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Objective To determine the household food insecurity (Hfi) prevalence in Canadians with diabetes and its relationship with diabetes management, self-care practices, and health status. Research Design and Methods We analyzed data from Canadians with diabetes aged =>12 years (n = 6,237) from cycle 3.1 of the Canadian Community Health Survey, a population-based cross-sectional survey conducted in 2005. The Hfiprevalence in Canadians with diabetes was compared with that in those without diabetes. The relationships between Hfiand management services, self-care practices, and health status were examined for Ontarians with diabetes (n = 2,523). Results Hfiwas more prevalent among individuals with diabetes (9.3% [8.2-10.4]) than among those without diabetes (6.8% [6.5-7.0]) and was not associated with diabetes management services but was associated with physical inactivity (odds ratio 1.54 [95% CI 1.10-2.17]), lower fruit and vegetable consumption (0.52 [0.33-0.81]), current smoking (1.71 [1.09-2.69]), unmet health care needs (2.71 [1.74-4.23]), having been an overnight patient (2.08 [1.43-3.04]), having a mood disorder (2.18 [1.54-3.08]), having effects from a stroke (2.39 [1.32-4.32]), lower satisfaction with life (0.28 [0.18-0.43]), self-rated general (0.37 [0.21-0.66]) and mental (0.17 [0.10-0.29]) health, and higher self-perceived stress (2.04 [1.30-3.20]). The odds of Hfiwere higher for an individual in whom diabetes was diagnosed at age <40 years (3.08 [1.96-4.84]). Conclusions Hfiprevalence is higher among Canadians with diabetes and is associated with an increased likelihood of unhealthy behaviors, psychological distress, and poorer physical health. More than 2 million Canadians have diabetes, and the rising prevalence is alarming (1). In 2003, the economic burden of treating diabetes and its complications and the subsequent loss of productivity and life were estimated to be 9 billion dollars (2). Evidence supports the benefits of aggressive glycemic control to reduce the risk of the development and progression of diabetes complications (3,4). Self-management, including nutrition therapy, is very challenging for individuals with diabetes. Food security, an important determinant of health, "exists when all people, at all times, have physical and economic access to sufficient, safe, and nutritious food to meet their dietary needs and food preferences for an active and healthy life" (5). In 2004, 9.2% of Canadian households, an estimated 1.1 million households, were food insecure (6). Among adults, household food insecurity (Hfi) is associated with lower nutrient intakes and consumption of a less healthy diet (7). A healthy diet is important for both the prevention and treatment of diabetes. Our objectives were to determine the prevalence of Hfiand its associated factors in Canadians with diabetes and to examine the relationship between Hfiand diabetes management. The findings have potential policy implications for delivery of health care and social services.