study (EAS) P01 type 2 diabetes (T2D) Project, we will use ecological momentary assessment (EMA) to link continuous glucose monitoring (CGM) to smartphone-based measures of ambulatory cognitive function. Though the funded Project includes daily self-report (SR) measures of medication adherence, it lacks objective and real-time measures of medication adherence. For this pilot, we propose to add electronic monitoring of adherence to oral medications using Medication Event Monitoring System (MEMS), and EMA assessment of real-time insulin adherence, in a sample of 60-75 older adults with T2D enrolled in the EAS. The addition of real-time assessment of medication adherence provides opportunities to study the bidirectional relationships of medication adherence and cognitive function and the adherence-mediated role of cognitive function on glycemic control in older adults with T2D. In addition, objective assessment of adherence will provide a unique opportunity to assess the validity of SR adherence already assessed in the EAS. Assessment of objective and real-time medication adherence, integrated with CGM and EMA, provides intensive longitudinal data for each participant allowing for robust modeling of within-person processes, which increases sensitivity and power and overcomes measurement limitations of prior research. In this pilot proposal, we plan to collect critical feasibility and acceptability data, power calculations, and perform preliminary analyses in older adults with T2D for use in a future K01 award application. In Aim 1, we will assess feasibility and acceptability of adding MEMS and EMA insulin adherence to EAS. In aim 2, we will examine whether day-level changes in adherence measured by MEMS are associated with changes in daily CGM metrics in older adults treated for T2D with oral meds. In Aim 3, we test cognitive and psychosocial predictors (depression/negative affect and social support) of MEMS adherence among older adults treated for T2D. In Aim 4, we will examine whether cognitive factors, age, and depression affect the strength of the association between MEMS adherence and SR adherence in those treated for T2D. The pairing of objective and real-time medication adherence, glycemic data, and ambulatory cognition is novel and an important area of study for the development of effective interventions.

Sandra Echevveria, PhD
University of North Carolina, Greensboro

“Feasibility of community-based digital tools to promote physical activity among Latinos with diabetes”

We examine if a community-clinical integrated, real- time referral system (NCCare360) can be leveraged to refer patients to community-based physical activity programs. We apply a community-engaged study design involving patients, providers and community-based organizations (CBO’s) to examine implementation factors necessary to maximize the potential of community- clinical linkage systems to improve health. Our Specific Aims are to: 1) Characterize the range of social and structural determinants shaping diabetes care and physical activity adoption among Latinos and what they would like to see in a community-based referral system using survey and semi-structured data (n=50); 2) Adapt the existing referral system specific to Latinos using data from Aim 1 and pilot test the integration of physical activity referrals into the NCCARE360 system to determine acceptability, adoption, appropriateness, and feasibility of integration. The results from this study will be used to design a future intervention testing optimal intervention components for integrating health promotion programs in existing referral systems, uptake of physical activity among study participants, and resulting changes in diabetes outcomes.

Amanda McClain, PhD
San Diego State University

“The role of neighborhood and household food environments and food shopping behaviors in shaping diet quality and glucose metabolism among Hispanic/Latino youth and their caregivers”

A large proportion of U.S. Hispanic/Latino adults (16.9%) have type 2 diabetes and U.S. Hispanic/Latino youth have prediabetes (22.5%), which is concerning as glycemic dysregulation increases susceptibility to additional poor cardiometabolic health outcomes. Simultaneously, U.S. Hispanic/Latino households with children are disproportionally affected by socioeconomic disparities, including household food insecurity (33.0% vs 14.0% national prevalence). Food-insecure households often perceive their neighborhood food environments to be poor and household members are more likely to have poor diet quality, a risk factor for prediabetes and type 2 diabetes. Yet, food shopping behaviors have the potential to influence the types of foods available in the homes of low-income Hispanic/Latino families, which could directly influence individual-level diet quality. Thus, multi-level, targeted evidence of these complex food security-environment-shopping relationships is greatly needed in order to better understand how to intervene to promote healthy diet quality and glucose metabolism among the diverse heritages that comprise the U.S. Hispanic/Latino population. This research aims to use data from a cohort of Hispanic/Latino caregivers and youth, representative of diverse heritages, to (1) Identify latent food security-environment-shopping classes based on similarities in household food security status, the perceived neighborhood food environment characteristics, and the type and frequency of food outlet used for food shopping among Hispanic/Latino families; (2) Determine the relationship of food security-environment-shopping classes with the type of food available in the home and with youth and caregiver’s diet quality among Hispanic/Latino families; and (3) Determine the relationship of food security-environment-shopping classes with youth and caregiver’s glucose metabolism among Hispanic/Latino families. Data for all aims will be from the national Hispanic Community Health Study/Study of Latinos- Youth ancillary study, and findings will provide pilot data to develop a family-based type 2 diabetes prevention intervention in Hispanics/Latinos.

Adelaide Fortmann, PhD
Scripps Whittier Diabetes Institute

“Emotional Distress in Type 1 Diabetes: The integration of Routine Psychosocial Screenings in a Real-World Endocrinology Clinic”

Diabetes distress (DD), defined as the negative emotional burden of living with a demanding chronic condition, is highly prevalent, and has demonstrated stronger associations with important diabetes outcomes than depression. In 2016, the American Diabetes Association (ADA) released its inaugural Position Statement on Psychosocial Care for People with Diabetes that details evidence-based guidelines for DD screening, and identifies diabetes self-management education and support (DSME/S) as the first-line intervention for people who screen positive for DD. Despite clear recommendations from the ADA to screen for DD as part of routine diabetes care, and the availability of brief, well-validated measures to do so, this guideline has not been translated into practice by most typical healthcare settings. Further, little is known about if or how DD affects an individual’s ability to access, engage with, and derive clinical benefits from DSME/S. While research is needed to determine how best to ameliorate DD, most US health systems have yet to accomplish the first necessary step, which is to integrate DD screenings as part of routine diabetes care. Thus, it is imperative to better understand the real-world barriers and facilitators of routine psychosocial screening in diabetes in Endocrinology -- i.e., where the majority of T1D is managed. The proposed feasibility pilot will directly address this gap by enlisting diverse stakeholders (patients, clinicians, clinic staff and leadership) to refine and pilot an approach for integrating routine DD screenings and referrals in the Scripps Division of Diabetes and Endocrinology, in San Diego, CA (Aim 1). Electronic health records (EHR) will be used to identify patients and quantify process outcomes (i.e., DD screening, and DSME/S referral and utilization rates; Aim 2a), and improvements in glycemic control and DD over 12 months (Aim 3a-c). Specific Aim 2b will elicit valuable, post-implementation feedback from T1D patients and Scripps stakeholders on the feasibility and acceptability of the DD screening and referral processes. By developing and evaluating a systematic approach for identifying patients who are experiencing significant DD, this research will guide US health systems’ efforts to translate the ADA’s 2016 call for integrated psychosocial assessments in diabetes into practice. Further, by establishing this approach within a large, “real-world” Endocrinology division, we will maximize integration with routine care processes and capitalize on staffing and EHR resources that are commonly found in US healthcare settings, thus maximizing the generalizability of our findings. Finally, this study will provide important preliminary data for a larger, fully powered randomized R01 trial to test a refined DD screening, referral, and intervention approach.

Shivani Agarwal, MD
Albert Einstein College of Medicine/Montefiore Health Systems

“Use of ecological momentary assessment tools in Type 1 diabetes”

Young adults (YA) with type 1 diabetes (T1D) of racial-ethnic minority and low socioeconomic status are amongst the most at risk for poor outcomes, with worse glycemic control, higher rates of diabetes complications, and premature mortality compared to non-disadvantaged peers. There remains a paucity of work examining and linking this population’s poor outcomes to their unique social, biological, and behavioral experiences, yet this information would be critical in identifying new and potentially modifiable targets for intervention. The Social Determinants of Health (SDH) model describes “a set of factors that affect the health of individuals and communities beyond personal choices that are a product of their life experiences, physical, social, and economic environments”. There is ample data to suggest that exposure to certain SDH can have negative health effects in disadvantaged populations. Preliminary work from Dr. Agarwal’s NIDDK-funded K23 award demonstrated for the first time, in a national population of disadvantaged YA with T1D, that SDH were highly prevalent and substantially predictive of poor glycemic control. However, this epidemiological work only provides a static snapshot of associations among factors and requires a deeper understanding of the dynamic nature of these relationships. No studies have examined the complex interplay between daily varying SDH, mood, stress, diabetes distress, diabetes self-care, and glycemia. In this pilot proposal, we plan to collect critical feasibility and acceptability data as well as perform preliminary analyses in disadvantaged YA with T1D for use in future larger R01 applications. In Aim 1, we will test the feasibility and acceptability of several innovative data collection methods to capture dynamic daily behavioral and multi-level biologic data, including: 1) mobile app-based ecological momentary assessments (EMA); 2) salivary and hair cortisol testing; and 3) continuous glucose monitoring (CGM). In Aim 2, we plan to preliminarily explore SDH-self-care-glycemia relationships to supply us with sufficient information to form well-founded hypotheses and power analyses for future larger grant applications. The pairing of this dynamic detailed behavioral and glycemic data is highly innovative and has great advantage over studies using retrospective reporting of behavioral variables and global measures of glycemia. This work will be foundational in establishing data collection methods, finding new ways of measuring SDH, and exploring dynamic relationships from which we will gain new insight. This work is critical to advancing the field and identifying new targets for intervention.

Leonor Corsino, MD/Iris Padilla, PhD
Duke University

“A Transition of Care Model from Hospital to Community for Hispanic/Latino Adult Patients with Diabetes”

The prevalence of diabetes in adults over the age of 20 is significantly higher in the Hispanic/Latino population compared to non-Hispanic whites. Diabetes imposes a large economic burden as individuals with diabetes have significantly higher rates of hospital admission compared to those without diabetes. Moreover, admitted patients with diabetes are at higher risk for readmission and Emergency Department (ED) visits than those without diabetes especially those in lower socioeconomic status and racial/ethnic minority groups. Despite the economic burden and growing interest in factors leading to readmission, a paucity of research exists focusing on the transition of care among patients with diabetes. The goals of this proposed study are to: 1) explore patients and providers perceptions of the current discharge process which will inform the development of a patient-centered transition of care model for Hispanic/Latino adults (≥18 years of age) with diabetes from hospital to the community, and 2) pilot test and determine the feasibility of the transition of care model for Hispanic/Latino adult patients with diabetes. A total of 32, self-identified Hispanic/Latino adults admitted to local community hospital with a diagnosis of diabetes will be randomized using a 1:1 randomization to two arms: 1) usual transition of care and 2) the transition of care model. This pilot feasibility study will generate and provide valuable data that will serve as a strong foundation for a larger scale multicenter randomized controlled trial.

Karen Florez, PhD
City University of New York

“Characterization of the personal networks of Latino adults to identify individual and network-level factors associated with T2DM”

The goal of this exploratory study is to examine how personal social networks of Latino adults influence their diabetes-related outcomes such as glycemic control and diabetes self-management. The study will first explore this by conducting a secondary analysis with existing HCHS/SOL data from the Social Network Index to evaluate the types of principal influencers of glycemic control among Latinos with T2DM. Then, the proposed study will employ a more nuanced approach to social network mapping to disentangle the positive and negative influences of social relationships in relation to risk and progression of T2DM among HCHS/SOL participants by collecting egocentric network data on a subsample of SOL participants in New York City (N=138). Findings from Aims 1 and 2 will inform an R01 application to develop and pilot a social network intervention with the most influential alters for T2DM-related health behaviors. The proposed study represents an important step in Dr. Flórez’s progress toward becoming an independent New Investigator and will advance the National Institutes of Health’s mission to increase diversity in health-related research.

Lu Hu, PhD, RN
New York University

“Feasibility of a Family-oriented mHealth Intervention for Chinese Americans with Type 2 Diabetes”

Chinese Americans are one of the fastest growing immigrant groups in the US, who suffer disproportionately high type 2 diabetes (T2D) burden and have poorly controlled T2D. Given the high economic and societal burden of T2D and rapid population growth in Chinese Americans, there is an urgent need for research to develop effective interventions to address T2D burden in this population. Recent evidence suggests the importance of involving and empowering family members in diabetes intervention and calls for family intervention. A mobile health approach such as short message service (SMS) might be a promising way to deliver such family-oriented interventions to the target population given prior studies suggests that Chinese Americans often report challenges to attend in-person lifestyle counseling because of long working hours and lack of sick time from work. A SMS-based intervention provides the flexibility of allowing them to view the intervention at a time and place convenient to them. However, such intervention has not been developed for or tested in Chinese Americans with T2D. This study will serve as the first step to explore an alternative approach for managing T2D in this group. The goal of this pilot study is to examine the feasibility and acceptability of a family-oriented SMS intervention in 30 Chinese Americans with T2D and their family members. Participants will be randomized to one of 2 arms (n=15 each): 1) wait-list control and 2) SMS intervention. Both groups will continue to receive standard of care treatment for their T2D. The SMS group will receive brief lifestyle counseling videos via SMS links. At the end of the study, the wait-list control group will be provided the opportunity to receive the counseling videos. Measurements will be obtained at baseline, 3, and 6 months. The primary outcome is HbA1c and secondary outcomes include self-efficacy and diabetes self-management behaviors. Findings from this pilot study will inform a larger full-scale R01 efficacy trial of the SMS intervention, and ultimately, an implementation study in the real-world setting. This project can serve as a program model for other chronic disease interventions in Chinese Americans that require lifestyle modification (e.g., prediabetes, hypertension), or for disparities research in other high-risk immigrant populations (e.g., South Asians, Hispanic Americans).

Sean Lucan, MD, MPH
EHE Health

“Food and drink advertisements and impact on obesity in urban environment”

Now that alcohol ads have been banned from transit, it is unknown what ads have taken their place. Relevant to obesity, replacement ads may be 'neutral' (e.g., for music, travel, technology), possibly beneficial e.g., promoting physical fitness), or detrimental (e.g., for candy, fast food, soda). Replacement ads (post­policy) may have modified found associations (pre-policy) between subway ads and demographics, diet, and disease characteristics in surrounding communities. Relevant to surrounding communities, another consideration is what ads appear on streets adjacent to subway stations. Adjacent ads may have similarly high viewership (viewed by riders entering and exiting stations). Moreover, adjacent ads-though perhaps viewed more briefly-may serve as even stronger cues for impulse purchases and consumption, being even more proximate to sources of food/drink on city streets. The proposed project will assess ads for food/drink in, and around, subway stations. It will capitalize on the alcohol-ad policy change and use direct observation and secondary data. This study will serve as feasibility work to demonstrate: (a) capability for conducting longitudinal matched-pair research to assess for change, and (b) capability for assessing neighborhood food/drink ads as a component of local "food environments". Future grants, building on both Aims, will evaluate how local food environments relate to obesity-related conditions in patients: longitudinally, and including food/drink ads. The goal is to inform policy change (for food/drink: ads and sources) towards improved community health.

Sunit Jariwala, MD, MS
Albert Einstein College of Medicine/Montefiore Health Systems

“Developing and Evaluating the T2DXcel Mobile Application for Adult Patients with Type 2 Diabetes”

Since 2014, our multidisciplinary team at Einstein and Montefiore has been developing and evaluating an innovative and personalized mobile application (the first mobile application that has been developed and evaluated at Einstein and Montefiore) for patients with asthma, which - like diabetes - has a very high prevalence in the Bronx. The ASTHMAXcel mobile application (available for tablets and smartphones) has been developed for adults and children. ASTHMAXcel is available on iOS and Android platforms, and consists of animated educational videos, personalized algorithms, push notifications, and games. Our pilot study with 72 adult patients demonstrated that ASTHMAXcel was associated with a high degree of patient satisfaction, time-efficiency, and significant post-intervention improvements in asthma control, asthma-related quality of life, and asthma knowledge. ASTHMAXcel was linked to significant decreases in asthma emergency department visits and hospitalizations. Given our team's experience in establishing the ASTHMAXcel application, and the need for similar personalizable and adaptive mobile applications for patients with diabetes, this proposal will develop, evaluate, and refine a patient-centered mobile application (T2DXcel), which will promote diabetes education and improve process and diabetes-related outcomes. By building upon our lessons learned in developing and evaluating the ASTHMAXcel application, through this current project, we will conduct a single-arm, proof of concept study and recruit 50 adult patients with type 2 diabetes (T2D) from outpatient primary and specialty care sites at Montefiore.

Margaret McCarthy, PhD, RN
New York University

“Cardiovascular Health in Emerging Adults with Type 1 Diabetes: Identifying Targets for Early Intervention”

To assess the cardiovascular health of large populations, the American Heart Association has defined the concept of ideal cardiovascular health which includes seven indices: smoking, body mass index, physical activity, ucose, all of which are modifiable. Individuals with type 1 diabetes (T1D) are at increased risk of cardiovascular disease (CVD), but that risk can be significantly reduced through control of traditional CVD risk factors. Emerging adults with T1D (age 18-24) have often experienced poor diabetes self-management and higher hemoglobin A1c. This is a time of change and exploration where they are often managing diabetes on their own. This includes attempts to minimize CVD risk. The purpose of this pilot is to describe the cardiovascular health of a sample of emerging adults with T1D, substituting hemoglobin A1c for fasting blood glucose. At the end of data collection, results of the assessment will be shared with each participant. We will then seek feedback about the barriers and facilitators to achieving optimal cardiovascular health. These pilot data will be used in the planning an R-level NIH/NIDDK application to test an intervention to improve cardiovascular health indices.

Jeannette Beasley, PhD, MPH
New York University

“Bringing the DPP to Geriatric Populations-BRIDGE”

The goal of this study is to test the feasibility of implementing Alive-PD, a telehealth adaptation of the DPP that is reimbursable through Medicare and other health insurers, in NYC senior centers. Using NYC senior centers as a recruitment base, we will enroll 30 adults over the age of 65 y to test program acceptability, changes in knowledge and behaviors, and changes in weight in a pre-post 12 month single-arm trial. We hypothesize that program acceptability will be demonstrated by consistent program use and an attrition <30% over 6-months. The Alive-PD program will also lead to improved diet quality and increased physical activity, as measured by self-reported diet and physical activity and a mean 5% weight reduction. The proposed intervention has the potential to reduce health disparities in an underserved, high-risk population served by the nationwide congregate meals program, therefore yielding considerable public health benefits. This formative research will inform the development of an R01 application in response to PAR-16-238 to test the effectiveness of an intervention within a multi-site trial to reduce risk of diabetes in older adults.

Jessica Rieder, MD, MS
Albert Einstein College of Medicine/Montefiore Health Systems

“B’N Fit Power: A School-Based Wellness Initiative for School-Age Children in the Bronx”

In this proposal, we aim to test a school-based intervention to promote resilience and prevent obesity related co-morbidities for impoverished racial/ethnic minority Bronx youth who are at increased risk for diabetes. B’N Fit POWER is a wellness program that integrates existing school wellness promotion activities, the Montefiore School Health Program (MSHP) – a network of school-based health clinics, and the Mosholu Montefiore Community Center (MMCC) – a network of afterschool programming, to promote health and build on the resilience of the adolescents. It offers culturally-relevant guidance related to the attainment of 7 Target Behaviors, namely to increase fruit, vegetable and sugar-free beverage intake, obtain adequate sleep, daily physical activity, eating breakfast and lunch daily, and limiting fast food and unhealthy snacks. Although B’N Fit POWER targets youth with overweight and obesity and at high risk for diabetes, it is open to all middle school students at the school, via community-led recruitment efforts to reduce obesity-related stigma by promoting wellness and fitness.  We will conduct a quasi-experimental trial of B’N Fit POWER and will compare students receiving B’N Fit POWER (Group 1) to two comparison groups: one from the same school receiving standard of care (Group 2) and, to assess the external validity of Group 2 in terms of characteristics and outcomes, an additional group from another school also receiving standard of care (Group 3). Effects of the program will be evaluated using data routinely collected at the schools (e.g. anthropometrics and labs from clinic and the school Fitnessgram, attendance, grades) and surveys. Multivariate logistic regressions and mixed-effects linear models will assess program effects for categorical or continuous outcomes and the RE-AIM approach will identify barriers and solutions to implementation.

Earle Chambers, PhD, MPH
Albert Einstein College of Medicine/Montefiore Health Systems

“Gender Disparities in Recruitment and Placement in a Health System DPP”

The Diabetes Prevention Program (DPP) was a landmark lifestyle intervention demonstrating a 58% reduction in risk of diabetes among adults with impaired glucose tolerance. Supporting the adaptation of the DPP to community-based settings is one of the core components of the national DPP agenda. There is recognition that targeted strategies are necessary to recruit eligible men for DPP given their low participation in DPPs nationwide (<20%) and their high risk for diabetes and related complications. The goal of this P&F proposal is to inform an R01 application to NIH in response to PA-16-428: Health Promotion Among Racial and Ethnic Minority Males (R01). This initiative is intended to: 1) enhance our understanding of the numerous factors (e.g., sociodemographic, community, societal, personal) influencing the health promoting behaviors of racial and ethnic minority males across the life cycle, and 2) encourage applications focusing on the development and testing of culturally and linguistically appropriate health-promoting interventions designed to reduce health disparities among racially and ethnically diverse males age 18 and older. Montefiore Health System (MHS) is a large integrated health system in the Bronx and Hudson Valley serving roughly 85% government payer (Medicaid and/or Medicare) patients of which approximately 90% are either Black or Hispanic. As of October 2016, 23% of patients referred to MDPP are male and 7.5% of patients enrolled (i.e. attending 4 sessions or more) in MDPP are male. The proposed pilot study will provide preliminary data on the potential facilitators and barriers to participation among men identified through the Montefiore Diabetes Prevention Program (MDPP), a health system-based DPP.

Victoria Mayer, MD, MS
Icahn School of Medicine at Mount Sinai

“A pilot study to address food insecurity in low-income patients with diabetes”

Food insecurity, the inability to obtain sufficient food for an active and healthy life, has been associated with poor glucose control and increased incidence of hypoglycemic episodes in patients with diabetes. However, few clinically-based interventions addressing food insecurity have been implemented or evaluated among low-income patients. Through “Project Powerfood: Promoting Food Security, Equity, and Health,” developed in partnership with local community-based organizations (the New York Common Pantry, Wholesome Wave, and the Corbin Hill Food Project), our team is piloting and evaluating a new approach to addressing food insecurity in primary care. For “A Pilot study to address food insecurity in low-income patients with diabetes,” we will enroll patients with poorly-controlled diabetes being seen in a primary-care clinic who screen positive for food insecurity and/or receive food assistance benefits into a randomized pilot study that offers fresh fruit and vegetable “prescriptions” that subsidize the purchase of local produce. We will evaluate the feasibility of this program within a busy primary-care setting and its impact on clinical and patient reported outcomes. These preliminary findings can then be the basis of future studies of clinical-community partnerships to improve health outcomes for vulnerable populations.