Objective: To evaluate the associations of supermarket and fast-food outlet accessibility and availability with dietary intake among youth with diabetes. Design: Subjects' residential location and dietary intake was obtained from the SEARCH for Diabetes in Youth study. Food outlet data obtained from the South Carolina Department of Health and Environmental Control and InfoUSA were merged based on names and addresses of the outlets. The comprehensive data were then used to construct accessibility and availability measures for each participant. Setting: State of South Carolina. Participants: Three hundred fifty-nine youths with diabetes (10 years old and older) from the SEARCH for Diabetes in Youth study. Phenomena of Interest: Supermarket and fast-food outlet accessibility and availability; dietary intake represented by Dietary Approaches to Stop Hypertension (DASH) score. Analysis: Generalized estimating equations analyses. Results: Increased availability and accessibility of supermarkets were significantly associated with higher DASH score, even after adjusting for individual-level correlates, urbanicity, and fast-food outlet accessibility or availability. Fast-food accessibility, however, was associated only with specific food groups (meat, sweets, and low-fat dairy intake), not with the DASH score. Conclusions and Implications: Efforts to promote environments conducive to healthful eating may significantly improve the overall dietary intake and reduce diet-related health complications among youth with diabetes. (Contains 5 tables.)