Type 2 diabetes mellitus (T2DM) is a leading cause of chronic disease burden worldwide, and dietary management remains central to glycaemic control and prevention of complications (1). Food literacy, comprising planning and management, selection, preparation, and eating, has been proposed as a determinant of dietary behaviour that extends beyond nutrition knowledge alone, yet its role in T2DM self-management has not been comprehensively synthesised (2). This scoping review aimed to identify, map, and synthesise evidence on food literacy-related factors influencing food and nutrition intake and dietary behaviours among adults with T2DM. The review was conducted in accordance with PRISMA-ScR guidelines and prospectively registered with the Open Science Framework (10.17605/OSF.IO/G35MH) (3). MEDLINE and CINAHL Complete were searched for quantitative observational studies published in English (2006–2026) examining adults ≥18 years with T2DM and food literacy-related exposures. Title/abstract and full-text screening were conducted independently by two reviewers, with discrepancies resolved by an additional reviewer. Data were extracted using a piloted form and mapped against the Vidgen and Gallegos food literacy framework (2). Database searching identified 633 records, of which 12 cross-sectional (or predominantly cross-sectional) studies from Africa, Asia, North America, and Europe met eligibility criteria (n = 17 to 421 participants per study). Food literacy was most frequently operationalised as nutrition or diabetes-related knowledge (11 of 12 studies), with only one study using a validated multidimensional food literacy instrument. The eating domain was most commonly assessed (n = 10 studies), followed by planning and management (n = 7), selection (n = 6), and preparation (n = 1). Seven of 12 studies reported associations between higher food literacy-related factors and healthier dietary behaviours or improved diet quality, including greater fruit and vegetable intake and lower dietary glycaemic index. However, three studies found no significant association between nutrition knowledge and dietary patterns or macronutrient intake, and knowledge alone was frequently insufficient to predict adherence; self-efficacy, food label use, motivation, and socioeconomic and environmental factors (education, food insecurity, social support) appeared to mediate or moderate outcomes. Food literacy in adults with T2DM is predominantly conceptualised through nutrition knowledge rather than as a multidimensional construct, and while higher food literacy-related factors were generally associated with healthier dietary outcomes, knowledge alone did not consistently translate into behaviour change. Interventions incorporating practical food skills, self-efficacy building, and attention to environmental barriers, evaluated with validated multidimensional food literacy measures in future research, may better support dietary self-management in this population.
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