OBJECTIVE Patients with diabetes presenting to safety-net emergency departments (ED) represent an at-risk population with limited resources and significant medical and social needs. We conducted a needs assessment of this group evaluating its demographic composition, health status, attitudes and beliefs about diabetes self-care and utilization of health maintenance services. We hypothesized that decreased self-efficacy and primary care use would correlate with higher glycosylated hemoglobin (HbA1C). METHODS Consecutive patients with a known history of diabetes seen in an urban, safety-net ED completed a 102-item questionnaire and had HbA1C measured. The questionnaire was developed using elements of the transtheoretical model of behavior change and self-efficacy theory. RESULTS In 230 patients enrolled, mean age was 53 years and HbA1C was 8.8%. The overwhelming majority were Hispanic, low-income, and Spanish-speaking. Major depression was common (34% prevalence). By the transtheoretical model, 81.8% demonstrated advanced readiness to change (preparation/ action stages). HbA1C varied with self-efficacy as the least empowered quartile had the highest HbA1C (9.3%) while progressively higher quartiles had lower HbA1C (9.2%, 8.3%, 8.5%, P = .03 for trend). Only 69% reported having a primary care provider (PCP) and only 3% received all ADA recommended health maintenance services. Patients with a PCP had lower HbA1C than those without a PCP (7.6% vs. 9.5%, P < .01). CONCLUSIONS In this study of largely Latino patients seen in an urban county ED, we observed extremely poor glycemic control, low diabetes-specific knowledge, high rates of major and severe major depression, low self-efficacy and unacceptably low rates of primary care and preventive health service utilization.