In adjusted models controlling for age, sex, marital status, urban versus rural setting, diabetes severity (insulin use and duration), and social support, participants who reported food insecurity had 2.21-fold higher odds of experiencing moderate-severe diabetes distress (Table 3, CI 1.29–3.76) and 1.5-fold higher odds of experiencing distress for each increase in SDoH (Table 4, CI 1.15–2.02). This evidence concerns the gene INS and diabetes mellitus.