Assessment of Diabetes-Related Nutritional Knowledge and Adherence to Dietary Recommendations Among Patients with Type 2 Diabetes at Mthatha Hospital Complex, Eastern Cape, South Africa: A Facility-Based Cross-Sectional Study

Objective: To assess diabetes-related nutritional knowledge, dietary adherence, and factors associated with poor dietary adherence among patients with type 2 diabetes mellitus (T2DM) attending the Mthatha Hospital Complex in the Eastern Cape, South Africa. Methods: A facility-based cross-sectional study was conducted between May and December 2025 among 227 patients with T2DM attending Mthatha Regional Hospital and Nelson Mandela Academic Hospital. Participants were selected using systematic sampling. Data were collected using a structured interviewer-administered questionnaire. Nutritional knowledge was assessed using items adapted from the revised General Nutrition Knowledge Questionnaire, while dietary adherence was measured using the nine-item Perceived Dietary Adherence Questionnaire (PDAQ). Binary logistic regression was performed to identify factors associated with poor dietary adherence. Results: The median age of participants was 61 years (IQR: 49–68), and 53.3% were female. Overall, 48.5% (95% CI: 42.0–54.9) of participants had poor dietary adherence, while 61.2% (95% CI: 54.8–67.4) demonstrated high diabetes-related nutritional knowledge. Poor dietary adherence was significantly associated with age ≤ 30 years [Adjusted Odds Ratio (AOR) = 6.36, 95% CI: 1.36–29.74)], low nutritional knowledge (AOR = 4.89, 95% CI: 2.24–10.65), gathering with friends and family (AOR = 4.75, 95% CI: 1.87–12.05), eating outside the home (AOR = 2.79, 95% CI: 1.27–6.13), and uncontrolled HbA1c levels (AOR = 2.55, 95% CI: 1.25–5.19). Attendance at nutrition education sessions was associated with lower odds of poor dietary adherence (AOR = 0.22, 95% CI: 0.05–0.97). Conclusions: Significant knowledge-related, social, behavioral, and environmental barriers to optimal dietary adherence persist, highlighting the need for strengthened diabetes nutrition education, patient-centered interventions, and supportive public health strategies that facilitate healthy dietary practices and improved glycaemic control.