This study explored food security status among Supplemental Nutrition Assistance Program (SNAP) participants with prediabetes in relation to food choice decisions over a 30-day benefit cycle that potentially increases the risk of Type 2 diabetes. A cross-sectional, quantitative design based on food choice process model constructs was used. SNAP participants (n = 36) with prediabetes, aged 21–70 years, were recruited as outpatients from Bronx Lebanon Hospital Center and completed self-reported questionnaires on demographics and health, food security, and food frequency over time. Descriptive statistics, Pearson chi square tests, and regression analysis were performed using SPSS. Two post-hoc tests, the Friedman’s test, and Wilcoxon signed-rank test were used to measure the difference in means between food groups. Using a multiple response analysis, the 11 food categories had the greatest variation for Week 1, compared to Weeks 2–4. Use of coping strategies to minimize hunger was limited. Very low food security associated with certain coping strategies disrupted eating patterns that affected food variation over time and increased the intake of non-nutrient-dense foods. Changing SNAP’s benefit allotments, and making mandatory, a nutrition package and nutrition education, may increase food security and nutrient-dense food variation thereby decreasing the risk for Type 2 diabetes.