Diabetes is driven by lifestyle transitions, urbanization, and changing dietary patterns. Dietary modification is a key lifestyle component in the management of type 2 diabetes mellitus (T2DM) and is essential for achieving optimal glycemic control. Although diet and physical activity are widely recognized as crucial to diabetes care, adherence to recommended practices remains suboptimal. This study aimed to assess dietary behaviors among individuals with T2DM and identify determinants influencing adherence to healthy dietary patterns. In addition, the study aimed to explore participants’ perceptions regarding the role of diet in diabetes management and assess the gap between perception and actual practice.

A hospital-based cross-sectional study was conducted among 212 adults with T2DM attending non-communicable disease (NCD) clinics in tertiary hospitals centres. Dietary behavior was measured using a culturally adapted version of the UK Diabetes and Diet Questionnaire (UKDDQ). Bivariate analysis, including chi-square tests and ordinal logistic regression were applied using Stata software.

Healthiest dietary behaviors reported were complete abstinence from alcohol (98.9%), avoidance of processed meat (88.3%), frequent high-fibre breakfast intake (79.1%), and daily vegetable consumption (78.2%). Less favorable habits included regular intake of sugar-sweetened beverages (28%) and high glycemic-index foods (21.2%). The composite dietary score had a mean (SD) of 65.3 (8.7) and a median (IQR) of 63 (60–72). Tertile analysis showed that older age was negatively associated with higher dietary adherence scores (β = 0.011, p = 0.001). Female participants (OR = 0.301; p = 0.010) and individuals from three-generation households were also less likely to fall in the highest adherence tertile.

Approximately half of the participants demonstrated overall healthy dietary behaviors. Better adherence was observed among younger adults, males, and those living in nuclear or joint family systems. The greatest perception-practice mismatch was found in fruit intake and rice consumption. Strengthening education and behavior-change strategies targeting dietary patterns may help improve long-term diabetes management outcomes.