The consumption of ultra-processed food (UPF) in people with diabetes and its impact on health is little investigated. The study aims are 1) to document in a large cohort of diabetic people the habitual consumption of UPF and their major food sources, 2) to evaluate the association of UPF intake with diet quality and cardiometabolic profile. The participants are 2660 people with type 2 diabetes aged 55-75 years recruited in 60 diabetes clinics distributed all over Italy, participating in the TOSCA.IT study. Nutritional data were collected by the EPIC food frequency questionnaire; glucose, HbA1c, insulin, lipids and blood pressure were measured, the Index of NASH (ION) was also calculated. Average UPF consumption was 117.3±75.8 g/day (i.e., 13.6% of the total energy of the diet). These figures are similar to those reported in non-diabetic Italian cohorts, but considerably lower than those reported in people from non-mediterranean countries. The major food sources of UPF were fruit juices, soft drinks, pizza, processed meat, bread substitutes, and biscuits, representing respectively 15.6%, 7.1%, 12.4% 11.8% and 11.7% of the total intake. Regarding the quality of the diet, people in the upper quintile (Q5) of UPF consumption had a higher intake of saturated fat, polyunsaturated fat, cholesterol, and added sugar, and a lower intake of proteins, particularly vegetable proteins, monounsaturated fat, starch, fibre, alcohol, and polyphenols. High vs low intake of UPF (Q5 vs Q1) was associated with higher LDL-cholesterol and triglycerides, higher BMI (30.4±4.5 vs 29.7±4.3 kg/m2, p=0.027), HOMA-IR (6.31±5.43 vs 5.99±4.88, p=0.044), C-reactive protein (0.47±2.5 vs 0.31±0.5 mg/dL, p<0.001), and ION index (51.4±2.7 vs 48.5±2.4, p=0.006). In conclusion, UPF consumption is not uncommon in people with type 2 diabetes and is associated with an overall poor quality of the diet and a more adverse cardiometabolic profile. Efforts should be made to discourage the use of UPF in people with diabetes and in general in people with a high cardiometabolic risk.