Diet quality as assessed by the healthy eating Index-2020 among individuals diagnosed with and without type 2 diabetes

Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Using National Health and Nutrition Examination Survey (NHANES) data from 2011–2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates better dietary quality. HEI-2020 scores were calculated per person using a standard scoring algorithm. Survey-weighted descriptive analyses and regression models were applied. The prevalence of diagnosed T2DM in the US adults (≥20 years) was 9.9%, with an average HEI-2020 score of 53.9. In unadjusted analyses, males with diagnosed T2DM had a significantly higher HEI score than those without (53.3 vs. 51.8, respectively) . Across both sexes, individuals with diagnosed T2DM reported higher HEI component scores for added sugar, indicating lower sugar intake, but lower scores for sodium and refined grains, indicating higher intake of these components, compared to those without diagnoses. Age- and sex-specific patterns were evident in adjusted models: adults aged ≥60 years with T2DM consumed less added sugar but more sodium than their non-diagnosed counterparts, while younger women (20–40 years) with T2DM reported higher added sugar intake. Diet quality among adults with diagnosed T2DM was heterogeneous rather than uniformly improved. Although lower added sugar intake represents a favorable dietary change, persistently high sodium and refined grain consumption remains a concern, particularly among older adults, and poorer sugar intake was observed among younger women. These findings highlight important gaps in dietary management following diabetes diagnosis and underscore the need for targeted, subgroup-specific nutritional guidance in T2DM care.