(R33 Phase) DELISH Study: Diabetes Education to Lower Insulin, Sugars, and Hunger

The investigators will randomize 120 persons with T2DM in a 1:1 ratio to a nutrition education alone arm (Ed n=60) vs. a nutrition education with mindfulness-based intervention components (Ed+MBI n=60) arm and follow them for 12 months. The interventions will be provided in a weekly group setting, with about 10 to 12 persons per group. Some educational intervention components will be delivered using a smartphone app. After the 12-week initial intervention, the investigators will re-randomize participants using an adaptive intervention design to receive low, medium, or high intensity maintenance training, depending on level of adherence achieved during the initial intervention period. Follow-up assessments will be performed at 3, 6, 9, and 12 months. The investigators will address the following specific aims: 1. Test the hypothesis that the Ed+MBI arm will have better dietary adherence than the Ed arm. 2. Test whether our proposed behavioral mechanisms (e.g. decreased eating in response to cravings or difficult emotions) predict dietary adherence. 3. Obtain preliminary assessment of intervention effects on clinical outcomes This is the second phase of a two-phase study. Pilot testing has been completed in the first phase (R61). The focus of the second phase (R33) is on comparing dietary adherence between the Ed only and ED + MBI arms over a 12-month period. This phase will also include employing an adaptive intervention design in the post-treatment phase to test optimization of the maintenance intervention (i.e. assigning maintenance intensity/dose based on how a participant is doing). The maintenance phase intensities will be assessed to provide preliminary data for planning future trials. The primary analysis focus of this phase will be on the comparing the groups formed by the initial randomization to Ed versus Ed + MBI. The investigators will use fingerstick blood ketone measures, which provide an objective measure of whether the target levels of carbohydrate restriction have been attained, as our primary adherence outcome measure. This will be supplemented by 24-hour diet recall measures of carbohydrate consumption. Important secondary outcome measures will include clinical measures such as glycosylated hemoglobin and behavioral measures such as frequency of eating in response to food cravings.