This report examines factors that contribute to a low utilization rate of Diabetes Self-Management Education and Support (DSMES) at Oregon Health & Science University (OHSU) and proposes a set of recommendations that can be used to improve utilization of DSMES services. Primary research aided in identifying utilization barriers experienced by patients, internal stakeholders, and external organizations. Secondary research reinforced the benefits of including DSMES as a standard of care for diabetes. Recommendations covered three broad areas to enhance DSMES services. First, integrating DSMES in primary care will provide the opportunity to collaborate with population health leaders to target the key patient population. Second, centralizing DSMES operations will streamline processes and reduce system inefficiencies. Third, implementing curriculum enhancements that address social determinants of health and educating and training the next generation of providers will reduce access barriers for patients. Our work has honed in on ways to overcome barriers that patients and providers face as a result of structural and unconscious bias and has laid the groundwork to establish DSMES as a standard of care across the institution. Co-authors: Rocha, Lolis Kaur, Inrun Moersen, Ana Howard, Jacqueline Mentor: Walter, Jessica