Food Delivery, Remote Monitoring, and Coaching-Enhanced Education for Optimized Diabetes Management (FREEDOM)

Brief Summary: The FREEDOM study aims to develop a scalable intervention to improve type 2 diabetes mellitus control in low-income Black adults in the Deep South. The intervention targets social determinants of health (SDoH) such as reduced healthcare access, poverty, transportation barriers, and food insecurity.

Inclusion criteria: 1. Self-identified as Black/African American 2. ICD diagnosis of T2DM 3. ≥18 years of age 4. Ongoing insulin treatment 5. HbA1c ≥8% within 6 weeks of study screening 6. has the ability to converse in and read English 7. must provide written informed consent prior to enrollment Exclusion criteria: 1. Current enrollment in any diabetes-related interventional study 2. Cognitive impairment 3. End-stage kidney disease (CKD-5) 4. Pregnant or plans to become pregnant within 12 months 5. Currently enrolled in a structured lifestyle change program 6. Enrolled in remote patient monitoring or health coaching within 60 days of the study or intervention HIV Cohort Criteria Inclusion Criteria 1. ≥ 18 years of age 2. ICD diagnosis of T2DM 3. HbA1c ≥ 7% 4. Confirmed HIV+ diagnosis 5. Prescribed HIV ART therapy as part of care Exclusion Criteria 1. Current enrollment in any diabetes-related interventional study or structured lifestyle change program 2. Enrolled in RPM or health coaching (except for coaching on smoking cessation) within 60 days of the intervention 3. Cognitive impairment 4. End-stage kidney disease (CKD-5) 5. Pregnant or plans to become pregnant within 12 months